Syphilis

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Syphilis
Clinical Aspects ofSecondary Syphilis

• Thad Zajdowicz, MD, MPH
• Medical Director, STD/HIV Program
• Chicago Dept of Public Health

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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 for centuries.
Further, control of syphilis is
vital because of its interactions with HIV. This
lecture will focus on secondary
syphilis.
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Objectives

• To review the pathogenesis of
  secondary syphilis
• To demonstrate the clinical features of secondary
  syphilis
• To describe nondermatologic features of secondary
  syphilis

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Clinical Stages

• Syphilis is conventionally divided into several
  stages
• Primary
• Secondary
• Latent
• Late, or tertiary
• This lecture will focus on secondary syphilis

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Natural History of Untreated Syphilis
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Progression Into
Secondary Syphilis

• Secondary syphilis is the most florid stage of
  syphilis
• Systemic infection
• Dermatologic findings are most common
• However, treponemes infect virtually all tissues
• Resolves when host immune response overcomes
  infection

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Histopathology
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Secondary Syphilis
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Secondary Syphilis
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Secondary Syphilis
An example of lesions of secondary syphilis on
the foot, including the sole.
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Secondary Syphilis
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Secondary Syphilis
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Secondary Syphilis
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Condyloma Lata
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Mucous Patch
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Syphilis - Secondary
Manifestation Percent of cases
Skin 90
Constitutional 70
Mouth throat 35
Genital lesions 20
CNS 8-40
Renal, GI, Rheumatologic Unusual
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Constitutional Symptoms

• Malaise
• Sore throat
• Headache
• Myalgias
• Pruritis

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Constitutional Signs

• Fever (low-grade)
• Weight loss
• Lymphadenopathy
• Inguinal most common
• May be generalized
• Periosteal involvement
• Hepatitis
• Immune complex disease

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Conclusions

• Secondary syphilis is a systemic disease and is
  typically florid
• Constitutional symptoms and signs are common and
  may cause diagnostic confusion
• Dermatologic findings are typically multiple and
  florid
• The basic pathology is obliterative endarteritis

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Sources of Information
The following sites are useful if more
information on syphilis is sought www.cdc.gov
Centers for Disease Control www.who.int World
Health Organization www.ashastd.org American
Social
Hygiene Association www.vnh.org Virtual Naval
Hospital