Syphilis

Write short notes on the types and stages of syphilis.
Answer:

Syphilis is a sexually transmitted disease caused by Treponema pallidum.

Types of Syphilis

Stages of Syphilis

Acquired syphilis is divided into three stages, i.e.:

Syphilis

Primary Syphilis

Lesion of primary syphilis is chancre.
Chancre appears on genital or at extragenital sites in 2 to 4 weeks after exposure to bacteria.
Initially, lesion is a painless papule that ulcerates in the center and there is the development of a chancre which is indurated lesion.
Regional lymphadenitis is present.
Chancre heals without scarring.

Syphilis Pathological Features

The chancre histologically presents the following features:
Proliferative granulation tissue is present at the margin of the ulcer.
Dense infiltrates of plasma cells, lymphocytes, and macrophages.
Obliterative endarteritis with perivascular infiltration of chronic inflammatory cells.
T. pallidum may be seen when immunofluorescence studies or silver staining are done.

Secondary Syphilis

When primary syphilis is not treated patient undergoes mucocutaneous lesions and painless lymphadenopathy in 2 to 3 months.
Mucocutaneous lesions are mucous patches on the mouth, pharynx, and vagina.
This stage is highly infective and spirochetes are easily demonstrated in lesions.

Syphilis Pathological Features

The macular lesion shows inflammatory cell infiltration and obliterative endarteritis.
The papular lesion exhibits endothelial proliferation, swelling, and perivascular chronic inflammatory cell infiltration.
Condyloma lata reveals hyperplastic epithelium with hyperkeratosis and acanthosis.
Obliterative endarteritis may also be seen and there may be occasional presence of epithelioid cells.

Primary vs secondary syphilis

Syphilis Tertiary Syphilis

After the latent period of appearance of secondary lesions and after 2–3 years of initial exposure tertiary lesions appear.
Lesions of this stage are of two types:
- Syphilitic gumma: It is a solitary, localized, rubbery lesion with central necrosis seen in organs like the liver, testis, bone, and brain.
- Diffuse lesions: Seen in nervous and cardiovascular systems. Cardiovascular syphilis involves the thoracic aorta. The wall of the aorta is weakened and dilated due to syphilitic aortitis which leads to an aortic aneurysm. Neurosyphilis manifests as meningioma vascular syphilis affecting the meninges; tabes dorsalis affecting the spinal cord; general paresis affecting the brain.

Syphilis Pathological Features

The gumma microscopically presents a peripheral rim made up of fibroblasts, which surrounds a central zone of coagulative necrosis.
Fibroblasts are plump and they often resemble epitheliod cells.
The occasional presence of giant cells and the regular presence of chronic inflammatory cells like plasma cells, lymphocytes, histiocytes, etc.

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