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Syphilis – Clinical Syphilis – Clinical Aspects Aspects
of Late Syphilisof Late Syphilis
Thad Zajdowicz, MD, MPHMedical Director, STD/HIV ProgramMedical Director, STD/HIV Program
Chicago Dept of Public HealthChicago Dept of Public Health
Why a lecture on syphilis?Why a lecture on syphilis?
Although syphilis is an eminently treatabledisease, its continuing occurrence illustrates that our control efforts still need to be improved. The disease remains elusive clinically even today, and unless thought of and sought for can silently cause disease as it has forcenturies. Further, control of syphilis is vital because of its interactions with HIV. This lecture will focus on clinical manifestations of late syphilis.
ObjectivesObjectives
•To review the clinical manifestations of late syphilis
Clinical StagesClinical Stages
• Syphilis is conventionally divided into several stages:– Primary– Secondary– Latent– Late, or tertiary
• This lecture will focus on late syphilis – cardiovascular, neurosyphilis, and gummas
Natural History of Natural History of Untreated SyphilisUntreated Syphilis
Syphlitic Aortic Syphlitic Aortic AneurysmAneurysm
Aortic AneurysmAortic Aneurysm
Syphilitic AortitisSyphilitic Aortitis
Tree-barkingTree-barking
Ruptured Aortic Ruptured Aortic AneurysmAneurysm
Tree-barkingTree-barking ClotClot
Stenosis of Coronary Stenosis of Coronary ArteriesArteries
NeurosyphilisNeurosyphilis
• Asymptomatic– no clinical manifestations– defined by presence of CNS
abnormalities including:•WBC > 5/mm3, mostly lymphocytes•elevated protein•reactive CSF-VDRL (variable)
– may progress to overt neurosyphilis
NeurosyphilisNeurosyphilis
• Meningeal neurosyphilis– includes acute syphilitic meningitis– headache, fever, CSF abnormalities
• Meningovascular neurosyphilis– “syphilitic stroke”– hemiparesis, hemiplegia, aphasia,
seizure• Parenchymatous neurosyphilis
– general paresis– tabes dorsalis
Parenchymatous Parenchymatous neurosyphilisneurosyphilis
•General paresis (dementia paralytica)– T. pallidum directly invades cerebrum
•memory loss, personality changes, headache, delusions, seizure
– neurologic findings include: •Argyll Robertson pupils•slurred speech•expressionless face•tremors
Parenchymatous Parenchymatous neurosyphilisneurosyphilis
•Tabes dorsalis– occurs after long latent period
(20-25 yrs.)•early features: lightning pains, paresthesias, diminished DTRs, poor pupillary responses
•late features: ataxia, bladder and rectal disturbances, Charcot joints, “visceral crises”
– cranial nerve involvement often overlooked– “tabetic facies” due to ptosis and flabbiness
of facial muscles
Charcot JointCharcot Joint
Gumma of FaceGumma of Face
Gummas of the NoseGummas of the Nose
Gumma - NoseGumma - Nose
Gummas - ScalpGummas - Scalp
Gmmas of ArmGmmas of Arm
Gummas - ArmGummas - Arm
Ulcerating GummaUlcerating Gumma
ConclusionsConclusions
• Late complications of syphilis occurred in about 1/3 of patients in the preantibiotic era
• Prompt penicillin therapy of early disease not only prevents infection in others, but also prevents late complications
• Neurosyphilis may present and progress rapidly in patients co-infected with HIV
Sources of InformationSources of Information
The following sites are useful if more information on syphilis is sought:
www.cdc.gov Centers for Disease Controlwww.who.int World Health Organizationwww.ashastd.org American Social Hygiene Assocwww.vnh.org Virtual Naval Hospital