Syphilis

SOURCE

Source: Knodel LC, Duhon B, Argamany J. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146072585. Accessed March 9, 2017.

DEFINITION

• Sexually transmitted infection (STI)

ETIOLOGY

• Causative organism: Treponema pallidum, a spirochete.

• Usually acquired by sexual contact with infected mucous membranes or cutaneous lesions.

  • On rare occasions can be acquired by nonsexual personal contact, accidental inoculation, or blood transfusion.

PATHOPHYSIOLOGY

• Organism penetrates intact mucous membrane or break in epithelium, resulting in spirochetemia.

EPIDEMIOLOGY

• Highly contagious infection that can progress to chronic, seriously disabling, or fatal, systemic disease.

• Strong evidence of association between syphilis and HIV infection.

  • Centers for Disease Control and Prevention (CDC) recommends HIV testing in all patients diagnosed with syphilis.

PREVENTION

• Mutually monogamous sexual relationship between uninfected partners.

• Barrier contraceptive methods.

RISK FACTORS

• Unprotected sex.

  • Risk of syphilis after unprotected sex with individual with infectious syphilis is ~50–60%.

• Number of sexual partners.

• Sexual preference.

• Age.

  • Two-thirds of STIs occur in persons in teens and twenties.

CLINICAL PRESENTATION

• Clinical presentation of syphilis varies, with progression through multiple stages possible in untreated or inadequately treat patients (Table 1).

• Primary syphilis.

  • Characterized by appearance of chancre on cutaneous or mucocutaneous tissue.

  • Chancres persist only for 1–8 weeks before spontaneously disappearing.

• Secondary syphilis.

  • Characterized by variety of mucocutaneous eruptions, resulting from widespread hematogenous and lymphatic spread of T. pallidum.

  • Lesions may be generalized or localized to a small portion of the body, and are mostly (except for follicular lesions) nonpruritic.

  • Signs and symptoms of secondary syphilis disappear in 4–10 weeks; however, in untreated patients, lesions may recur at any time within 4 years.

• Latent syphilis.

  • Positive serologic test but no other evidence of disease.

  • Early latency (1 year from onset of infection, up to 2–4 years): patient is considered potentially infectious.

  • Late latency: mostly considered noninfectious, except in pregnancy, disease can pass from mother to fetus.

  • Most untreated patients with latent syphilis have no further sequelae.

    • ~25–30% progress to neurosyphilis or late syphilis with clinical manifestations other than neurosyphilis.

• Tertiary syphilis and neurosyphilis.

  • If untreated, syphilis can produce an inflammatory reaction in any organ in the body.

  • Neurosyphilis: any patient with CSF abnormalities consistent with CNS infection (affects approximately 40% of patients with primary or secondary syphilis).

SIGNS AND SYMPTOMS

• Summarized in Table 1.