Syphilis, Yaws, Bejel, and PintaSyphilisTreponema pallidumSyphilis epidemiologySlide 5Slide 6Serologic TestsSlide 8Slide 9Slide 10Slide 11Slide 12Biologic False-Positive Test ResultsBFP Test Results in SyphilisCutaneous SyphilisSlide 16ChancreChancresSlide 19Chancre HistologySlide 21Slide 22SerologyChancre vs. ChancroidDDx in SyphilisChancroidErosive lesion of granuloma inguinaleSecondary SyphilisSlide 29Secondary Syphilis Macular EruptionsSecondary Syphilis Papular EruptionsSecondary Syphilis Papular EruptionsSlide 33Secondary Syphilis Papular EruptionsSecondary Syphilis Papular EruptionsSlide 36Secondary Syphilis Mucous MembraneSecondary Syphilis Mucous membraneSlide 39Orogenital lesions of Secondary SyphilisSecondary Syphilis Systemic InvolvementSecondary Syphilis DiagnosisSlide 43Secondary Syphilis DDx “Great Imitator”Secondary Syphilis HistologySlide 46Slide 47Latent SyphilisLate SyphilisTertiary Cutaneous SyphilisTertiary SyphilidsSlide 52Nodular Tertiary SyphilidGummaGumma HistologyDiagnosis of Tertiary SyphilisDDx Tertiary SyphilisLate Osseous SyphilisSlide 59NeurosyphilisEarly NeurosyphilisMeningovascular NeurosyphilisLate NeurosyphilisTabes DorsalisSlide 65Late Cardiovascular SyphilisCongenital SyphilisSlide 68Early Congenital SyphilisEarly Congenital SyphilisSlide 71Late Congenital SyphilisSlide 73Slide 74Treatment of SyphilisSlide 76Treatment Recommendations for SyphilisJarisch- Herxheimer ReactionTreatment of Sex PartnersSerologic Testing after TxSyphilis and HIVYawsEarly YawsSlide 84Slide 85Late YawsSlide 87Slide 88Endemic Syphilis (Bejel)BejelSlide 91PintaSlide 93Slide 94Slide 95Treatment of Yaws, Bejel, and PintaThe END!!!!!!!Syphilis, Yaws, Bejel, Syphilis, Yaws, Bejel, and Pintaand PintaPatrick Keehan, Patrick Keehan, D.O.D.O.SyphilisSyphilisAKA AKA luesluesContagious, sexually transmitted Contagious, sexually transmitted disease caused by the spirochete disease caused by the spirochete Treponema pallidumTreponema pallidumEnters through skin or mucous Enters through skin or mucous membrane where primary membrane where primary manifestations are seenmanifestations are seenTreponema pallidumTreponema pallidumSpiral spirochete that is mobileSpiral spirochete that is mobile# of spirals varies from 4 to 14# of spirals varies from 4 to 14Length is 5 to 20 micronsLength is 5 to 20 micronsCan be seen on fresh primary or Can be seen on fresh primary or secondary lesions by darkfield secondary lesions by darkfield microscopy or fluorescent antibody microscopy or fluorescent antibody techniquestechniquesSyphilis epidemiologySyphilis epidemiologyMajor health problem throughout worldMajor health problem throughout world2.6 cases per 100,000 in 1999 in the US2.6 cases per 100,000 in 1999 in the USLowest level ever recorded Lowest level ever recorded Concentrated in 28 counties in the SE Concentrated in 28 counties in the SE U.S.U.S.Mainly gay men and crack cocaine Mainly gay men and crack cocaine usersusersSyphilis epidemiologySyphilis epidemiologyEnhances risk of transmission of HIVEnhances risk of transmission of HIVHIV testing recommended in all HIV testing recommended in all patients with syphilispatients with syphilisReportable diseaseReportable diseaseSerologic TestsSerologic TestsTesting reveals patients immune Testing reveals patients immune status, status, not not whether they are whether they are currently infected currently infected Non-treponemal antigen testNon-treponemal antigen test uses uses lipoidal antigens rather than T. lipoidal antigens rather than T. pallidum or components of itpallidum or components of itRPR = rapid plasma reaginRPR = rapid plasma reaginVDRL = Venereal Disease Research VDRL = Venereal Disease Research Laboratory LaboratorySerologic TestsSerologic TestsPositive within 5 to 6 weeks after Positive within 5 to 6 weeks after infectioninfectionStrongly positive in secondary phaseStrongly positive in secondary phaseStrength of reaction is stated in Strength of reaction is stated in dilutionsdilutionsMay become negative with May become negative with treatment or over decadestreatment or over decadesSerologic TestsSerologic TestsMHA-TP: microhemagglutination MHA-TP: microhemagglutination assay for assay for T. pallidumT. pallidumFTA-ABS: fluorescent treponemal FTA-ABS: fluorescent treponemal antibody absorption testantibody absorption testAll positive nontreponemal test All positive nontreponemal test results should be confirmed with a results should be confirmed with a specific treponemal test specific treponemal testSerologic TestsSerologic TestsTreponemal tests become positive Treponemal tests become positive early, useful in confirming primary early, useful in confirming primary syphilissyphilisRemain positive for life, useful in Remain positive for life, useful in diagnosing late diseasediagnosing late diseaseTreatment results in loss of positivity Treatment results in loss of positivity in 13-24% of patientsin 13-24% of patientsBiologic False-Positive Test Biologic False-Positive Test Results Results Positive test with no history or Positive test with no history or clinical evidence of syphilisclinical evidence of syphilisAcute BFP: those that revert to Acute BFP: those that revert to negative in less than 6 monthsnegative in less than 6 monthsChronic BFP: those that persist > 6 Chronic BFP: those that persist > 6 monthsmonthsBFP Test Results in SyphilisBFP Test Results in SyphilisAcute BFPAcute BFPVaccinationsVaccinationsInfectionsInfectionsPregnancyPregnancyConnective tissue Connective tissue disease (SLE)disease (SLE)Liver diseaseLiver diseaseBlood transfusionsBlood transfusionsIVDUIVDUCutaneous SyphilisCutaneous SyphilisChancre is usually the first Chancre is usually the first cutaneous lesion cutaneous lesion 18 to 21 days after infection18 to 21 days after infectionRound indurated papule with an Round indurated papule with an eroded surface that exudes a serous eroded surface that exudes a serous fluidfluidUsually painless and heals without Usually painless and heals without scarringscarringChancreChancreInguinal adenopathy 1-2 weeks after Inguinal adenopathy 1-2 weeks after chancrechancreGenerally occur singly, but may be Generally occur singly, but may be multiplemultipleDiameter of a few millimeters to Diameter of a few millimeters to several centimetersseveral centimetersChancresChancresIn women, the genital chancre is less In women, the genital chancre is less often observed due to location within often