Syphillis

Organism

 

Treponema Pallidum

 

Spirochete transmitted via

- direct contact with denuded epithelium

- transplacental infection

 

Types

 

Primary

 

Macule at site of contact

- painless hard ulcer

- chancre

 

Secondary

 

4-8/52

- a rash (the most characteristic finding)

- fever / headache / malaise / anorexia

- diffuse lymphadenopathy

 

Tertiary

 

2-20yrs latency

 

Gummas / granuloma of skin, mucosa, bone, joints

 

Painless non tender swelling of long bone or skull

- may be diffuse sclerotic reaction resembling Paget's

 

Quaternary 

 

Cardiovascular

- ascending aorta aneurysm

 

Neurosyphilis

- meningovascular - CN palsy, stroke

- general paresis of insane

- tabes dorsalis (sensory ataxia / numb legs / loss reflexes)

- charcot joints

- Argyll Robertson pupil

 

Congenital Syphilus

 

Presentation is multi-systemic, non-specific, variable 

- 1/3 still birth 

- 2/3 Present later

 

Metaphysitis / Osteitis / Periostitis

Pathological Fracture / Physeal separation

 

Nodes & Hepatosplenomegaly

 

Wimberger Sign

- erosion med prox tibial metphysis

 

DDx

 

Abuse

CRMO

Leukaemia

CMV

Rubella

Rickets

 

Investigation

 

Bone Biopsy

- spirochaetes

 

RPR Rapid Plasma Reagin

- screening

 

Fluoroscent Treponemal Antibody Test 

- confirmation

 

Lumbar puncture

- neuro-syphilis

 

Management

 

Antibiotics

 

Penicillin

- no reported resistance

- 100000 U/kg/D tds for 2/52

 

Syphilus of the bones

 

Congenital or acquired

- infection is localised to metaphysis and diaphysis

- doesn't cross into joint

 

Congenital Syphilis

- irritable and restless

- large, tender swelling around joint

- limb immobile

- cutaneous signs of syphilis may be present- skin lesions, mucous patches, and keratitis

 

X-rays

 

Show widening of metaphysis with marginal density and an indentation on its epiphyseal border

- diffuse periostitis

- with layers of new bone formation

- affected bone takes on a spindle shape with loss of metaph

 

Investigation

 

Serological markers not positive for 3/12 in neonate

- spirochete can be demonstrated on histology

 

Management

 

Responds well to Antibiotics

 

Late Stage / 2-3yrs

 

Characterised by osteoblastic activity

- a condensing osteitis

- mainly tibia, femur and skull

- subperiosteal bone formation produces characteristic prominent anterior tibia without bowing

- sabre tibia

 

Clutton's joints

- late stage of congenital syphilis

- 8-18 years

- recurrent bilat,eral painless effusions of knees

- aspirate shows high monomorph infiltrate