Gummas are highly destructive tertiary syphilitic lesions that usually occur in skin and bones but may also occur in other tissues. For unclear reasons, cardiovascular syphilis is much less common than during the pre-antibiotic era. Complications of neurosyphilis include dementia, loss of proprioception, strokes, and blindness. If the parenchymatous form involves the brain, it is called generalized paresis if it involves the spinal column, it is called tabes dorsalis. Neurologic syphilis may be meningeal, meningovascular, parenchymatous, or various combinations thereof. The subsequent aortitis produces complications such as aneurysms and coronary artery stenosis. Cardiovascular problems are usually attributed to local inflammation induced by the multiplication of treponemes within the wall of the thoracic aorta. Approximately 80 percent of fatalities are caused by cardiovascular involvement, while most of the remaining 20 percent are from neurologic involvement. ![]() Tertiary syphilis can affect almost any tissue. During this latter period, the patient harbors infectious organisms, especially in the spleen and lymph nodes and blood serology remains positive. Early latency refers to the first 4 years when secondary relapses may occur late latency is the asymptomatic period beyond 4 years. The period between secondary and tertiary syphilis, termed latency, can last for many years. About 25 percent of untreated patients experience recurrences of this secondary stage in the first several years following infection. Two to six weeks after the onset of secondary syphilis, host defenses bring about healing. Deposition of immune complexes consisting of treponemal antigens and host antibodies in glomerular basement membranes may produce nephrotic syndrome. All of these lesions teem with treponemes and are highly contagious. Superficial sores (mucous patches) may occur on mucous membranes of the mouth, vagina, or anus, while wart-like lesions called condylomata lata may form in moist intertriginous areas. The rash may be macular, papular, follicular, papulosquamous, or pustular. The rash initially appears on the palms and soles and eventually spreads to other areas. Clinical manifestations include slight fever, generalized lymphadenopathy, malaise, and a mucocutaneous rash. Organisms multiply in many different tissues. Treponema pallidum subspp pertenue and endemicum are intermediate in invasiveness and cause destructive lesions in bones and soft tissues.ĭevelopment of the clinical stages of syphilis over time.Īfter an asymptomatic period of 2 to 24 weeks, the secondary or disseminated stage begins. Treponema carateum is the least invasive and causes only cutaneous disease. Treponema pallidum subsp pallidum, the most invasive of the pathogenic treponemes, produces highly destructive lesions in almost any tissue of the body, including the central nervous system. ![]() After a relatively prolonged period, in some cases 20 to 30 years, the tertiary or late stage evolves. The dissemination of treponemes to other tissues results in the secondary stage. Multiplication of the organisms at the initial site of entry produces the primary stage. ![]() Treponemal infections are unique in that they are characterized by distinct clinical stages. 36-1), it has earned a reputation as “the great imitator.” Yaws, pinta, and endemic syphilis also have highly variable manifestations. The pathogenic treponemes have many cross-reacting antigens, and untreated infection is believed to confer partial protection against the other treponemal diseases.īecause syphilis exhibits diverse clinical manifestations that mimic many other infectious and noninfectious disorders ( Fig. Pinta remains endemic in Central and South America, and endemic syphilis is present in certain regions of the Middle East. Despite extensive eradication campaigns, yaws remains widespread in the tropics. Improved surveillance methods have helped to control this syphilis epidemic. The late 1980's experienced a major increase in the incidence of early syphilis cases which was largely related to crack cocaine usage among inner city minorities. Following the adoption of penicillin as the mainstay of syphilotherapy, the number of new syphilis cases progressively decreased until 1958, after which the trend reversed and a steady increase has occurred. ![]() Infectivity rates correspond to the most sexually active age groups. Venereal syphilis is distributed worldwide, and over the past several decades has become a significant public health problem in many underdeveloped countries. Humans are the only source of treponemal infection there are no known nonhuman reservoirs.
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