Treponema Pallidum :Syphilis

D i.e. Congenital Syphilis

D i.e. Vesicular rash with bulla over palms & soles

B i.e. Interstitial Keratitis

A i.e. Intensly pruritic

C i.e. Vesicular lesions

C i.e. Asymptomatic

A i.e. Painless lymphadenopathy; C i.e. Mucosal erosion

Ans. is ‘d’ i.e. Line diagram 

Ans. is ‘d’ i.e., Dubois abscess 

Ans. is ‘a’ i.e., Clutton’s joints 

Nasal syphilis may be:

Acquired:        

• Primary, e.g. chancre in vestibule
• Secondary, e.g. simple rhinitis, crusting and fissuring leading to atrophic rhinitis
• Tertiary, e.g. Gumma leads to septal perforation and saddle nose deformity (due to collapse of nasal bridge)

Congenital:     

• Early (first 3 months): Presenting as snuffles, purulent nasal discharge, fissuring excoriation.
• Late (around puberty): Gumma in septum and other stigmatas.

• Teritary syphilis is a common association: primary and secondary syphilis are rare association in nasal syphilitis.
• Septal perforation occurs in bony part in case of syphilis.

Ans. Saddle nose

Ans. C: FT-ABS

T. pallidum cannot be grown in vitro

Diagnostic tests for syphilis: Tests include serologic tests for syphilis (STS), which consist of screening (reaginic) and confirmatory (treponemal) tests, and dark field microscopy.

• Reaginic tests use lipid antigens (cardiolipin from bovine hearts) to detect reagin (human antibodies that bind to lipids). The Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests are sensitive, simple, and inexpensive reaginic tests that are used for screening but are not specific for syphilis. Results may be presented qualitatively (e.g., reactive, weakly reactive, borderline, or nonreactive) and quantitatively as titers (e.g., positive at 1:16 dilution).

Many disorders other than treponemal infections (e.g., SLE, antiphospholipid antibody syndromes) can produce a positive (biologically false-positive) reagin test result. CSF

reaginic tests are reasonably sensitive for early disease but less so for late neurosyphilis. CSF reagin tests can be used to diagnose neurosyphilis or to monitor response to treatment by measuring antibody titers.

• Treponemal tests detect antitreponemal antibodies qualitatively and are very specific for syphilis. They include the following:

– Fluorescent treponemal antibody absorption (FTA-ABS) test

– Microhemagglutination assay for antibodies to T. pallidum (MHA-TP)

T. pallidum hemagglutination assay (TPHA)

Ans. B: Interstitial keratitis

Hutchinson’s triad is named after Sir Jonathan Hutchinson.

It is a common pattern of presentation for congenital syphilis, and consists of three phenomena: interstitial keratitis, Hutchinson incisors (notching of the two upper central incisors in the permanent dentition), and eighth nerve deafness

Ans. B: Generalized and tender lymphadenopathy

Common symptoms include headache, achiness, loss of appetite and a rash.

The rash in secondary syphilis is usually reddish-brown in color, not itchy and widespread. However, the appearance of the rash’s individual lesions can vary dramatically: they may be flat or raised; they may or may not be scaly; and there may or may not be pustules present. It is partially do to the variablity of this rash that led to syphilis being called “the great imitator,” because it can resemble many other conditions. The rash can last for a few weeks or months.

In warm moist intertriginuous area (perianal region, vulva or scrotum) condyloma lata can be seen.

Other symptoms of secondary syphilis include sores in the mouth, nose, throat, and on the genitals or folds of the skin. Patchy hair loss can occur. All the signs and symptoms of the second stage of syphilis disappears without treatment in 1 to 6 months.

Ans. C: 9-90 days

Acquired syphilis:

–        Primary syphilis: incubation period 2-3 weeks (range 9-90 days): local infection

–        Secondary syphilis: incubation period 6-12 weeks (range 1-6 months): generalised infection

–        Early latent syphilis: asymptomatic syphilis of less than 2 years duration

–        Late latent syphilis: asymptomatic syphilis of 2 years or longer duration

–        Late symptomatic syphilis (tertiary syphilis): cardiovascular syphilis, neurosyphilis, gummatous syphilis

Congenital syphilis:

–        Early congenital syphilis occurs within the first 2 years of life.

–        Late congenital syphilis emerges in children older than 2 years.

Ans:A.)Primary.

Image shows:A, Syphilitic chancre of the scrotum. Such lesions typically are painless despite the presence of ulceration, and they heal spontaneously. B, Histologic features of the chancre include a diffuse plasma cell infiltrate beneath squamous epithelium of skin

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Ans. is ‘c’ i.e., Tertiary 

Nasal syphilis

• Nasal syphilis may be : i) Acquired or ii) Congenital.
• Tertiary stage in which nose is involved most commonly.
• There is formation of gumma followed by bony perforation of nasal septum.
• Bridge of the nose collapses causing a saddle deformity. Atrophic rhinitis may occur as a complication.