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- sexually active teenagers
- people infected with another sexually transmitted disease (STD), including AIDS
- sexually abused children
- women of childbearing age
- prostitutes of either sex and their customers
- persons who abuse drugs or alcohol
Causes and symptoms
- Asymptomatic. In this form of neurosyphilis, the patient's spinal fluid gives abnormal test results but there are no symptoms affecting the central nervous system.
- Meningovascular. This type of neurosyphilis is marked by changes in the blood vessels of the brain or inflammation of the meninges (the tissue layers covering the brain and spinal cord). The patient develops headaches, irritability, and visual problems. If the spinal cord is involved, the patient may experience weakness of the shoulder and upper arm muscles.
- Tabes dorsalis. Tabes dorsalis is a progressive degeneration of the spinal cord and nerve roots. Patients lose their sense of perception of one's body position and orientation in space (proprioception), resulting in difficulties walking and loss of muscle reflexes. They may also have shooting pains in the legs and periodic episodes of pain in the abdomen, throat, bladder, or rectum. Tabes dorsalis is sometimes called locomotor ataxia.
- General paresis. General paresis refers to the effects of neurosyphilis on the cortex of the brain. The patient has a slow but progressive loss of memory, ability to concentrate, and interest in self-care. Personality changes may include irresponsible behavior, depression, delusions of grandeur, or complete psychosis. General paresis is sometimes called dementia paralytica, and is most common in patients over 40.
Patient history and physical diagnosis
- pregnant women
- sexual contacts or partners of patients diagnosed with syphilis
- children born to mothers with syphilis
- patients with HIV infection
- persons applying for marriage licenses
Other laboratory tests
Public health measures
A positive test for syphilis should be repeated. A false positive result can be due to other diseases such as malaria, leprosy, and advanced pulmonary tuberculosis, and therefore should not be ignored. A false negative serological test can occur when the infection is too recent to have triggered the production of antibodies. A negative result can also occur if the disease is late symptomatic syphilis or if the patient's immune system is not functioning normally. If treatment of syphilis had been started before the test, the patient's blood could be temporarily nonreactive. Since alcohol interferes with and decreases the intensity of a reaction, it should be considered as a possible cause of a negative result. Once treatment has been started, patients with early syphilis should have repeated testing every three months for one full year.
Even if no treatment is given, the chancre will disappear in 10 to 40 days, often leading to the false conclusion that the disease is cured. Occasionally a chancre fails to develop or is too small to be noticed. Primary syphilis can be cured with antibiotics in adequate doses. (See Atlas 2, Part P.)
Like primary syphilis, the secondary stage disappears by itself, generally within 3 to 12 weeks, but may return later if the organisms are still present. As in the primary stage, the disease can be cured in the secondary stage by the use of penicillin or other antibiotics. Together, the primary and secondary stages are known as early syphilis.
Late syphilis is less contagious to others but is extremely dangerous to the person who has it. It may be fatal, particularly if the central nervous system or heart is affected. The spirochete can invade any cell of the body and can damage any organ or structure of the body, including the internal organs, bones, joints, and skin. The characteristic lesion of tertiary syphilis is a soft gummy tumor called a gumma.
If late syphilis attacks the heart, aorta, or aortic valve, death may result from rupture of the weakened aorta or from heart failure. When it attacks the central nervous system, general paresis, a severe disease of the brain, may result; if not treated promptly, it will cause insanity and death. Another serious disorder of the nervous system caused by late syphilis is tabes dorsalis, in which there is pain and loss of position sense. Blindness may result if the infection involves the eyes. Other possible effects are deep ulcers on the legs or elsewhere, chronic inflammation of the bones, which is especially painful at night, and perforation of the soft palate.
Cure of late or tertiary syphilis takes longer and is more difficult than that of primary or secondary syphilis. Sometimes the disease cannot be completely cured. As with early syphilis, however, it may be successfully treated with penicillin and other antibiotics.
To prevent congenital syphilis all pregnant women should have a blood test for syphilis during the early months of pregnancy. Treatment before the fifth month will always prevent infection of the unborn child. A syphilitic mother who is not treated early has only one chance in six of having a healthy child. If a child is born with syphilis, immediate treatment may be effective if the disease has not progressed too far.
syph·i·lis(sif'i-lis), Do not confuse this word with erysipelas.
syphilis/syph·i·lis/ (sif´ĭ-lis) a venereal disease caused by Treponema pallidum, leading to many structural and cutaneous lesions, transmitted by direct sexual contact or in utero. See primary s., secondary s., and tertiary s. syphilit´ic
syphilisSTD A multisystem STD caused by a spirochete, Treponema pallidum, when it penetrates broken or abraded mucotaneous tissue through sexual contact; ≥ 100,000 new cases/yr, US; it is the third most commonly reported infectious disease–gonorrhea is the first; it is common in urban areas, especially in the US South and affects young adults Clinical Primary stage or chancre stage causes a nasty looking, but painless rounded ulcer, which may heal spontaneously. See Benign late syphilis, Congenital syphilis, Latent syphilis, Neurosyphilis, Primary syphilis, Secondary syphilis, Tertiary syphilis.
syphilis(sif'i-lis) [ Syphilis, a shepherd having the disease in a Latin poem]
Syphilis is typically passed from person to person by direct contact with skin or mucous membranes. Spirochetes readily penetrate skin and disseminate from the initial site of inoculation to regional lymph nodes, the bloodstream, and multiple other sites including the central nervous system (CNS). After an incubation period of 10 days to 2 months, a papule appears on the skin that develops into a painless ulcer (chancre) characteristic of the primary stage of infection. Chancres and other syphilitic skin lesions are highly infectious. The genitals are the most common site of primary infection and formation of chancres although chancres may appear on other points of contact, e.g., the lips, mouth, anus, or rectum.
Chancres usually disappear within 3 to 6 weeks even without treatment. Within a few days to several months, the secondary stage appears: a widespread body rash, often with systemic symptoms, e.g., fever, headache, generalized lymph node swelling, nausea, vomiting, weight loss, and malaise. Highly infectious, moist, broad, pink or grayish-white papules may appear in the perineum (condyloma latum), along with shallow ulcers in the mouth (mucous patches). Hair loss, usually temporary, may also occur, and the nails may become brittle and pitted. If the disease is not eradicated with antibiotics, it establishes latent infection that may cause multiple destructive changes in many organ systems years later.
In the latent (formerly called tertiary stage), tissue destruction occurs in the aorta, the CNS, bone, and skin. The consequences include aortic aneurysm, meningitis, sensory and gait disturbances, dementia, and optic atrophy.
Serological Tests for Syphilis
The common laboratory tests for syphilis lack optimal sensitivity or specificity. Screening is usually performed with the nontreponemal rapid plasma reagin test (RPR) or the Venereal Disease Research Laboratory test (VDRL); either test may yield inaccurate results. Both tests become reactive about 1 to 2 weeks after initial infection. If either test result is positive, a confirmatory test is done: (1) by identifying the responsible bacterium, T. pallidum on dark-field examination of material from a genital lesion; (2) with the microhemagglutination assay for antibody to T. pallidum (MHA-TP); or (3) with the fluorescent treponemal antibody absorption test (FHA-ABS). Two-stage testing increases the likelihood of obtaining an accurate diagnosis.
CAUTION!Those diagnosed with syphilis may have other STDs, esp. HIV infection. Public health experts recommend testing everyone with either of these diseases for the other one and for other STDs (gonorrhea, Chlamydia, or trichomoniasis).
Intravenous or long-acting intramuscular preparations of penicillin are typically given to patients with syphilis. The duration of treatment varies depending on the stage of the disease and on whether there are comorbid illnesses, e.g., HIV infection, or complications, e.g., evidence of neurosyphilis. Doxycycline or tetracycline may be substituted in nonpregnant patients who are allergic to penicillin although, because of potential bacterial resistance, patients allergic to penicillin should be considered candidates for desensitization. Pregnant patients are not given tetracycline or doxycycline because they discolor primary teeth in the infant.
The patient is taught about the illness and the importance of locating all sexual contacts, treatment, and the need for follow-up care. The patient should avoid sexual contact with anyone until the full course of therapy has been completed, including previous partners who have not received adequate evaluation and treatment, if indicated, for syphilis. Contact precautions are instituted from the time the disease is suspected until 24 hr after initiation of proper antibiotic therapy and whenever draining lesions are present. Standard precautions apply. The patient is informed about safe sex practices and consistent condom use to prevent infection with syphilis and other STDs. Pregnant patients are screened for syphilis to prevent prenatal transmission. Rape victims are tested at the time of the attack and again 1 to 2 weeks later. All cases of syphilis must be reported to local public health authorities by both health care providers and laboratories.
prenatal syphilisCongenital syphilis.
serological tests for syphilisSee: serological tests for syphilis
syphilisA sexually or congenitally transmitted disease caused by the spirochaete Treponema pallidum . In the adult form the first sign is the chancre-a single, small, painless, hard-edged ulcerated crater with a wet base, teeming with spirochaetes, that appears on the genitalia about 3 weeks after exposure. The local lymph nodes enlarge. The chancre heals and the spirochaetes disperse throughout the body to cause a secondary stage, featuring conspicuous skin rashes, and a tertiary stage, many years later, in which the nervous system and the larger arteries may be affected, with serious consequences. Tertiary syphilis may involve TABES DORSALIS, GENERAL PARALYSIS OF THE INSANE and ANEURYSM of the AORTA. The prevalence of syphilis was declining until the 1980s but rose again in the late 1990s and in some risk groups has increased more than ten-fold. Treatment is by a single depot dose of benzathine penicillin G which maintains bactericidal levels for weeks. Resistance to the macrolide antibiotic azithromycin has been detected. This is associated with an A to G point mutation in the 23S ribosomal RNA genes of T. pallidum . See also CONGENITAL SYPHILIS.
syphilisa human disease of the sexual organs, caused by the spirochaete bacterium Treponema pallidum, that is normally spread by sexual contact. The organism penetrates mucous membranes, giving rise within a few days to primary ulceration of the membranes. This may give way to a secondary stage of low-grade fever and enlargement of the lymph nodes. A final tertiary stage can take place in which serious lesions occur in many organs and blindness is common. The bacterium can be transmitted from an infected mother to her foetus, resulting in congenital syphilis which may be fatal.
syphilissexually transmitted disease caused by infection with Treponema (Spirochaeta) pallidum , presenting over time in three stages: primary, secondary and tertiary syphilis (Table 1)
|Primary syphilis (10–90 days after initial infection)||Skin: papule develops at site of initial infection; undergoes ulceration to form a painless, firm chancre|
Lymphatics: painless regional lymphadenopathy
Duration: lesion heals spontaneously in 2–3 weeks
Comment: cervical and rectal lesions may go unnoticed
|Secondary syphilis (4–10 weeks after appearance of primary lesion)||Constitutional illness: fever, sore throat, malaise and arthralgia; inflammation of many organs, e.g. hepatitis, nephritis, arthritis|
Skin: generalized papular, non-itchy rash involving plantar and palmar skin, but excluding the face; condylomata lata; oral and genital snail track ulcers
Lymphatics: generalized lymphadenopathy
Duration: signs subside in 3–12 weeks, but 20% of cases show recurrent symptoms over 1–2 years
|Tertiary syphilis (3–30 years after secondary stage has passed)||Widely varying signs and symptoms|
Skin: granulomatous and ulcerating lesions (gumma) often developing at sites of trauma
Bone: gumma-like lesions develop in any bone causing local pain and pathological fracture
Viscera: gumma-like lesions of the gastrointestinal tract, especially in the liver, with resultant dysfunction
Cardiovascular: aortitis and aortic aneurysm
Neurosyphilis: aseptic meningitis, tabes dorsalis, general paralysis of the insane; Argyll Robertson pupils
|Congenital syphilis||Early signs show at age 2–6 weeks, and include:|
Skin: chronic catarrhal inflammation of mucous membranes
Failure to thrive
Late signs show at 2+ years and include:
Corneal keratitis (corneal deposits)
Tooth deformity: peg (Hutchinson) incisors, multicusped (mulberry) molars
Collapse of nasal cartilage (saddle nose)
actinic conjunctivitis See actinic keratoconjunctivitis.
acute conjunctivitis Conjunctivitis characterized by an onset of hyperaemia (most intense near the fornices), purulent or mucopurulent discharge and symptoms of irritation, grittiness and sticking together of the eyelids on waking. In severe cases there will be chemosis, eyelid oedema, subconjunctival haemorrhages and photophobia. The bacterial type is caused by Staphylococcus epidermidis, Staph. aureus, Haemophilus influenzae (H. aegyptius, Koch-Weeks bacillus), Streptococcus pneumoniae (pneumococcus). A rare form of acute conjunctivitis is caused by the Neisseria species (gonococcus, meningococcus, e.g. gonococcal conjunctivitis), which produce a more severe form of the disease referred to as hyperacute bacterial conjunctivitis or acute purulent conjunctivitis. These require immediate treatment with systemic and topical antibiotics. Acute conjunctivitis is also caused by viruses (viral conjunctivitis), such as herpes simplex or adenoviruses. All forms of acute conjunctivitis occasionally spread to the cornea. Bacterial conjunctivitis often resolves without treatment within two weeks. Management consists of topical antibiotic therapy (e.g. chloramphenicol, erythromycin) and cold compresses to relieve symptoms. Acute allergic conjunctivitis most typically resolves spontaneously, otherwise treatment includes sodium cromoglicate. Acute viral conjunctivitis caused by herpes simplex is treated with antiviral agents (e.g. acyclovir), although viral conjunctivitis caused by other viruses does not respond well to any drug therapy. Supportive treatment such as cold compresses relieves symptoms.
acute haemorrhagic conjunctivitis A highly contagious viral infection of the anterior segment resulting in haemorrhage of the bulbar conjunctiva. The infection is caused by a picornavirus, often associated with pre-auricular adenopathy and a follicular conjunctivitis. The infection is self-limited and lasts 7-10 days. No specific treatment is presently available.
adult inclusion conjunctivitis An acute conjunctivitis caused by the serotypes D to K of Chlamydia trachomatis and typically occurring in sexually active adults in whom the genitourinary tract is infected. Signs in the eye usually appear one week following sexual exposure. It may also occur after using contaminated eye cosmetics or soon after having been in a public swimming pool, or in newborn infants (called neonatal inclusion conjunctivitis or neonatal chlamydial conjunctivitis), which is transmitted from the mother during delivery and appears some 5 to 14 days after birth. The conjunctivitis is mucopurulent with follicles in the fornices, which often spread to the limbal region. The condition is commonly associated with punctate epithelial keratitis, preauricular lymphadenopathy, marginal infiltrates and, in long-standing infection, micropannus in the superior corneal region may also appear. Differentiation from viral follicular conjunctivitis is made through culture, serological and cytological studies. Treatment consists of using both systemic and topical tetracyclines, although in pregnant or lactating women erythromycin is preferable. Syn. trachoma-inclusion conjunctivitis (TRIC). See conjunctival follicle; punctate epithelial keratitis; lymphadenopathy; ophthalmia neonatorum; trachoma.
allergic conjunctivitis Conjunctivitis which is due to a type 1 hypersensitivity reaction to allergens. Common allergens are pollens associated with hay fever, grass (seasonal allergic conjunctivitis) and air pollutants, house dust mites, smoke (perennial allergic conjunctivitis). It is characterized by hyperaemia, itching, burning, swelling, tearing, discharge and small papillae. Conjunctival scrapings contain a large number of eosinophils and serum IgE is elevated. The condition is commonly associated with rhinitis (allergic rhinoconjunctivitis) in which there is also sneezing and nasal discharge. Treatment commonly includes decongestants, oral antihistamines, mast cell stabilizers (e.g. lodoxamine, sodium cromoglicate) and if severe, topical corticosteroid eyedrops. See vernal conjunctivitis; decongestants; hypersensitivity.
angular conjunctivitis Subacute bilateral inflammation of the conjunctiva due to the diplobacillus of Morax-Axenfeld. It involves the conjunctiva in the region of the canthi.
bacterial conjunctivitis See acute conjunctivitis.
catarrhal conjunctivitis Type of conjunctivitis associated with the common cold or catarrhal irritation. It can appear in the acute or chronic form.
contagious conjunctivitis Acute conjunctivitis caused by Koch-Weeks bacillus, adenovirus types 3, 7 or 8 and 19, or a pneumococcus infection. It may be transmitted by respiratory or ocular infections, contaminated towels or equipment (e.g. tonometer heads). It is characterized by acute onset, redness, tearing, discomfort and photophobia. The condition is often self-limiting but keratitis is a common complication. Syn. epidemic conjunctivitis; epidemic keratoconjunctivitis; pink eye (colloquial).
eczematous conjunctivitis See phlyctenular conjunctivitis.
egyptian conjunctivitis See trachoma.
epidemic conjunctivitis See contagious conjunctivitis.
flash conjunctivitis Conjunctivitis due to exposure to an electric arc, as from a welder's torch.
follicular conjunctivitis Conjunctivitis characterized by follicles (usually in one eye only) caused by adenoviruses or chemical or toxic irritation and frequently associated with lymph-adenopathy. See adult inclusion conjunctivitis; conjunctival follicle; lymphadenopathy.
fungal conjunctivitis See mycophthalmia.
giant papillary conjunctivitis (GPC) Conjunctivitis, characterized by the appearance of 'cobblestones' (large papillae of 0.5 mm or more) on the tarsal conjunctiva of the upper eyelid (and sometimes the lower eyelid). Symptoms include itching, discomfort, mucous discharge and poor vision due to the presence of mucus. The condition may be induced by contact lens wear, ocular prosthesis, or exposed sutures following surgery. This conjunctivitis closely resembles vernal conjunctivitis and is also believed to be an allergic condition. In its early stages as a contact lens-induced condition, it is often referred to as contact lens papillary conjunctivitis or contact lens associated papillary conjunctivitis (CLPC, CLAPC). In these cases the regular use of surfactant and protein removal tablets as well as frequent lens replacement reduce the incidence of this condition, which is less prevalent with the wear of rigid gas permeable than soft contact lenses. Management may also include mast cell stabilizers (e.g. sodium cromoglicate) or antihistamine (e.g. levocabastine) and cessation of lens wear. See vernal conjunctivitis; contact lens deposits; enzyme; surfactant.
gonococcal conjunctivitis See acute conjunctivitis.
granular conjunctivitis See trachoma.
lacrimal conjunctivitis Chronic conjunctivitis caused by an infection of the lacrimal passages. See lacrimal apparatus.
ligneous conjunctivitis A rare, chronic conjunctivitis characterized by the formation of a firm, whitish membrane or pseudomembrane on the tarsal conjunctiva, usually of the upper eyelid. It is typically bilateral, begins in childhood although it may present in patients up to age 85, is more common in females than in males and may persist for months or years. Its cause is unknown but the predisposing factors include bacterial and viral infections, trauma, hypersensitivity reactions and increased vascular permeability, and it is often associated with inflammations of other mucous membranes. The most effective treatment is surgical excision followed by topical cyclosporine drops, but the condition has a tendency to recur. See pseudomembranous conjunctivitis.
membranous conjunctivitis See pseudomembranous conjunctivitis.
neonatal conjunctivitis See ophthalmia neonatorum.
phlyctenular conjunctivitis See phlyctenular keratoconjunctivitis.
pseudomembranous conjunctivitis A non-specific inflammatory reaction characterized by the formation on the conjunctiva of a coagulated fibrinous plaque consisting of inflammatory cells and an exudate containing mucus and proteins. This plaque forms either a membrane or a pseudomembrane. The latter is loosely adherent to the conjunctival epithelium and can be peeled off without bleeding or damage to the underlying epithelium. A true membrane, on the other hand, usually occurs with intense inflammation (membranous conjunctivitis). In this case the conjunctival epithelium becomes necrotic and adheres firmly to the overlying membrane which when peeled leaves a raw, bleeding surface. The cause of either condition may be an infection, of which the common sources are herpes simplex virus, adenovirus, beta-haemolytic Streptococcus, Neisseria gonorrhoeae or as a result of the Stevens-Johnson syndrome, ligneous conjunctivitis, ocular cicatricial pemphigoid, atopic keratoconjunctivitis, chemical burns (especially alkali burns), radiation injury or post-surgical complications.
sun lamp conjunctivitis See actinic keratoconjunctivitis.
swimming pool conjunctivitis See adult inclusion conjunctivitis.
vernal conjunctivitis Chronic, bilateral conjunctivitis which recurs in the spring and summer and is more often seen in boys than girls. Its origin is probably due to an allergy. It is characterized by hard flattened papillae of a bluish-white colour separated by furrows and having the appearance of 'cobblestones' located in the upper palpebral portion of the conjunctiva with mucus deposition between the papillae. A second type of vernal conjunctivitis exists which affects the limbal region of the bulbar conjunctiva, characterized by the formation of small, gelatinous white dots called Trantas' dots or Horner-Trantas' dots. The chief symptom of the disease is intense itching. Treatment consists mainly of cold compresses and limited (because of side effects) use of topical corticosteroids (e.g. dexamethasone, prednisolone). Sodium cromoglicate or lodoxamide have also been found to be very successful in treating this condition and with fewer side effects than corticosteroids. Syn. vernal keratoconjunctivitis (VKC) (although this is not strictly speaking a synonym since the condition often involves the cornea; spring catarrh; vernal catarrh (Fig. C14). See antihistamine; atopic keratoconjunctivitis; mast cell stabilizers.
viral conjunctivitis Conjunctivitis caused by a virus. A variety of viruses can produce the disease. See acute conjunctivitis.
luxation of the lens
fungal uveitis Uveitis caused by a fungus such as Candida albicans, Cryptococcus neoformans and Histoplasma capsulatum. It is often accompanied by other disorders (e.g. choroiditis, retinitis). It may have spread from other bodily tissues (e.g. skin, mouth, gastrointestinal tract) in patients who are intravenous drug addicts, patients with indwelling venous catheters or patients who are immunosuppressed.
intermediate uveitis A chronic inflammation of the ciliary body (cyclitis) or its pars plana zone (pars planitis) or of the peripheral retina and vitreous (peripheral uveitis). The cause is unknown in most cases but others are associated with systemic conditions such as multiple sclerosis, sarcoidosis or HIV infection. It affects mainly young adults and is bilateral in about 80% of cases. Symptoms are floaters and, sometimes, blurred vision, and there may be anterior chamber cells and flare. Ophthalmoscopic examination may show vitreous condensation and gelatinous exudates ('cotton balls' or 'snowballs'). Snowbanking, i.e. a whitish plaque or exudates involving the pars plana, often the inferior part of it, appears mainly in pars planitis. Intermediate uveitis may be associated with retinal vasculitis (i.e. inflammation of a retinal blood vessel). In a few cases the condition is self-limiting within a few months. However, in most cases the condition lasts several years may lead to complications such as cystoid macular oedema, posterior subcapsular cataract, retinal detachment or cyclitic membrane formation. Treatment includes corticosteroids and in resistant cases immunosuppressive agents.
posterior uveitis A uveitis involving the posterior segment of the eye. Symptoms include floaters and visual loss if the choroiditis involves the macular area. Ophthalmoscopically there is an accumulation of debris in the vitreous and choroidal lesions appear as yellow-white areas of infiltrates surrounded by normal fundus. Retinitis is also present in most cases, as well as retinal vasculitis. Posterior uveitis may be associated with AIDS, Behçet's disease, Lyme disease, histoplasmosis, sarcoidosis, toxoplasmosis, syphilis, tuberculosis, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, etc.
viral uveitis Uveitis caused by a virus. Common viruses are: herpes simplex, which is usually associated with keratitis and may cause anterior uveitis; herpes zoster which may also be associated with keratitis; human T-cell lymphotrophic virus; measles; cytomegalovirus; rubella; human immunodeficiency virus (HIV). See herpes simplex blepharoconjunctivitis; herpes zoster ophthalmicus.
syphilis (sif´ilis) (lues),
T. pallidum and usually transmitted by direct contact. Oral lesions include primary chancre, secondary mucous patches and split papule, and tertiary gumma.
chancre, exuding a fluid that swarms with spirochetes. The disease is highly contagious during this stage.
gummas; the valves of the heart may be damaged, and late stages may lead to mental or physical disability and premature death.