Syphilis-slides.ppt 412k6l

Syphilis Curriculum

By : Bella Anggraeni Sari Rani Oktaviani Utina Muh. Taufik Syarifuddin BAGIAN ILMU KESEHATAN KULIT KELAMIN FAKULTAS KEDOKTERAN UNIVERSITAS MUSLIM INDONESIA 2014

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Syphilis Curriculum

Epidemiology

Syphilis Definition Sexually acquired infection Etiologic agent: Treponema pallidum Disease progresses in stages May become chronic without treatment

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Syphilis Curriculum

Epidemiology

Transmission Sexual Congenital infection Blood products

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Syphilis Curriculum

Epidemiology syphilis incident various country in all the world in

the year 1996 ranging from 0,04-0,52%.Low Incident in cina, while highest Incident in USA. In Indonesia incident 0,61%. In decreasing order: 20 to 39 years, 15 to 19 years, 40 to 49 years. Males outnumber females 2:1 to 4:1

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Syphilis Curriculum

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Syphilis Curriculum

Early Stage

T.Pallidum skin or through membran microlesi forming infiltrates in perivasculer proliferate in T. Pallidum hypertrophic in endothelium obliteration of the lumen erosion

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Syphilis Curriculum

Advance stage

Troponema apparently in a state of the dorman antibodies in the serum of patients trauma is one of the factor precipitation S III shaped guma

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Syphilis Curriculum

Pathogenesis

Treponema pallidum

Electron photomicrograph, 36,000 x. 8

Syphilis Curriculum

Venereal syphilis: Treponema pallidum subspecies

pallidum (T. pallidum). Yaws: T. pallidum subspecies pertenue. Endemic syphilis (bejel): T. pallidum subspecies endemicum. Pinta: T. carateum. T. pallidum is a thin delicate spirochete with 6 to 14 spirals. Only natural host for T. pallidum is the human.

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Syphilis Curriculum

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Syphilis Curriculum

Clinical Manifestations

Primary Syphilis Primary lesion or "chancre" develops at the site

of inoculation

Chancre:

 Progresses from macule to papule to ulcer  Typically painless, indurated, and has a clean base  Highly infectious  Heals spontaneously within 1 to 6 weeks  25% present with multiple lesions

Regional lymphadenopathy: classically rubbery,

painless, bilateral

Serologic tests for syphilis may not be positive

during early primary syphilis

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Clinical Manifestations

Secondary Syphilis Secondary lesions occur 3 to 6 weeks after the

primary chancre appears; may persist for weeks to months Primary and secondary stages may overlap Mucocutaneous lesions most common Manifestations:  Rash (75%-100%)  Lymphadenopathy (50%-86%)  Malaise  Mucous patches (6%-30%)  Condylomata lata (10%-20%)  Alopecia (5%)

Serologic tests are usually highest in titer during

this stage

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Clinical Manifestations

Secondary Syphilis: Palmar/Plantar Rash

Source: Seattle STD/HIV Prevention Training Center at the University of Washington, UW HSCER Slide Bank

Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides 15

Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Clinical Manifestations

Latent Syphilis Host suppresses the infection enough so

that no lesions are clinically apparent Only evidence is positive serologic test for syphilis May occur between primary and secondary stages, between secondary relapses, and after secondary stage Categories: Early latent: <1 year duration Late latent: 1 year duration

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Syphilis Curriculum

Clinical Manifestations

Tertiary (Late) Syphilis Approximately 30% of untreated patients

progress to the tertiary stage within 1 to 20 years

Rare because of the widespread

availability and use of antibiotics

Manifestations Gummatous lesions Cardiovascular syphilis

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Neurosyphilis Occurs when T. pallidum invades the CNS May occur at any stage of syphilis Can be asymptomatic Early neurosyphilis occurs a few months to a few

years after infection

 Clinical manifestations include acute syphilitic meningitis,

meningovascular syphilis, ocular involvement

Late neurosyphilis occurs decades after infection

and is rarely seen

 Clinical manifestations include general paresis, tabes

dorsalis, ocular involvement

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Syphilis Curriculum

Neurosyphilis - Spirochetes in Neural Tissue

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Syphilis Curriculum

Clinical Manifestations

Congenital Syphilis  

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 

Occurs when T. pallidum is transmitted from a pregnant woman with syphilis to her fetus May lead to stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment, and bone deformities Transmission to the fetus in pregnancy can occur during any stage of syphilis; risk is much higher during primary and secondary syphilis Fetal infection can occur during any trimester of pregnancy Wide spectrum of severity exists; only severe cases are clinically apparent at birth  

Early lesions (most common): Infants <2 years old; usually inflammatory Late lesions: Children >2 years old; tend to be immunologic and destructive 24

Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

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Syphilis Curriculum

Syphilis has long been known as the "great

imitator," because the various cutaneous manifestahons may simulate almost any cutaneous or systemic disease. Pityriasis rosea may be mistaken for secondary syphilis, especxally since both begin on the trunk. The herald patch, the oval patches with a fine scale at the edge, patterned in the lines of skin cleavage, the absence of lymphadenopathy, and infrequent mucous membrane lesions help to distinguish pityriasis rosea from secondary syphiIis. 27

Syphilis Curriculum

Differential diagnosis S I

Genital herpes, traumatic ulcer, fixed drug eruption,chancroid, lymphogranuloma venereum S II Adverse cutaneous drug eruption (e.g., captopril), pityriasis rosea, viral exanthem, infectious mononucleosis, tinea corporis, tinea versicolor, scabies, condylomata acuminata, acute guttate psoriasis, lichen planus. 28

Syphilis Curriculum

S III

Cutaneous tuberculosis, cutaneous atypical mycobacterial infection, lymphoma, invasive fungal infections

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Syphilis Curriculum

Diagnosis

Laboratory Diagnosis Identification of Treponema pallidum in

lesions

Darkfield microscopy Direct fluorescent antibody - T. pallidum (DFA-

TP)

Serologic tests Nontreponemal tests Treponemal tests Histopatoloy

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Syphilis Curriculum

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Syphilis Curriculum

 Primary syphilis

1.Penisilin G benzatin 4,8 million unit I.M once a week 2.Penisilin G prokain in akua 0,6 million unit /day for 10 days 3.PAM 1,2 million unit/time, 2 time a week  Latent syphilis

1.Penisilin G benzatin 7,2 million unit total dose 2.Penisilin G prokain in akua 0,6 million unit /day 3.PAM 1,2 million unit/time, 2 time a week  Sifilis III 

1.Penisilin G benzatin 9,6 million unit total dose 2.Penisilin G prokain in akua 0,6 million unit /day 3.PAM 1,2 million unit/time, 2 time a week 32

Syphilis Curriculum

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Syphilis Curriculum

Prevention

Patient Counseling and Education Nature of the disease Transmission Treatment and follow up Risk reduction

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Syphilis Curriculum

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