53 Syphilis

There are 4 pathogenic treponemes

pallidum - syphilis pertenue - yaws endemicum - bejel carateum - pinta

So syphilis is the one that causes CV disease, neuro disease, and vertical transmission. (who knows, the others might)

However they are morphologically identical, and can’t be distinguished serologically, and cause v similar disease, and are >99.8% identical

So there is a theory that they might all be the same disease, and it just depends on how you get infected!

Visceral complications and congenital transmission may also occur in Yaws.

Long incubation

A few weeks of primary stage

Secondary stage is seen the first 2 years

Tertiary complications are about a decade later.

Fully sensitive to penicillin (benzathine penicillin)

The treatment for HIV positive patients is same as non

53.1 Congenital Syphilis

What’s the outcome for pregnant women with syphilis. Syphilis pregnant women had 1/4 risk of stillbirth (1% in no syphilis). 1/3 low birth weigh (10% in no syphilis). 1/5 premature (3% in no syphilis). Treatment during pregnancy reduces the risk of all these things, bringing it back to the same risk.

Congenital syphilis used to account for 50% of stillbirths in northern tanzania. It was one of the most cost-effective health interventions ever found. But there’s a world wide benzathine penicillin shortage, and also a lot of countries still don’t routinely screen. And of those screened a lot don’t get treated!

The WHO has called for global elimination of CS back in 2006.

Ulcers seen in soles of feet, palms of hands. V high mortality in congenital syphilis. Not feeding, not gaining weight. Hepatosplenomegaly. Nasal discharge. Desquamating lesions on palms and soles. Syphilitic osteitis. The peristeoum raises off the bones and is super painful

Signs of congenital syphilis, treat with procaine penicillin daily for 10 days