Syphilis The Great Mimic - PowerPoint Presentation

Slide1

SyphilisThe Great Mimic

What is Syphilis?

Caused by the bacterium Treponema pallidumTime between infection and start of first symptom is 10-90 days Diagnosed by Dark field microscopy of material taken from a lesion or lymph node Serologic tests (

RPR & VDRL)

1

CDC.

2014.

STD treatment guidelines

.

Stages of Syphilis

Disease has 4 distinct phases:Primary SecondaryLatent (early & late)Tertiary

How Do I Get Syphilis?

Bacteria enter body through minute abrasions in skin Transmitted through contact with moist lesions, especially during sexual activityRate of transmission from infected sexual partner is about 30%-60%1Primary, secondary, and early latent stage account for nearly all transmission Syphilis may also be acquired congenitally (at birth)

1.

Augenbraun

M. 2003. In: Dale DC.

Syphilis

Syphilis has been around since at least the 15th century.National public reporting of syphilis cases began in 1941.In the year 2000, the rate of primary and secondary (P&S) syphilis hit an all time low.In 2013, the total case counts (all stages) were the highest recorded since 1996.

From 2012 to 2013, there was a 13.1% increase in overall cases.

.

Syphilis and MSM75% of primary and secondary syphilis in 2013 was associated with men having sex with men (MSM).

Syphilis cases among MSM are characterized by high rates of HIV co-infection and high-risk sexual behaviors.In 2006, the rate was highest among men ages 35 – 39 years.In 2013 the rate was highest in men 20 -29 years old. CDC, “2013 STD Surveillance Syphilis”

Syphilis and Youth20% of all newly diagnosed cases are in young people, ages 15 – 24.

1 Racial disparities in young people ages 15 – 19Rates among black males were 11.7 times higher than white males in the same age group.Rates among black females were 18.2 times higher than white females in the same age group.CDC, “Sexuallly

Transmitted Infections Among Young Americans”

Source: CDC. 2010.

STD Surveillance.

Reported Cases of Syphilis

What is Primary Syphilis?

Single or multiple sores (chancres)Firm, round, painless; indicates point of bacterial entryTypically occurs on genital skin and mucosaMay also occur in mouth, hands, or other parts of the bodyChancre heals by itself in 3-6 weeks

Neurosyphilis

can occur during any stage of syphilis, including primary and secondary syphilis.

1

Syphilis chancre

Vaginal opening

Syphilitic Chancre, Mouth

Syphilitic Chancre, Female Abdomen

Syphilitic Chancre, Male

Syphilis chancre

What is Secondary Syphilis?

Symptoms are caused by the spread ofthe bacteriaFever, sore throat, rash, lymph gland swelling, loss of hair1External genital lesions called condyloma lata

Lesions resolve in 3-12 weeks

2

Augenbraun

M. 2003. In: Dale DC.

Sparling PF. 2008. In: Holmes KK, et al.

What is Latent Syphilis?

Latent stage can be divided into early and late stagesMostly asymptomatic and contagious Early latent stage usually during first year of infectionOne-fourth of patients in early latent stage have a relapse (ie, become symptomatic again)Relapse is rare in late latent syphilis

May resolve by itself or advance to the tertiary stage

1

Sparling, PF. 2008. In: Holmes KK, et al.

What is Tertiary Syphilis?

Occurs in 1/3 of the cases, months or years after latency1Causes walls of major arteries to weaken and balloon out; these aneurysms can rupture and may be fatalAffects the brain and its coverings to cause paralysis, mental confusion, insomnia, and headaches

Gummas

- destructive lesions in skin, bones, and other organs

2

Augenbraun

M. 2003. In: Dale DC.

Sparling PF.2008

. In: Holmes KK, et al.

Incubation

Tertiary

Late latent

Primary

Secondary

Early latent

1-3 wks

3-6 wks

3-12 wks

< 1 yr

1-5 yrs

many years

Infectious & symptomatic

Noninfectious & symptomatic

Infectious & asymptomatic

Noninfectious & asymptomatic

Stages of Syphilis

(approximate duration)

How is Syphilis Treated?

Effectively treated with antibiotics (penicillin)Repeated tests are important to confirm cure2-to-5 fold increased risk of HIV infection with syphilis1 Syphilis is on the increase in HIV positive homosexual males2All patients with syphilis should be tested for HIV

CDC. 2010. Fact Sheet.

CDC. 2010

. STD Surveillance

.

Reducing Syphilis Risk

Syphilis is a dangerous STI100% consistent use of condoms may reduce the risk of transmission, but does not eliminate the risk.1Screening of all pregnant females is recommended2All infants born to infected mothers should

be treated

2

Koss. 2009. Sexually Trans. Diseases

CDC. 2010. STD Treatment Guidelines.

Avoiding Syphilis

For unmarried individuals, sexual abstinence is the only practical and certain way to avoid syphilis For those who choose to be sexually active, a marriage (mutually faithful, life-long relationship with an uninfected sexual partner) is the healthiest choice