Is an acute infectious bacterial disease, if not treated become chronic and causes disability. Causative agent (Treponema pallidum: weak organism – spirochaetal, spiral filament with coils), Reservoir (Cases & no. carrier), Exit (Exudates of skin & mucous membranes, Blood and Body fluids), Incubation Period (3 weeks).

Treponema pallidum

Mode of transmission: Sexual contact including kissing, From wet nurse to suckling baby and vice versa, Trans placental from mother to baby, Exposure to infected blood including professional infection and through Contaminated articles & fomites (Rare).

Clinical picture: Primary syphilis (Chancre: Button like painless induration on genitals, lips, etc. that will ulcerate. The chancre will spontaneously disappear in 4 – 6 weeks.  The exudate of the chancre   is highly infectious), Secondary syphilis (Generalized skin rash, Mucous patches on mouth and genitals as well as Eye involvement. The symptoms disappear after weeks or months. The exudate of the mucous patches is highly infectious) and Tertiary syphilis (Occur after latent period of years. Gummata involving different parts of the body as well as Cardiovascular & Neuro syphilis).

Chancre on surface of tongue


Secondary stage syphilis sores


Secondary stage syphilis rash

Diagnosis: Demonstration of treponema pallidum in exudates of chancre or mucous patches by dark field microscopy or immuno fluorescence. Serologic testing is helpful. Serologic tests include: Non – specific tests (Using non – treponemal antigen:  Wasserman or Kahn test, become +ve one week after appearance of chancre, Persist through secondary & late stages) and Specific tests (Using treponemal antigen).

Serologic tests can be used for case finding: Individual case finding as for the other marital partner, Mass case finding and Survey studies.

Mass case finding: On health appraisal of particular groups: Premarital examination, Antenatal care, Blood donors, Wet nurses & other child care providers, Army recruits.

Why syphilis constitute a public health problem? Is a social disease (Its prevalence is intimately related to social conditions), Affects outcome of pregnancy (Lethal: abortion, stillbirth & neonatal deaths, Sub lethal: congenital deformities & disease), Is associated with Cardiovascular & Neurological manifestations.

Clinical manifestations of congenital syphilis: Skin rash, Condylomata, Mucous patches, Generalized lymphadenopathy, Marasmus, Syphilitic epiphysitis, Syphilitic cirrhosis. All these manifestations are considered early manifestation. The late manifestation include: Hutchinson’s teeth (short & wide permanent central incisors), Deafness due to 8th nerve affection, Eye keratitis, retinitis & blindness, Palate perforation  due to gumma in palate, Bone deformity as sword tibia and Saddle nose due to gumma of the nose.

Congenital syphilis with face rash

Prevention: General measures (Same as for gonorrhea in addition to measures to prevent congenital infection (Using the serological test on the occasions of premarital & prenatal care to diagnose and treat cases) and Specific protection (By penicillin chemoprophylaxis (inject 2 – 4 million units IM) after exposure to a case).

Control: Case control (Case finding by clinical picture & serologic testing. Screening of pregnant women for congenital infection by amniocentesis & cord blood sampling. Notification of cases. Treatment by penicillin in big dose.  Re-examination to confirm cure), Contacts control (Examination of the marital partner of diagnosed cases for case finding) and Community control (Epidemiological studies to trace the source and channels of infection, Mass chemoprophylaxis for high risk groups as well as Mass education campaigns).

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