STD Syphilis secondry & terciary lesions

Clinical Features

1.3.1 The typical Primary lesion in the male is a chancre on  the

externalr  genitalia. This is an indurated papule that  ulcerates

the edge and base continue to be indurated on palpation.

In  women, the primary sites are the labia and  cervix.  Regional

lymphadenopathy  appears (groin) a week later being painless  and

non-suppurative

1.3.2 SECONDARY LESIONS

Secondary lesions are many and include:

*  Generalised or localized mucocutaneous lesions

*  Generalised  non-tender lymphadenopathy and skin rash  can  be

   seen in most cases and occasionally papular lesions are seen.

*  Initial  lesions are  5-10 mm in diameter distributed  on  the

   trunk and legs

1.3.3 CONSTITUTIONAL SYMPTOMS

*  Include  fever,  sore throat, hoarsness, joint  pains,  weight

   loss and anorexia

*  Acute meningitis in 1-2% of patients

1.3.4 TERTIARY SYPHILIS (LATE SYPHILIS)

A   symptomatic  neurosyphilis  occurs  if  latent  syphilis   is

untreated and becomes symptomatic.

*  Manifestation of general paresis are due to parenchymal damage   

   in CNS and produce hyperactive reflexes and personality changes

*  Tabes  dorsalis  is due  to  demyelination  of  the  posterior

   columns and produce ataxia, paresthesia, hypeerflexia, bladder

   disturbance and Charcot's joints

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Sexually Transmitted desease Syphylis Pathology

Pathology

Treponema  can penetrate mucus membrane or skin and then  through

the  lymphatics  and  blood stream  produce  systemic  infection.

The  median incubation period is 21 days. Primary lesion  appears

at the site of penetration and persists for 2 to 6 weeks.

*  The  histopathology of these lesions  will  show  perivascular

   infiltration  by  plasma  cells  and  histiocytes.   Capillary

   endothelial proliferation eventually leades to obliteration of

   small blood vessels.

*  The  chancre  (primary  lesion) will  show  treponema  between

   epithelial cells.

*  Treponema will also be seen in the lymphatic channels and  the

   regional lymph nodes

*  The manifestations of secondary syphilis appear six to  twelve

   weeks later and consists of dull red rash like skin lesions.

*  Maculo-papular lesions appear later

*  There is a generalised lymphadenopathy

*  Treponema is found in many tissues including the spinal fluid

*  Secondary lesions subside in 2-6 weeks

*  The patient enters the latent stage

*  This stage is detectable only by serological tests

*  The World  Health Organization defines latent stage more  than

   one year may continue for a life time.

*  About one third  of patients with untreated  syphilis  develop

   clinically apparent tertiary diseases.

*  In the past, tertiary disease was associated with Gumma; today

   Gumma   has  become  uncommon  and  the  disorder  caused   by

   obliterative    small   vessel  endarteritis   involving   the

   vesavasorum  of the aorta and the central nervous  system  are

   more in evidence.

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Sexually transmitted deseases Syphilis epidemiology

Epidemiology

Most  cases  are acquired by sexual contact (the  chancre,  mucus

patch  or condyloma latum). 

The organism dies rapidly  on  drying

hence  infective  lesions are in moist  areas  (genitalia,  mouth

anus). 

Highest incidence of syphilis occur between the ages of 20

to 24. 

There is a male predominance infection can be  transmitted

from surface lesion upto 2 years starting from primary tests.

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Sexually Transmitted Deseases (STI) Introduction

Sexually Transmitted Disease (STD)

INTRODUCTION

In this chapter the diseases discussed are Syphilis,  Gonorrhoea,

Chanceroid,  Lymphgranuloma Inguniale, Yaws and AIDS. At the  end

of  this  chapter you should be able to diagnose those  cases  of

sexually transmitted disorder that a surgeon may encounter in his

practice, either with presenting complaints (ulcers, lymph  gland

enlargments  fever) or as coincidental late manifestation in  the

course  of other surgical disorders. Early recognition  of  these

disorders is essential to avoid needless surgical intervention.

1. SYPHILIS

This is systemic infection caused by Treponema pallidum-a  spiral

organism 6-15 Um in length.

*  The  incubation  period is three  weeks.  Transmission  occurs

   through  direct  contact  with  a  surface  lesion  containing

   treponema.

*  The  primary  chancre (Ulcer) is assoicated  with  lymph  gland

   enlargement.

*  There is a  secondary stage of bacteremia and a latent  period

   of two years when the patient can transmit infection.

*  A third of the untreated cases pass into the tertiary stage of

   destructive muco-cutaneous lesion

*  There  may  also be  parenchymal and  central  nervous  system

   lesions

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