5-Minute Clinical Consult
Syphilis
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Basics
Description
- A chronic, systemic infectious disease caused by Treponema pallidum
- Transmitted sexually by direct contact with an active lesion; also transmitted vertically (maternal–fetal) and via blood transfusions
- Untreated disease includes four overlapping stages.
- Primary: single (usually) painless chancre at point of entry; appears in 10 to 90 days; chancre heals without treatment in 3 to 6 weeks.
- Secondary: appears 2 to 8 weeks after primary chancre; nonpruritic rash on palms or soles of feet, mucous membrane lesions, headache, fever, lymphadenopathy, alopecia
- Latent: seroreactive without evidence of disease
- Early latent: acquired within the last year
- Late latent: exposure >12 months prior to diagnosis
- Tertiary (late): Serology may be negative (fluorescent treponemal antibody absorption [FTA-ABS] test typically positive).
- Gumma, cardiovascular, and late neurosyphilis; may be fatal
- Neurosyphilis: any type of CNS involvement; can occur at any stage
- Psychosis, delirium, dementia
- Syphilis can affect nearly every organ/tissue.
Pediatric Considerations
In noncongenital cases, consider child abuse.
Pregnancy Considerations
Epidemiology
Incidence- Syphilis rate decreased through 2000 and have since increased (primarily in men who have sex with men [MSM]) (3).
- All stages: 35 per 100,000
- Congenital: 33/100,000 live births (3)
- Primary and secondary syphilis statistics (3)
- HIV coinfection
- MSM: 41.6%
- Men who have sex with women only (MSW): 7.9%
- Women: 4%
- Male (per 100,000 population)
- Overall: 18.7 (highest for men ages 25 to 29 years)
- Whites, non-Hispanic: 10.3
- Blacks, non-Hispanic: 49.5
- Hispanics: 22.7
- Asians: 9.1
- American Indians/Alaska natives: 21.4
- Native Hawaiians/Pacific Islanders: 29
- Multi-race: 16.7
- Female (per 100,000 population)
- Overall: 3 (highest for women ages 20 to 24 years)
- Whites, non-Hispanic: 1.8
- Blacks, non-Hispanic: 8.4
- Hispanics: 3.1
- Asians: 0.5
- American Indians/Alaska natives: 9.8
- Native Hawaiians/Pacific Islanders: 3.5
- Multi-race: 2.2
- HIV coinfection
Prevalence
Etiology and Pathophysiology
T. pallidum enters through intact mucous membranes or breaks in skin. The organism quickly enters the lymphatics to cause systemic disease. Highly infectious; exposure to as few as 60 spirochetes is associated with ~50% chance of infection.
Risk Factors
MSM, multiple sexual partners, exposure to infected body fluids, IV drug use, transplacental transmission, adult inmates, high-risk sexual behavior, people living with HIV (PLWH)
General Prevention
Education regarding safe sex; condoms reduce but do not eliminate transmission (4)[A].
Commonly Associated Conditions
HIV infection, hepatitis B, other STIs
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A chronic, systemic infectious disease caused by Treponema pallidum
- Transmitted sexually by direct contact with an active lesion; also transmitted vertically (maternal–fetal) and via blood transfusions
- Untreated disease includes four overlapping stages.
- Primary: single (usually) painless chancre at point of entry; appears in 10 to 90 days; chancre heals without treatment in 3 to 6 weeks.
- Secondary: appears 2 to 8 weeks after primary chancre; nonpruritic rash on palms or soles of feet, mucous membrane lesions, headache, fever, lymphadenopathy, alopecia
- Latent: seroreactive without evidence of disease
- Early latent: acquired within the last year
- Late latent: exposure >12 months prior to diagnosis
- Tertiary (late): Serology may be negative (fluorescent treponemal antibody absorption [FTA-ABS] test typically positive).
- Gumma, cardiovascular, and late neurosyphilis; may be fatal
- Neurosyphilis: any type of CNS involvement; can occur at any stage
- Psychosis, delirium, dementia
- Syphilis can affect nearly every organ/tissue.
Pediatric Considerations
In noncongenital cases, consider child abuse.
Pregnancy Considerations
Epidemiology
Incidence- Syphilis rate decreased through 2000 and have since increased (primarily in men who have sex with men [MSM]) (3).
- All stages: 35 per 100,000
- Congenital: 33/100,000 live births (3)
- Primary and secondary syphilis statistics (3)
- HIV coinfection
- MSM: 41.6%
- Men who have sex with women only (MSW): 7.9%
- Women: 4%
- Male (per 100,000 population)
- Overall: 18.7 (highest for men ages 25 to 29 years)
- Whites, non-Hispanic: 10.3
- Blacks, non-Hispanic: 49.5
- Hispanics: 22.7
- Asians: 9.1
- American Indians/Alaska natives: 21.4
- Native Hawaiians/Pacific Islanders: 29
- Multi-race: 16.7
- Female (per 100,000 population)
- Overall: 3 (highest for women ages 20 to 24 years)
- Whites, non-Hispanic: 1.8
- Blacks, non-Hispanic: 8.4
- Hispanics: 3.1
- Asians: 0.5
- American Indians/Alaska natives: 9.8
- Native Hawaiians/Pacific Islanders: 3.5
- Multi-race: 2.2
- HIV coinfection
Prevalence
Etiology and Pathophysiology
T. pallidum enters through intact mucous membranes or breaks in skin. The organism quickly enters the lymphatics to cause systemic disease. Highly infectious; exposure to as few as 60 spirochetes is associated with ~50% chance of infection.
Risk Factors
MSM, multiple sexual partners, exposure to infected body fluids, IV drug use, transplacental transmission, adult inmates, high-risk sexual behavior, people living with HIV (PLWH)
General Prevention
Education regarding safe sex; condoms reduce but do not eliminate transmission (4)[A].
Commonly Associated Conditions
HIV infection, hepatitis B, other STIs
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