Syphilis

It is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum.
Clinically it has four stages primary, secondary, latent, and tertiary.

Typically acquired by direct sexual contact with the infectious lesions of another person.
Chancre approximately appears 2–6 weeks after contact, which is classically single, firm, painless and non-itchy.
It has a clean base and sharp borders approximately 0.3–3.0 cm in size.
The lesion may take on almost any form, classically is a macule to a papule and finally to an erosion or ulcer.
Occasionally, multiple lesions may be present (~40%), with multiple lesions being more common when coinfected with HIV.
Lesions may be painful or tender (30%), and they may occur in places other than the genitals (2–7%).
The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally in men who have sex with men (34%).
Lymphadenopathy frequently (80%) occurs around the area of infection, occurring seven to 10 days after chancre formation.
The lesion may persist for three to six weeks if left untreated.

Typical presentation of secondary syphilis with a rash on the palms of the hands
Reddish papules and nodules over much of the body
It occurs approximately 4-10 weeks after the primary infection.
Secondary syphilis most commonly involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles.
The rash may become maculopapular or pustular. It may form flat, broad, whitish, wart-like lesions on mucous membranes, known as condyloma latum. All of these lesions harbor bacteria and are infectious.
Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache.
Rare manifestations include liver inflammation, kidney disease, Arthritis, Periostitis, Optic neuritis, Uveitis, and Interstitial keratitis.
The acute symptoms usually resolve after three to six weeks; about 25% of people may present with a recurrence of secondary symptoms.
Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having had the classical chancre of primary syphilis.

Latent syphilis is defined as having serologic proof of infection without symptoms of disease. It develops after secondary syphilis and is divided into early latent and late latent stages.
- Early latent syphilis is defined by the World Health Organization as less than 2 years after original infection. Early latent syphilis is infectious as up to 25% of people can develop a recurrent secondary infection (during which spirochetes are actively replicating and are infectious).
- Two years after the original infection the person will enter late latent syphilis and is not as infectious as the early phase. The latent phase of syphilis can last many years after which, without treatment, approximately 15-40% of people can develop tertiary syphilis.

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms:

It is occurred in 15%
It is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere.

It is occurred in 6.5% involving CNS.
Early stages are asymptomatic or in the form of syphilitic meningitis, but late stages are meningovascular syphilis, manifesting as general paresis or tabes dorsalis.
It involves inflammation of the small and medium arteries of CNS, present between 1–10 years after the initial infection and characterized by Stroke, Cranial nerve palsies and Spinal cord inflammation. It includes 2 types
1. General paresis: It presents with dementia, personality changes, delusions, seizures, psychosis and depression.
2. Tabes dorsalis: It is characterized by gait instability, sharp pains in the trunk and limbs, impaired positional sensation of the limbs as well as having a positive Romberg's sign.

Both tabes dorsalis and general paresis may present with Argyll Robertson pupil which are pupils that constrict when the person focuses on near objects (accommodation reflex) but do not constrict when exposed to bright light (pupillary reflex).

It is occurred in 10%
The most common complication is syphilitic aortitis, which may result in aortic aneurysm formation.
People with tertiary syphilis are not infectious.

Common symptoms include

Hepatosplenomegaly (70%)
Rash (70%)
Fever (40%)
Neurosyphilis (20%)
Lung inflammation (20%)
If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higouménakis' sign, saber shin, or Clutton's joints among others. Infection during pregnancy is also associated with miscarriage.
The three main dental defects in congenital syphilis are Hutchinson's incisors (screwdriver-shaped incisors), Moon's molars or bud molars, and Fournier's molars or mulberry molars (molars with abnormal occlusal anatomy resembling a mulberry).

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