References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM. Treponema pallidum subsp. pallidum A microaerophilic gram-negative spirochete |
| Reservoir | Human |
| Vector | None |
| Vehicle | Sexual contact Infected secretions |
| Incubation Period | 2 to 4 weeks (As early or late as 10 days to 8 weeks) |
| Diagnostic Tests | Dark field microscopy (chancre) VDRL confirmed by antitreponemal test (FTA, MHTP) Nucleic acid amplification |
| Typical Adult Therapy | Primary, secondary or early (< 1 year) latent: Benzathine Penicillin G 2.4 million units IM Other stages: Repeat dosage at one and two weeks Alternatives: Tetracycline, Ceftriaxone |
| Typical Pediatric Therapy | Primary, secondary or early (< 1 year) latent: Benzathine Penicillin G : Weight <14 kg: 600,000u IM Weight 14 to 28 kg: 1,200,000u IM Other stages: Repeat dosage at one and two weeks |
| Clinical Hints | Firm, painless chancre (primary syphilis); later fever, papulosquamous rash and multisystem infection (secondary syphilis); late lesions of brain, aorta, bone or other organs (tertiary syphilis). |
| Synonyms | Canton rash, Chinese ulcer, Christian disease, French disease, German sickness, Harde sjanker, Lues, Neopolitan itch, Polish sickness, Sifilide, Sifilis, Spanish pockes, Syfilis, Treponema pallidum. |
WHO Case Definition for Surveillance
The signs and symptoms of syphilis are multiple. The primary stage usually, but not necessarily, involves ulceration of the external genital organs and local lymphadenopathy; secondary and tertiary syphilis show mainly dermatological and systemic manifestations. For surveillance purposes, only confirmed cases will be considered.
- Confirmed case: A person with a confirmed positive serology for syphilis (Rapid Plasma Reagin (RPR) or VDRL confirmed by TPHA (Treponema pallidum hemagglutination antibodies) or FTA (fluorescent treponemal antibody absorption).
- Case classification
- Congenital syphilis: An infant with a positive serology, whether or not the mother had a positive serology during pregnancy.
- Acquired syphilis: All others.
Additional notes:
- The prevalence rate among pregnant women in developing countries varies between 3% and 19%. Maternal syphilis is associated with congenital syphilis (one third of births from such pregnancies), and with spontaneous abortion and stillbirth.
- Because the primary lesion is often painless and secondary syphilis is usually not diagnosed, women are mainly identified through serological screening.
Syphilis is a chronic disease with a waxing and waning course; and is reported from all countries.
- Transmission is mainly by sexual contact.
- Primary, secondary, and early latent syphilis are potentially infectious.
Stages of Syphilis
- Primary syphilis is characterized by a painless chancre at the site of inoculation. Penile swelling without an overt chancre has also been reported.
- The secondary stage is characterized by a generalized (rarely localized 3 non-pruritic polymorphic or papulonecrotic rash, lymphadenopathy, and systemic manifestations. Moist flat genital or mucosal lesions (condyloma lata) or granulomatous dermatitis may be evident.
- An asymptomatic latent period follows, which for epidemiological purposes is divided into early (<1 year) and late (>1 year) stages.
- The tertiary stage is the most destructive and is marked by cardiovascular 16 and neurological sequelae, and gummatous involvement of any organ system.
- As of 2009, the world’s literature contained 165 reports of cerebral syphilitic gummata: 64% in men and 66% located on the cerebral convexities.
- Syphilitic uveitis may present in the absence or other clinical manifestations of syphilis. Acute posterior placoid chorioretinitis is also encountered. 143 cases of syphilitic uveitis were reported in the English Language literature during 1984 to 2008.
The clinical features of congenital infection are similar to those of secondary syphilis, and may be associated with deformation of teeth, bones and other structures.
Acquired syphilis in patients with HIV infection is characterized by severe and accelerated infection, often with overt meningitis, hepatitis, lues maligna (a florid papulopustular rash) and other forms of systemic involvement.
- The presence of concurrent syphilis does not affect the progression of AIDS.