Syphilis Clinical Aspects of Late Syphilis. Part 4

Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health Why a lecture on syphilis? Although syphilis is an eminently treatable disease, its continuing occurrence illustrates that our control efforts still need to be improved. The disease remains elusive clinically even today, and unless thought of and sought for can silently cause disease as it has for centuries. Further, control of syphilis is vital because of its interactions with HIV. This lecture will focus on clinical manifestations of late syphilis. Objectives • To review the clinical manifestations of late syphilis Clinical Stages • Syphilis is conventionally divided into several stages: – Primary – Secondary – Latent – Late, or tertiary • This lecture will focus on late syphilis – cardiovascular, neurosyphilis, and gummas Natural History of Untreated Syphilis Syphlitic Aortic Aneurysm Aortic Aneurysm Syphilitic Aortitis Tree-barking Ruptured Aortic Aneurysm Tree-barking Clot Stenosis of Coronary Arteries Neurosyphilis • Asymptomatic – no clinical manifestations – defined by presence of CNS abnormalities including: • WBC > 5/mm3, mostly lymphocytes • elevated protein • reactive CSF-VDRL (variable) – may progress to overt neurosyphilis Neurosyphilis • Meningeal neurosyphilis – includes acute syphilitic meningitis – headache, fever, CSF abnormalities • Meningovascular neurosyphilis – “syphilitic stroke” – hemiparesis, hemiplegia, aphasia, seizure • Parenchymatous neurosyphilis – general paresis – tabes dorsalis Parenchymatous neurosyphilis • General paresis (dementia paralytica) – T. pallidum directly invades cerebrum • memory loss, personality changes, headache, delusions, seizure – neurologic findings include: • Argyll Robertson pupils • slurred speech • expressionless face • tremors Parenchymatous neurosyphilis • Tabes dorsalis – occurs after long latent period (20-25 yrs.) • early features: lightning pains, paresthesias, diminished DTRs, poor pupillary responses • late features: ataxia, bladder and rectal disturbances, Charcot joints, “visceral crises” – cranial nerve involvement often overlooked – “tabetic facies” due to ptosis and flabbiness of facial muscles Charcot Joint Gumma of Face Gummas of the Nose Gumma - Nose Gummas - Scalp Gmmas of Arm Gummas - Arm Ulcerating Gumma Conclusions • Late complications of syphilis occurred in about 1/3 of patients in the preantibiotic era • Prompt penicillin therapy of early disease not only prevents infection in others, but also prevents late complications • Neurosyphilis may present and progress rapidly in patients coinfected with HIV Sources of Information The following sites are useful if more information on syphilis is sought: www.cdc.gov Centers for Disease Control www.who.int World Health Organization www.ashastd.org American Social Hygiene Assoc www.vnh.org Virtual Naval Hospital