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Syphilis - Coggle Diagram
Syphilis
Mechanisms/Pathophysiology
Motile spirochetes ‘outrun’ infiltrating phagocytes and reach sequestered locations
Spirochetes invade tissues using direct motility to negotiate their way through intercellular junctions
Local Inflammatory response elicited by spirochetes root cause of all clinical manifestations
Poorly defined
T. pallidum must adhere to epithelial cells and extracellular matrix components
Multiply locally and begin to disseminate through the lymphatics and bloodstream
As infection proceeds, the antibody repertoire possibly broadens
Spirochete is overwhelmed and its capacity for antigenic variation is exhausted, ushering in the asymptomatic period called latency
Treatment (WHO guidelines)
Late syphilis
Or intramuscular procaine penicillin (daily doses for 20 days)
If penicillin-based treatment cannot be used, oral doxycycline (daily doses for 30 days)
Intramuscular benzathine penicillin G (weekly doses for 3 weeks)
Congenital syphilis
Intravenous aqueous benzyl penicillin six hourly (for 10–15 days)
Or intramuscular procaine penicillin daily (for 10–15 days)
Early syphilis
Or intramuscular procaine penicillin (daily doses for 10–14 days)
If penicillin-based treatment cannot be used, oral doxycycline (twice daily doses for 10–14 days) or intramuscular ceftriaxone (daily doses for 10–14 days)
Intramuscular benzathine penicillin G (single dose)
Acquired syphilis (spread by sexual contact)
Late syphilis
Neurosyphilis (meningitis, hemiplegia, stroke, aphasia, seizures, tabes dorsalis)
Gummatous syphilis (infiltration of any organ and its subsequent destruction)
Cardiovascular syphilis (an aortic aneurysm, aortic valvulopathy)
Can manifest months or years after the initial infection
Early syphilis
Secondary syphilis
macular rash (local or regional)
diffuse lymphadenopathy
hands and feet lesions
Appears 2 to 8 weeks after the disappearance of the chancre
condyloma lata (papulosquamous eruption)
headache, myalgia, arthralgia
pharyngitis
hepatosplenomegaly
alopecia
Latent syphilis
No signs or symptoms
S/S may never return
Develops if primary and secondary syphilis is left untreated
Positive serologic tests, negative clinical manifestations
Primary syphilis
Regional lymphadenopathy
10 to 90 days after exposure to T. pallidum
Solitary non-tender genital chancre
Multiple chancre may appear in non-genital areas such as digits, nipples, tonsils, and oral mucosa
Will go away even without treatment
single chancre at site of inoculation
T. pallidum disseminates widely into a variety of tissues
Early CNS invasion
Latent syphilis
Tertiary (late) syphilis
cardiovascular syphilis
ascending aorta
syphilitic aortitis
uncomplicated and asymptomatic
Primary cause of deaths before penicillin
Late neurosyphilis
Early invasion of the CNS may progress to meningovascular syphilis
Gumma
granulomatous, nodular lesions with variable central necrosis
as early as 2 years after intial infection
"Late benign"