UNIVERSITY OF RWANDA

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF CLINICAL MEDICINE AND COMMUNITY HEALTH

MODULE OF INTERNAL MEDICINE

 GROUP 3 MEMBERS
No Names Registration Number

1. HASINGIZWIMANA Eric 222000943

2. UMUTONI Divine 222001004
3. NTAKIRUTIMANA Pierre 222000528
4. IRAKOZE MFURA Yves 222000444
5. AYEBARE Fortunate 222013311
6. BUCYENSENGE RUFINI Paterne 222000527
7. ISHIMWE Emmanuel 222004271
SYPHILIS
 INTRODUCTION

Syphilis is infectious disease caused by gram-negative spiral

shaped bacteria called treponema pallidum. It is a complex
disease with distinct stages, each exhibiting different
symptoms and potential complications. Historically significant,
syphilis has affected many populations and remains a public
health concern worldwide.
Mode of transmission
•Sexual Contact:
Mainly spread through vaginal, anal, or oral sex with an infected partner.
•Direct Contact with Sores:
Transmission occurs through contact with syphilis sores (chancres) on the genitals, anus,
or mouth.
•Congenital Syphilis:
An infected pregnant woman can pass syphilis to her baby during pregnancy or childbirth.
•Blood Transfusion:
Rarely transmitted through contaminated blood transfusions, though screening has
minimized this risk.
•Shared Needles:
Syphilis can potentially spread through shared needles among intravenous drug users.
•Skin-to-Skin Contact:
Transmission can occur through skin contact with infected areas, even if no visible sores
are present.
 Pathogenesis of Syphilis
Entry: Treponema pallidum enters the body through skin and mucous
membranes via abrasions during sexual contact and spreads
systemically through the blood and lymphatic systems.
Systemic Spread: Once in the bloodstream, the bacteria induce
inflammation of the endothelial cells lining blood vessels, a condition
known as endarteritis.
Endarteritis: This inflammation affects the blood vessels supplying
the nerves, resulting in reduced blood flow and oxygen to the nerves,
which can lead to nerve damage. This is why many lesions in syphilis
are typically painless.
Complications of syphilis
•Chancre: Painful or painless •Psychiatric Symptoms: Behavioral
sores at the infection site. changes and mood disorders.
•Aortitis: Inflammation of the aorta
•Skin Rashes: Widespread
leading to aneurysms.
rashes on the body. •Coronary Artery Disease: Increased
•Mucous Membrane Lesions: risk of heart disease.
Condylomata lata (wart-like •Gummas: Soft, tumor-like lesions in
growths) in moist areas. various tissues.
•Neurosyphilis: •Ocular Syphilis: Inflammation leading
to vision problems or blindness.
•Meningitis •Congenital Syphilis: Serious health
•Cognitive impairment issues in infants from maternal
•Coordination issues transmission.
Stages of syphilis
Syphilis is a sexually transmitted infection caused by the bacterium Treponema
pallidum. The disease progresses through distinct stages, each characterized by
specific symptoms and potential complications. Understanding these stages is crucial
for early diagnosis and effective treatment.

1.Primary Infection
2.Secondary Infection
3.Latent Infection
•a. Early Latent: Less than 1 year
•b. Late Latent: More than 1 year
4.Tertiary Infection
1. The primary syphilis
Overview:
Primary syphilis is the first stage of infection, typically appearing 2-3
weeks after exposure to Treponema pallidum.
Symptoms:
• Chancre:
• Painless, firm, round ulcer at the site of infection (genitals,
anus, mouth).
• Heals spontaneously within 3-6 weeks.
• Regional Lymphadenopathy:
• Swollen, painless lymph nodes near the chancre.
 Primary Syphilis
Penile Chancre Penile Chancre
 Primary Syphilis
Labial Chancre Perianal Chancre
2. Secondary syphilis
Overview:
Secondary syphilis occurs weeks to months after the initial infection and is
characterized by systemic symptoms as Treponema pallidum spreads
throughout the body. It is highly contagious during this stage.
Symptoms:
• Rash: Non-itchy, reddish-brown, affecting palms and soles.
• Condylomata Lata: Wart-like, moist lesions in genital/anal area.
• Mucous Patches: Painless gray-white patches on mucous membranes.
• Flu-like Symptoms: Fever, sore throat, muscle aches, weight loss.
• Lymphadenopathy: Generalized swelling of lymph nodes.
 Secondary Syphilis
Plantar Rash Palmar

13
 Secondary Syphilis
Generalized Body Rash Generalized Body Rash
 3.latent Syphilis
Overview:
Latent syphilis is a stage where the infection is asymptomatic but still
present in the body. It can be detected through serologic tests and is
divided into two phases: early and late latent.
Types:
• Early Latent Syphilis:
• Occurs within the first year after infection.
• May still be infectious, particularly during relapses.
• Late Latent Syphilis:
• More than 1 year after infection.
Typically non-infectious, but can progress to tertiary syphilis.
Symptoms: No visible signs or symptoms.
4.Tertiary syphilis
Tertiary syphilis is the late stage of syphilis that can occur years after the
initial infection if left untreated. It can lead to severe complications affecting
multiple organ systems. The disease is characterized by the formation of
gummas (soft tissue growths), cardiovascular issues, and neurological
problems. Tertiary syphilis can significantly impact the quality of life and may
be life-threatening.

Types of Tertiary Syphilis

• Gummatous Syphilis
• Cardiovascular Syphilis
• Neurosyphilis
• Ocular Syphilis
Gummas
Overview:
Gummas are soft, non-cancerous, tumor-like growths that develop
during the tertiary stage of syphilis, typically years after the initial
infection. They can affect various organs and tissues.
Signs and Symptoms:
• Appearance:
• Firm, rubbery lesions that may ulcerate.
• Found on skin, bones, liver, or other organs.
• Skin: Painless, nodular lesions that can ulcerate.
• Bones: Deep, localized pain (often nocturnal).
• Organs: Can cause organ dysfunction (e.g., liver gummas lead to hepatic
dysfunction).
Cardiovascular syphilis
Overview:
Cardiovascular syphilis typically occurs in the tertiary stage of syphilis,
developing 10-30 years after initial infection. It primarily affects the aorta
and can lead to life-threatening complications if untreated.
Symptoms: Chest pain, shortness of breath, fatigue, palpitations.
Diagnosis:
• Serologic Testing: Syphilis blood tests.
• Imaging: Chest X-ray, echocardiography, CT/MRI to assess heart and vessel
damage.
Treatment:
• Benzathine Penicillin G: Weekly injections for 3 weeks.
• Surgery: For aneurysms or valve dysfunction.
Neuro syphilis
Overview:
Neurosyphilis occurs when Treponema pallidum infects the central
nervous system. It can develop at any stage of syphilis and leads to
various neurological complications if left untreated.
Diagnosis:
• CSF Analysis: Elevated white cells and protein, positive syphilis tests.
• Serologic Testing: Non-treponemal and treponemal tests.
• Neurological Exam: Assess symptoms and rule out other causes.
Treatment:
• Aqueous Crystalline Penicillin G: 18–24 million units IV daily for 10–14 days.
• Follow-Up: Regular CSF analysis every 6 months until normalization.
 Ocular syphilis
Overview:
Ocular syphilis can occur at any stage of syphilis and may
lead to permanent vision loss if untreated.
Symptoms:
• Uveitis: Most common; inflammation of the uvea.
• Optic Neuritis: Vision disturbances due to optic nerve
inflammation.
• Retinitis: Blurred or distorted vision from retinal
inflammation.
• Scleritis: Painful inflammation of the sclera.
• Photophobia: Light sensitivity.
• Conjunctivitis: Eye redness and irritation
5.Congenital syphilis
Overview:
Congenital syphilis occurs when Treponema pallidum is transmitted
from an infected mother to her baby during pregnancy or birth. It can
cause severe complications or even death if untreated.
Early Congenital Syphilis (0-2 years):
Symptoms:
• Skin Rash: Peeling, especially on palms and soles.
• Snuffles: Nasal discharge with treponemes.
• Hepatosplenomegaly: Enlarged liver and spleen.
• Jaundice.
• Bone Deformities: "Saber shins," "saddle nose."
Late Congenital Syphilis >2 years
Symptoms:
• Hutchinson’s Triad:
• Hutchinson Teeth: Notched, peg-
shaped incisors.
• Deafness: Sensorineural hearing
loss.
• Interstitial Keratitis: Inflammation of
the cornea leading to vision loss.
• Bone Deformities: Thickened
bones, joint issues.
• Neurosyphilis: Cognitive
impairments, seizures.

Hutchinson Teeth
Lab investigations
Serologic Tests
•Non-Treponemal:
•RPR and VDRL: Screening and monitoring.
•Treponemal (Confirmatory):
•FTA-ABS and TPPA: Detect specific antibodies.
CSF Analysis (for neurosyphilis)
•VDRL-CSF: Detects syphilis in cerebrospinal fluid.
•Elevated white cells and protein levels.
Dark field Microscopy
•Direct detection of T. pallidum from lesions.
PCR
•Detects treponemal DNA in tissue or CSF.
Patient Management and Treatment
Diagnosis: Treatment:
•Primary, Secondary, or Early Latent
•Clinical Examination: Look for Syphilis:
 Benzathine Penicillin G (2.4 million units
symptoms like chancre or rashes. IM once).
•Serologic Testing: •Late Latent or Tertiary Syphilis:
•Non-treponemal tests (RPR,  Benzathine Penicillin G (2.4 million units
VDRL): For initial screening. IM weekly for 3 weeks).
•Treponemal tests (FTA-ABS, •Neurosyphilis:
 Aqueous Crystalline Penicillin G (18–24
TPPA): For confirmation. million units IV daily for 10–14 days).
•CSF Analysis: If neurosyphilis is •Penicillin Allergy:
suspected.  Use Doxycycline (100 mg twice daily for
14 days) or desensitization.
Patient management
Follow-Up:
•Serologic Testing: Repeat at 6, 12, and 24 months to monitor
progress.
•Neurological Symptoms: Monitor for complications.
•Sexual Partners: Screen and treat all sexual contacts.
Patient Education:
•Prevention: Safe sex practices, condom use, and regular screening.
•Reinfection: Patients can be reinfected; emphasize ongoing
prevention.
Congenital Syphilis Management:
•Screen and treat pregnant women early to prevent transmission.
•Evaluate and treat infants born to infected mothers.
Differential Diagnosis of syphilis
• A differential diagnosis is the process doctors 1. Primary Syphilis:
use to distinguish a particular disease or
condition from others that have similar • Genital sores like in herpes or
symptoms. It involves identifying all possible chancroid.
causes of a patient's symptoms and then
narrowing them down through medical 2. Secondary Syphilis:
history, physical exams, and tests. • Skin rashes similar to pityriasis
• In the case of syphilis, its symptoms can look rosea, psoriasis, or viral infections
like those of many other diseases, so doctors
must consider a range of possibilities before like measles.
confirming the diagnosis. By comparing the 3. Tertiary Syphilis:
symptoms of syphilis to those of other
conditions, they aim to rule out similar • Late-stage symptoms resemble
diseases and find the correct cause of the tuberculosis, leprosy, or
patient's symptoms. autoimmune diseases like lupus.
Global statistics and facts
Global Statistics and Facts about Syphilis • Congenital Syphilis:
• Prevalence: • Globally, there are an estimated 1.4 million cases of
congenital syphilis annually, leading to severe health issues
• An estimated 7.9 million new cases of syphilis occur for newborns.
worldwide each year.
• The global prevalence of syphilis among the general • Screening and Treatment:
population is approximately 0.5%. • Screening rates for syphilis vary significantly by region,
with many areas lacking adequate testing resources.
• Regions Affected: • Early diagnosis and treatment with penicillin are highly
• The highest rates of syphilis are found in Sub-Saharan effective, yet many cases go untreated.
Africa, where prevalence can exceed 10% in some areas.
• Rising Trends:
• Rates have also increased in regions such as North
America, Europe, and Asia. • In recent years, many countries have reported a
resurgence in syphilis cases, particularly among young
• At-Risk Populations: adults and MSM.
• Men who have sex with men (MSM) are at a significantly • Impact on Public Health:
higher risk for syphilis, with infection rates among MSM
• Syphilis increases the risk of HIV transmission and
being several times higher than the general population.
acquisition due to mucosal lesions that facilitate infection.
• Pregnant women are also a critical focus, as untreated • Untreated syphilis can lead to serious long-term health
syphilis can lead to congenital syphilis in infants. complications, including neurological and cardiovascular
issues.
 References.
• Lecture notes on Infectious Diseases:
BIBHAT K. MANDAL, EDMUND G. L.
Wilkins, EDWARD M. DUNBAR, RICHARD
T. MAYON – WHITE, Fifth Edition.
• Communicable Disease Control and Health
Protection Handbook: THIRD EDITION BY:
Jeremy Hawker, Norman Begg, Iain Blair,
Ralf Reintjes, Julius Weinberg, Karl Ekdahl
• Handbook of Infectious Diseases
Forwarded by David L. Lonworth, MD. The
cleveland Clinic Foundation
• Wabwire paul francis Okomosi
THANK YOU!