Syphilis

12 Key excerpts on "Syphilis"

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  eBook - ePub

  Genital and Perianal Diseases

  A Color Handbook

  • Tomasz F. Mroczkowski, Larry E. Millikan, Lawrence Charles Parish MD(Authors)
  • 2013(Publication Date)
  • CRC Press

    (Publisher)

  SECTION 1

  SEXUALLY TRANSMITTED DISEASES

  CHAPTER 1

  Syphilis

  Erin Santa, MD, and Joya Sahu, MD • Definition and epidemiology • Primary Syphilis • Secondary Syphilis • Early latent Syphilis • Tertiary Syphilis • Congenital Syphilis • Treatment

  Definition and epidemiology

  Syphilis (Lues) is a chronic sexually transmitted infection caused by the spirochete Treponema pallidum . The disease is defined by primary, secondary, and tertiary stages, with intervening periods of latency. If left untreated, it may be either self limiting or progress, causing serious complications several years after acquisition. Pregnant women, if untreated, may pass infection to their infants transplacentally – congenital Syphilis1,2 .

  In the USA, rates of Syphilis fell by 95% between 1945 and 2000 with the advent of penicillin therapy3 . Unfortunately, in more recent years, there has been a steady increase in rates of the disease, specifically in men who have sex with men (MSM). In the early 2000s, rates of Syphilis were reported to be highest in MSM aged in their 30s; however, a recent study has shown that Syphilis is increasingly affecting younger MSM, those between the ages of 15 and 29, in addition to black and Hispanic MSM4,5 .

  1.1 Primary lesion in the early stage of development.

  Primary Syphilis

  CLINICAL FEATURES

  The primary infection usually appears after an incubation period, ranging from 10 to 90 days, with an average of 3 weeks. The initial lesion or ‘primary chancre’ appears at the point of inoculation, which is most commonly the genitals or anus. The first sign may be a dusky, red macule, which quickly develops into a pinkish papule and then a painless chancre with an ulcerated center (1.1 ). The classical chancre is usually solitary, regular in shape, round or oval, with clearly defined, raised, smooth borders, surrounded by a dull red areola or even normal skin (1.2 ). The base is finely granular, glistening, and clean (1.3 ), unless secondarily infected. On palpation, the base of the ulcer has hard button-like or cartilaginous induration. Squeezing or abrading the ulcer produces a serous or yellowish exudate containing spirochetes. The chancre of Syphilis is painless, unless secondarily infected. In heterosexual men it is most commonly found on the penis (1.4 ), while in homosexual men, the anus (1.5 ), rectum, or mouth, and in women the labia and the cervix (1.6

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  Diagnostics to Pathogenomics of Sexually Transmitted Infections

  • Sunit Kumar Singh(Author)
  • 2018(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  11 Sexually Transmitted Treponematoses

  Lenka Mikalová and David Šmajs

  Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic

  11.1 Introduction

  Syphilis, first named in 1530 by Girolamo Fracastoro, is a well‐known example of a sexually transmitted treponematosis, which, before the invention of penicillin treatment, infected as much as 10% of the entire population of the United States in the early twentieth century (Rothschild 2005 ). The Syphilis‐causing Treponema pallidum subspecies pallidum (TPA) is very similar to the other pathogenic treponemes including T. pallidum ssp. pertenue (TPE), T. pallidum ssp. endemicum (TEN), and Treponema carateum, which cause yaws, bejel, and pinta, respectively. Syphilis is characterized by multiple clinically manifest stages (primary, secondary, and tertiary) that alternate with periods of latency. It is also the most invasive treponematosis, and it occurs globally. The ability of TPA to evade the host’s immune system, disseminate via the bloodstream to organs and tissues, and persist in affected individuals for decades are key characteristics of Syphilis pathogenesis. Endemic Syphilis, also called bejel, mainly affects children 2–15 years old and is transmitted mainly by direct skin‐to‐skin contact or by contaminated utensils. Primary lesions are painless and occur within the oral and nasopharyngeal mucosa. In the late stage, the nasopharynx, skin, and bones are affected. While there is a historical consensus that only Syphilis is sexually transmitted (reviewed by Giacani and Lukehart 2014 ), there is increasing evidence that TEN can also be transmitted through sexual contact (Turner and Hollander 1957 , Grange et al. 2016 , Mikalová et al. 2017a

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  Clinical Infectious Disease

  • David Schlossberg(Author)
  • 2015(Publication Date)
  • Cambridge University Press

    (Publisher)

  PART XIX Specific organisms: spirochetes 163. Syphilis and other treponematoses 1053 Arlene C. Se ~ na and Adaora A. Adimora 164. Lyme disease 1060 Janine Evans 165. Relapsing fever borreliosis 1068 Sally J. Cutler 166. Leptospirosis 1072 Christopher D. Huston 163. Syphilis and other treponematoses Arlene C. Se ~ na and Adaora A. Adimora Treponemes are members of the family Spiro- chaetaceae, which also contains Borrelia and Leptospira. Although most treponemes do not cause disease in human beings, a few cause sub- stantial morbidity. This chapter briefly reviews the clinical manifestations and treatment of syph- ilis in adults and the nonvenereal treponema- toses, yaws, pinta, and bejel. Syphilis Transmission and stages of infection Syphilis is primarily transmitted through sexual contact with infectious mucocutaneous lesions in primary and secondary Syphilis. Mother-to-child transmission can occur from transfer of the spiro- chete through the placenta or, less commonly, from contact with infectious exudates or blood through the birth canal. Transmission of Syphilis through blood products is now rare due to rou- tine screening of donors. Like other treponemal diseases, the clinical manifestations of Syphilis are divided into early and late stages. Early Syphilis is further divided into primary, secondary, and early latent stages. During the latent Syphilis stage, patients have positive serologic tests for Syphilis but no other signs of disease. The Centers for Disease Control and Prevention (CDC) classifies patients in the latent stage as having early Syphilis if they acquired infection during the preceding year. Otherwise, persons with latent disease are classi- fied as having either late latent Syphilis or latent Syphilis of unknown duration. Although clinical staging is useful for diagnosis and treatment, it is also imprecise; overlap between stages is rela- tively common. PRIMARY AND SECONDARY Syphilis Treponema pallidum subsp.

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  Women and Health

  • Marlene B. Goldman, Rebecca Troisi, Kathryn M. Rexrode(Authors)
  • 2012(Publication Date)
  • Academic Press

    (Publisher)

  Chapter 30

  Syphilis in Women

  Jeanne M. Marrazzo∗ and Connie L. Celum†

  ∗ Department of Medicine

  † Global Health, University of Washington, Seattle, WA, USA

  Introduction and History

  References to clinical syndromes consistent with Syphilis as a disease of humans exist in biblical and ancient Chinese records. The disease was so common in late 15th century Europe that it earned the sobriquet ‘the Great Pox’, aimed largely at distinguishing it from the concurrent scourge of smallpox.1 The bacterial etiology of Syphilis was discovered in 1905 by Schaudinn and Hoffmann, who named the corkscrew-shaped organism Treponema pallidum . By that time, the common clinical syndromes of Syphilis were well characterized, and included genital ulcers (called ‘hard’ chancres to distinguish them from the ‘soft’ chancres of chancroid), rash, cardiovascular and neurological complications, and numerous congenital abnormalities including spontaneous abortion, saddle nose deformity, and characteristic abnormalities of the teeth and bones (see the section ‘Syphilis and Pregnancy’). In the US, Syphilis was a leading cause of blindness and dementia during the first half of the 20th century. The discovery in the 1940s that penicillin, a widely available and affordable antibiotic, was highly active against T. pallidum heralded the possibility of eventual control of the disease. This hope was heightened when inexpensive and reasonably accurate blood screening tests for Syphilis – Syphilis serologies – became widely available in the 1940s. However, few infectious conditions illustrate so well the challenge of controlling a sexually transmitted infection (STI), whose viability at the population level depends in large part on complex socioeconomic factors. This challenge is currently manifested through the dramatic increases in the incidence of Syphilis among men who have sex with men (MSM) in many countries, with a high prevalence of concomitant infection with HIV-1.2

  The disease induced by T. pallidum is often characterized by clinical features that potentiate its perpetuation in the human population, with no physical signs or symptoms during much of its clinical course, and establishment of latency in sites relatively protected from immunological control (see the section ‘Natural History and Clinical Manifestations of Syphilis’). This allows for an infected person to unknowingly transmit T. pallidum

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  Head and Neck Manifestations of Systemic Disease

  • Jeffrey P. Harris, Michael H. Weisman, Jeffrey P. Harris, Michael H. Weisman(Authors)
  • 2007(Publication Date)
  • CRC Press

    (Publisher)

  from serum in 1905. One year later, August von Wassermann developed a complement fixation test to detect antibodies against the bacteria, allowing identification of millions of previously undiagnosed individuals. Paul Ehrlich then began his work with arsenic derivatives and in 1910 patented arsphenamine, which was found to be a significant improvement in treatment, though plagued by recurrences. The discovery of penicillin by Alexander Fleming in 1928 led to John Mahoney ’ s breakthrough demonstration of this antibiotic ’ s utility in treating Syphilis in 1943. Penicillin was widely available by the post – World-War-II era, and in combination with public health measures, it facilitated the near-eradication of this historical plague. However, this effective treatment has left most current health-care providers relatively unfamiliar with the disease, with many never having seen a case of Syphilis. Recent epidemiological data demonstrate an increasing incidence, particularly among the population of men who have sex with men. As such, a review of Syphilis including its head and neck manifestations is of timely benefit. DEFINITION Syphilis is caused by the gram-negative spirochete T. pallidum . As referred to in the introduction, there are several subspecies of T. pallidum . Although there is striking antigenic and genetic overlap within the species, the other subspecies including endemicum , pertenue , and carateum are generally of little virulence and produce nonvenereal disease. The name T. pallidum is commonly used to refer to subspecies pallidum , the etiology of Syphilis. These spiral-shaped bacteria are approximately 5 to 15 μ m long and roughly 0.2 μ m in width (Fig. 1). The bacterium is surrounded by an outer membrane rich in phospholipids but relatively free of exposed surface proteins.

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  Women and Health

  • Marlene B. Goldman, Maureen C. Hatch(Authors)
  • 1999(Publication Date)
  • Academic Press

    (Publisher)

  23

  Syphilis in Women

  JEANNE M. MARRAZZO and CONNIE L. CELUM,     Department of Medicine, University of Washington, Seattle-King County Department of Public Health, Seattle, Washington

  I. Introduction and History

  References to clinical syndromes consistent with Syphilis as a disease of humans exist in biblical and ancient Chinese records. The disease was so common in late fifteenth century Europe that it earned the sobriquet “the Great Pox,” aimed largely at distinguishing it from the concurrent scourge of small-pox [1 ]. The bacterial etiology of Syphilis was discovered in 1905 by Schaudinn and Hoffmann, who named the corkscrew-shaped organism Treponema pallidum. By that time, the common clinical syndromes of Syphilis were well-characterized and included genital ulcers (called “hard” chancres to distinguish them from the “soft” chancres of chancroid), rash, cardiovascular and neurologic complications, and numerous congenital abnormalities including spontaneous abortion, saddle nose deformity, and characteristic abnormalities of the teeth and bones (see Section VIII ). In the U.S., Syphilis was a leading cause of blindness and dementia during the first half of the twentieth century. The discovery in the 1940s that penicillin, a widely available and affordable antibiotic, was highly active against T. pallidum heralded the possibility for eventual control of the disease [2 ]. This hope was heightened when inexpensive and reasonably accurate blood screening tests for Syphilis—Syphilis serologies—became widely available in the 1940s. However, few infectious conditions illustrate so well the challenge of controlling a sexually transmitted disease (STD) whose viability at the population level depends in large part on complex socioeconomic factors.

  The disease induced by T. pallidum is often characterized by clinical features that potentiate its perpetuation in the human population, with no physical signs or symptoms during much of its clinical course and establishment of latency in sites relatively protected from immunologic control (see Section IV ). This allows for an infected person to unknowingly transmit T. pallidum

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  Uncommon Causes of Stroke

  • Louis Caplan, José Biller(Authors)
  • 2018(Publication Date)
  • Cambridge University Press

    (Publisher)

  This is one reason why the development of Syphilis vaccines has been so difficult. In nature, the only hosts for T. pallidum are humans. The organism is transmitted from person to person, mainly through vaginal or rectal sexual intercourse, when the spiro- chete penetrates intact mucosal membranes. However, occa- sional transmission has followed kissing, oral sex, close contact with an infected primary lesion, infected fresh blood transfu- sion, accidental inoculation, or by spread across the placenta from an infected mother to her fetus (congenital Syphilis). The number of spirochetes required to infect a human is unknown but rabbits can be infected with a small number of organisms. History and Epidemiology of NeuroSyphilis The origin of Syphilis remains unknown. However, by the sixteenth century it had rapidly spread throughout Europe, reportedly causing high morbidity and mortality. Current epi- demiology and historical evidence argues that Syphilis was endemic in the New World and came to Europe when Columbus returned (Farhi and Dupin, 2010). Unfortunately, in past centuries little is known about what Syphilis did to the central nervous system (CNS) and the types of vascular disease it may have caused. By the twentieth century, but before the advent of penicillin, it was estimated that approximately 10 percent of adults living in New York, Paris, or Berlin had a positive Wasserman blood test (nontreponemal antibody test similar to the rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL] assay). In spite of the high pre- valence of Syphilis, relatively few patients developed severe disease. In one study of 473 patients with untreated early Syphilis, two-thirds never developed clinical symptoms and only 9.5 percent developed neuroSyphilis (Moore, 1941).

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  Health, Medicine, and Society in Victorian England

  • Mary Wilson Carpenter(Author)
  • 2009(Publication Date)
  • Praeger

    (Publisher)

  Meanwhile, the active but unseen infection could sicken unsuspecting wives and cause the death of infants in the womb or after birth. What was not known about Syphilis in the nineteenth century would have been as frightening as what was known. Yet it was also during the nineteenth century that major advances in knowledge about Syphilis were made: first, that it was not simply the same disease, though a later stage, as gonorrhea (a sexually transmitted disease characterized by discharge from the urethra or vagina); and second, that Syphilis itself occurred in three stages, separated by latent periods during which the infected person might appear perfectly healthy. Prior to the nine- teenth century, it was commonly believed that Syphilis, or the ‘‘pox,’’ was a later stage of gonorrhea, or the ‘‘clap,’’ and that if a man (or a woman) who had the clap was treated, the pox could be prevented. By the end of the nineteenth century, however, with the rise of the new science of bacteriol- ogy, gonorrhea had been identified as a bacterial infection, and early in the twentieth century the specific bacterium that causes Syphilis, Treponema pallidum, was also identified. As a disease known to be sexually transmitted, Syphilis was always a guilt disease: either it was one’s own fault or somebody else’s. Warren’s early nineteenth-century portrait of the debauched syphilitic male, naming him as ‘‘a glaring tower of guilt,’’ is typical. Throughout most of the Victorian era, however, Syphilis was blamed on prostitutes, imaging them as a kind of 72 Health, Medicine, and Society in Victorian England womb of infection and implying that Syphilis was a product of the degener- ate female body.

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  Health, Medicine, and Society in Victorian England

  • Mary Wilson Carpenter(Author)
  • 2009(Publication Date)
  • Praeger

    (Publisher)

  4 The peculiar terror of Syphilis lay not only in its ghastly symptoms but in the hidden and undetectable nature of its progress. The disease is invisible during its latent stages, yet works incurable damage on various organ systems while the victims believe that they are cured, or that their symptoms are due to some other condition. Meanwhile, the active but unseen infection could sicken unsuspecting wives and cause the death of infants in the womb or after birth. What was not known about Syphilis in the nineteenth century would have been as frightening as what was known.

  Yet it was also during the nineteenth century that major advances in knowledge about Syphilis were made: first, that it was not simply the same disease, though a later stage, as gonorrhea (a sexually transmitted disease characterized by discharge from the urethra or vagina); and second, that Syphilis itself occurred in three stages, separated by latent periods during which the infected person might appear perfectly healthy. Prior to the nineteenth century, it was commonly believed that Syphilis, or the ‘‘pox,’’ was a later stage of gonorrhea, or the ‘‘clap,’’ and that if a man (or a woman) who had the clap was treated, the pox could be prevented. By the end of the nineteenth century, however, with the rise of the new science of bacteriology, gonorrhea had been identified as a bacterial infection, and early in the twentieth century the specific bacterium that causes Syphilis, Treponema pallidum , was also identified.

  As a disease known to be sexually transmitted, Syphilis was always a guilt disease: either it was one’s own fault or somebody else’s. Warren’s early nineteenth-century portrait of the debauched syphilitic male, naming him as ‘‘a glaring tower of guilt,’’ is typical. Throughout most of the Victorian era, however, Syphilis was blamed on prostitutes, imaging them as a kind of womb of infection and implying that Syphilis was a product of the degenerate female body. In Dante Gabriel Rossetti’s poem ‘‘Jenny,’’ which the poet began writing in 1848 but did not publish until 1870, the speaker describes a prostitute in imagery which identifies her as the source of contagion and himself, her client, as a distanced, impervious observer, a scholar who reads her like a book.

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  Bacterial Infections of the Central Nervous System

  • Karen L. Roos, Allan R. Tunkel(Authors)
  • 2010(Publication Date)
  • Elsevier

    (Publisher)

  Chapter 12 Spirochetal infections DIEGO CADAVID * Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Charlestown, MA, USA NEUROSyphilis Epidemiology S YPHILIS The peak reported incidence of early (primary and secondary) Syphilis in the general population of the USA was about 400/100 000 population in the 1940s. Since that time, there has been a steady fall, dropping to 2.1/100 000 by 2000 (Centers for Disease Control and Prevention, 2001). Despite this, Syphilis remains an important health problem in certain geographic areas and subgroups of the population, which include African American and Hispanic males (Centers for Disease Con-trol and Prevention, 1997), and men having sex with men (MSM) (Peterman and Furness, 2007; Zetola et al., 2007). The incidence of Syphilis in the USA is higher in certain states such as Florida, California, and New York (Centers for Disease Control and Prevention, 1988). Unprotected sex with infected subjects remains the single most important risk factor. Furthermore, up to 8% of healthy adults had serological evidence of prior exposure to Treponema pallidum (Traviesa et al., 1978); this increases to 11% in adults admitted to inner-city hos-pitals (Carey et al., 1995) and to 19% in adults admitted to psychiatric hospitals (Roberts et al., 1992). Reports in the early 1990s revealed that one in 200 patients admitted to neurology wards had active Syphilis (van de Ree et al., 1992), and one in 200 cases of dementia were caused by Syphilis (Powell et al., 1993). N EUROSyphilis Fortunately, only some patients with Syphilis develop neuroSyphilis. The estimated frequency depends on the stage of Syphilis when the cerebrospinal fluid (CSF) is examined, the risk of the population, prior treatment with antimicrobial therapy, and the diagnostic criteria. NeuroSyphilis is defined as any direct or indirect evidence of the presence of T.

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  Our Sexuality

  • Crooks/Baur, Robert Crooks, Karla Baur(Authors)
  • 2016(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  An infected pregnant woman can also transmit Treponema pallidum to her unborn child through the placental blood system. The resulting infection can cause miscarriage, stillbirth, or congenital Syphilis , which can result in death or extreme damage to infected newborns (Centers for Disease Control, 2014b; Friedrich, 2013a). Worldwide more than 2 million pregnant women have active Syphilis (Hawkes et al., 2011), and every year at least 500,000 children are born afflicted with congenital Syphilis (Friedrich, 2013a). If Syphilis is successfully treated before the 4th month of pregnancy, the fetus will not be affected. Therefore pregnant women should be tested for Syphilis some-time during their first 3 months of pregnancy. The CDC recommends that all pregnant women be tested for Syphilis at the first prenatal visit. Syphilis A sexually transmitted infection caused by a bacterium called Treponema pallidum . Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 478 CHAPTER 15 SYMPTOMS AND COMPLICATIONS If untreated, Syphilis can progress through the primary, secondary, latent, and tertiary phases of development. We provide a brief description of each phase in the following paragraphs. PRIMARY Syphilis In its initial or primary phase, Syphilis is generally manifested in the form of a single, painless sore called a chancre (SHANG-kur), which usually appears about 3 weeks after initial infection at the site where the spirochete organism entered the body (see • Figure 15.2). In women this sore most commonly appears on the inner vaginal walls or cervix.

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  Infectious Diseases in Obstetrics and Gynecology

  • Faro Sebastian, Gilles R. G. Monif, David A. Baker, Gilles R. G. Monif, David A. Baker(Authors)
  • 2008(Publication Date)
  • CRC Press

    (Publisher)

  What causes the ultimate destruction of T. pallidum is controversial. It is currently postulated that the destruc-tion of the organisms occurs extracellularly. The histo-logic lesions caused by T. pallidum suggest that both humoral immunity (immobilizing antibodies, plasma cells) and cellular immunity (lymphocytes) play impor-tant roles in its eradication. The seroresponse of women treated for primary or secondary Syphilis is such that the VDRL should decline approximately fourfold at three months and eightfold at six months. Failure of the VDRL to change significantly with time should alert the physician to possible treat-ment failures or reinfection. NATURAL HISTORY OF THE DISEASE Syphilis is an infection of mucous membranes. Transmis-sion of the spirochete is predominantly the result of coitus. In the female, the primary lesion may occur on the labia, vaginal wall, or cervix. Extragenital sites, depending on sexual proclivities, are not uncommon. Adequate sexual exposure is not the sole determinant of infection. Infection develops in only 10% of human vol-unteers from a single sexual encounter. In clinical situa-tions, almost two-thirds of individuals intensively exposed to Syphilis in its infectious stage will acquire infection. It is probable that T. pallidum breaches the mucous membrane barrier, but it is equally probable that minute breaks in the membrane in many instances provide the true portal of infection. Treatment during incubation is almost 100% effective and should be considered mandatory in the man-agement of persons exposed to infectious Syphilis. The time required for the development of the primary lesion is partly a function of the number of organisms establishing the initial infection and their subsequent replication at the portal of entry. Infections with a large inoculum (e.g., 107 organisms) may cause a chancre in five to seven days. The inoculation of 50 to 100 organisms is followed by an incubation period of about three weeks.

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