Transcript Barber-Say Syndrome

SEXUALLY TRANSMITED DISEASES
SYPHILIS ( LUES )
Dr D. Tenea
Department of Dermatology
University of Pretoria
INTRODUCTION
History
• Venereal disease = old term
• STD – infections transmitted by sexual contact
• Sexually transmissible infections – caused by pathogens
for which non-sexual routes of transmission predominate
SEXUALLY TRANSMITTED AND
HistoryPATHOGENS
TRANSMISSIBLE
• Bacteria : Neisseria gonorrhoea– Gonorrhoea
Treponema Pallidum– Syphilis
Haemophilus Ducreyi– Chancroid
Chlamidia Trachomatis– LGV
Mycoplasma Hominis / Ureaplasma urealyticum
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Viruses : HIV , HSV , CMV , HPV , MC , HTLV-1, -2, HAV, HBV, HCV
Protozoa : Trichomonas vaginalis , Giardia Lamblia , E. Histolytica
Fungi : Candida Albicans
Ectoparasites : Phthirus pubis , Sarcoptes scabies
SYPHILIS
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Lues
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History
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Sexually acquired chronic, systemic infection / congenital infection
Progresses through active and latent stages
Caused by genus Treponema pallidum – order Spirochaetales
Leading cause of genital ulcer
Worldwide distribution
Higher incidence : men ( Blacks, Hispanics ) homosexuals, prostitutes
Laboratory
Dx.
of
Syphilis
History
• Direct detection of Treponemes by darkfield microscopy
• Serologic tests for Ab. response ( treponemal tests : TPHA and nontreponemal tests : VDRL , RPR )
• T. pallidum cannot be routinely cultured in vitro
• PCR—molecular biological detection of treponemal DNA – not as a
routine test ( used in dx. of Neurosyphilis )
• Histology : H&E + special stains ( Warthin-Starry stain for identification
of Spirochetes in the tissues )
NATURAL HISTORY OF UNTREATED
History
SYPHILIS
• Inoculation + penetration – mucosa and abraded skin
• Incubation : 14 – 21 days
• Primary Syphilis : painless chancre + regional lymphadenopathy
VDRL / RPR / TPHA +ve in 80% cases
• Haematogeneous and lymphatic dissemination 3-8 wks. later
• Secondary Syphilis :
- constitutional symptoms ( systemic manifestations )
- generalised lymphadenopathy
- mucocutaneous manifestations
- positive syphilis serology ( 100% )
- lesions disappear spontaneously ( 25% relapse in the first year )
NATURALHistory
HISTORY – Ctd.
• Latent Syphilis : Early latent stage ( < 1 year )
Late latent stage ( > 2 years ) – may last 2-20 years
Absence of any clinical signs and positive serology
1/3 patients – clinical symptoms of tertiary syphilis
• Tertiary Syphilis :
- superficial nodular syphilides ( confined to the skin )
- gummatous syphilides of the skin , bones , liver
- cardiovascular syphilis
- neurosyphilis
- syphilitic hepatic cirrhosis
- reactive blood + presence of anti-treponema Ab. in CSF
CONGENITAL
SYPHILIS
History
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Mother-to-child transmission risk :
- Infection of the mother from contraception to 7th. month of pregnancy
transmission 100% - abortion, stillbirth, IUD, severe Cong. Syphilis
- Infection 2 years before pregnancy or earlier : 50% risk
- Infection after 7th month of pregnancy : reduced risk of transmission
- Infection 3-6 weeks before labor : no placental transmission ; risk of
perinatal transmission
EARLY CONGENITAL
SYPHILIS
History
• Symptoms apparent during perinatal period –first 3months after birth
• Symptoms similar to acquired secondary Syphilis :
- annular skin lesions / bullous disease with erosions
- periorificial fissures ( perioral + perianal )
- snuffles ( bloody or purulent mucinous nasal discharge )
- lymphadenopathy
- osteochondritis – painful (Parrot pseudoparalysis )
• Skin manifestations are accompanied by constitutional symptoms
( fever, malaise, myalgia, arthralgia ) ; underweight , senile features
LATE CONGENITAL
SYPHILIS
History
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Child / adolescent
Corresponds to tertiary Syphilis in the adult
Is not infectious
Stigmata :
- keratitis
- Hutchinson`s teeth
- neural deafness
- Hutchinson`s triad
SYPHILIS
AND
HIV
History
• Syphilis / any other genital ulcers add to an increased risk
for acquisition of HIV
• Syphilis manifestations are altered in HIV+ve patients
• Neurological manifestations are observed more often
( neurosyphilis is common in HIV )
• Higher incidence of ulcerative lesions of secondary Syphilis
in HIV + ve patients
Treatment recommendations for
History
Syphilis
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Penicillin G is still the treatment of choice for all stages of Syphilis
No tendency toward Penicillin resistance found in T. Pallidum
Tetracyclines are used as a 2nd line therapy ( allergy / intolerance)
Follow-up examinations ( VDRL, TPHA ) – every 3-6 months for 2 years
for Early Syphilis and 3 years for Late Syphilis
• Evaluation of sexual partners + reporting are mandatory in many countries
• Primary , Secondary , Early latent Syphilis – a single dose 2.4 MU
Benzanthine Penicillin
• Latent Syphilis > 1 year duration + Late Syphilis : 3 weekly IM. Inj. of
2.4 MU Penicillin
TREATMENT
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Ctd.
History
• Neurosyphilis ( persistent high titres of VDRL /TPHA ) – 24 million units
IV. Pen. G in 6 divided doses for 14 days
• Pregnancy : Benzanthine Penicillin 2.4 MU given IM. Weekly X 3
Procaine Penicillin 50 000 units IM daily for 14-21 days
• Congenital : Benzanthine Penicillin 2.4 MU given IM. Weekly X 3 or
Procaine Penicillin 50 000 u / kg IM daily for 14 days
• HIV infection : Benzanthine Penicillin 2.4 MU given IM weekly X 3 or
Pen. G 2.4 MU adm. IV every 4 h. ( 12-14 mil. Dly for 14/7)
• Alternative regimens for Penicillin allergies : Doxycycline 200mg/d -14/7
Tetracycline 500mg 6hr. -14/7
Erythromycin 2g/dly – 14/7