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Pathology - Syphilis
Pathogen
• Treponema pallidum, a helical spirochete.
Epidemiology
• Global prevalence.
• Rising incidence since the 1990s.
Transmission occurs predominantly by sexual contact with an infected individual.
• Can be transmitted from mother to infant, resulting in congenital syphilis.
Pathogenesis
Organisms infiltrate the body through tiny epithelial abrasions.
• The organism generates a non-antigenic mucin coat that promotes rapid dissemination throughout the body via the bloodstream and lymphatic system.
Presentation
• Primary syphilis results in a firm, painless skin ulcer ('chancre') that manifests approximately three weeks post-exposure. The chancre manifests at the site of touch and is typically located in the genital or perianal region. There may be some regional lymphadenopathy.
• Secondary syphilis manifests 1–2 months post-chancre with a rash, malaise, lymphadenopathy, and fever.
Tertiary syphilis manifests years post-exposure with gummas in the skin, mucosa, bone, joints, lungs, and testes.
Gummas are inflammatory lesions resulting from a granulomatous response to the pathogen.
Quaternary syphilis induces ascending aortic aneurysms, cranial nerve palsies, dementia, and tabes dorsalis.
Diagnosis • In primary syphilis, the organisms can be observed through microscopy of the chancre fluid. At this time, serology is frequently negative. In secondary syphilis, the pathogens may be observed in the lesions, and serological tests are typically positive. Organisms are typically absent in the later stages of syphilis, but serological tests generally stay positive.
Prognosis: Antibiotic therapy in the primary or secondary stages is typically curative and mitigates the risk of long-term problems associated with advanced disease.
Pathogen
• Treponema pallidum, a helical spirochete.
Epidemiology
• Global prevalence.
• Rising incidence since the 1990s.
Transmission occurs predominantly by sexual contact with an infected individual.
• Can be transmitted from mother to infant, resulting in congenital syphilis.
Pathogenesis
Organisms infiltrate the body through tiny epithelial abrasions.
• The organism generates a non-antigenic mucin coat that promotes rapid dissemination throughout the body via the bloodstream and lymphatic system.
Presentation
• Primary syphilis results in a firm, painless skin ulcer ('chancre') that manifests approximately three weeks post-exposure. The chancre manifests at the site of touch and is typically located in the genital or perianal region. There may be some regional lymphadenopathy.
• Secondary syphilis manifests 1–2 months post-chancre with a rash, malaise, lymphadenopathy, and fever.
Tertiary syphilis manifests years post-exposure with gummas in the skin, mucosa, bone, joints, lungs, and testes.
Gummas are inflammatory lesions resulting from a granulomatous response to the pathogen.
Quaternary syphilis induces ascending aortic aneurysms, cranial nerve palsies, dementia, and tabes dorsalis.
Diagnosis • In primary syphilis, the organisms can be observed through microscopy of the chancre fluid. At this time, serology is frequently negative. In secondary syphilis, the pathogens may be observed in the lesions, and serological tests are typically positive. Organisms are typically absent in the later stages of syphilis, but serological tests generally stay positive.
Prognosis: Antibiotic therapy in the primary or secondary stages is typically curative and mitigates the risk of long-term problems associated with advanced disease.
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