SYPHILIS
Syphilis
is a STD (sexually transmitted disease) caused by a spirochaete called
TREPONEMA PALLIDUM.
Treponema
palladium is a slender, spiral-shaped, thread like, actively motile organism
measuring 6-14 in length. It is identified under the microscope by a special
technique known as a dark ground illumination.
EPIDIMIOLOGY:-
The
disease is widely prevalent especially in large cities, industrial areas and
sea ports. The northern parts of India especially Kashmir, himachal Pradesh and
uttar Pradesh are heavily infected. It has been estimated that nearly 5 percent
of the population in India is infected with syphilis. The infection rate varies
from 4 to 7.5 percent to a maximum of 13 percent in different parts of the
country.
The disease may be either congenital or acquired.
CONGENITAL SYPHILIS:-
Syphilis
transmitted to the foetus during intrauterine life is called congenital
syphilis. During the early months of pregnancy, syphilis may cause still birth.
If the child is born full term, certain stigmata of the disease are either
present at birth or develop subsequently during early childhood.
Stigmata
during 1-2 years of age.
1.
The child may be born premature or fails to gain
weight afterwards.
2.
A scaly yellow or copper coloured rash may be
present over the napkin area or around the genitals. Such rashes may sometimes
be present over the palms and soles.
3.
Syphilitic rhinitis (snuffles) develops within a
month or two and is persistant. This ultimately leads to failure of development
of the nasal bones producing the typical depression of the bridge of the nose
(saddle shaped nose).
4.
Cracks and fissures (rhagades) appear at the
angles of the mouth. These heal leaving behind prominent scars radiating from
the angles of the mouth.
5.
Condylomata may appear over the perineum or
under the arms.
6.
Spleen and liver may be a palpable.
7.
Syphilitic basal meningitis may occur producing
hydrocephalus.
STIGMATA APPEARING LATER IN CHILDHOOD:-
1.
Bony changes – periostitis with bowing produces
the typical sabre shaped tibia. Localized elevations over the frontal and
parietal bones produce frontal and parietal bossing (also known as parrot’s
nodes or hot cross bun appearance).
2.
Hutchinson’s teeth – the teeth are widely separated.
The permanent upper central incisors are peg-shaped, tapering from the gum
margins with notches present over the cutting edge.
3.
Eye changes – interstitial keartitis may occur
and cause blindness.
4.
Otitis
media or gummatous destruction of the internal ears may occur resulting in
deafness.
5.
Nervous lesions – juvenile tabes dorsalis and
general paralysis of the insane are possible but extremely rare. Mental
deficiency or dementia may occur but is rare.
6.
Cardiovascular lesions – syphilitic aortitis and
aortic incompetence are rare manifestations of congenital syphilis.
7.
Joints – painless effusion may occur inside the
bigger joints.
ACQUIRED SYPHILIS:-
The infection is almost always acquired
through sexual intercourse. Rarely, the infection may be acquired by handling
infected material or implanted during kissing by an infected person.
The incubation period varies from
10 days to 3 months. The disease occurs in all age groups but is more common in
adults. It passes through three well defined stages primary, secondary and
tertiary.
PATHOLOGY:-
Syphilis
is a notorious disease in the sense that it can affect almost any organ in the
body and that the lesions, though apparently looking healed, are essentially
chronic and slowly progressive. Syphilis is a chronic granuloma infiltration of
round cells occurs around a central zone of necrosis. The arteries are
particularly affected causing endarteritis obliterans and possibly thrombosis.
The
primary lesion, known as primary sore or chancre is a hard, indurated,
exudative and painless lesion. The organism is present in the exudates. A
chancre heals in 6-8 weeks but always leaves behind extensive scar. A chancre
occurs usually on the genitalia but may occur on the lips, fingers or
elsewhere. Treponemes thereafter, pass to the regional lymph nodes and then
invade the blood stream.
During
the secondary stage, the infection is generalized. Lymph nodes, especially the
posterior cervical group, axillary and the epitrochlear glands are enlarged.
Various types of rashes appear due to chronic inflammatory reaction around the
cutaneous blood vessels.
The
tertiary stage is marked by formation of gummas. Gumma is a chronic granuloma
which is comparatively avascular due to endarteritis obliterans affecting the
small blood vessels. A gumma heals by extensive scarring and destroys part of
the organ at the site of its formation.
SYMPTOMS:-
1.
PRIMARY STAGE:-
There is history of sexual contact, after a period varying from 3 weeks
to 3 months, a red small indurated lesion forms on the penis or the labia. In
the following 2 – 3 weeks, the lesion becomes harder and more indurated. This
is the primary chancre. The regional lymph nodes are enlarged. The primary
chancre heals in about 2 months time leaving behind a scar.
2.
SECONDARY STAGE:-
The secondary stage usually starts 4 weeks after the appearance of the
primary chancre and lasts up to 2 years. This is the stage during which the
infection becomes generalized.
a.
Generalized, painless enlargement of the lymph
nodes, especially the posterior cervical, axillary and the epitrochlear glands.
b.
Various types of papular or maculopapular rashes
appear over the trunk and the limbs. The rashes are symmetrical in
distribution, brownish in colour and with no itching.
c.
Warty lesions called Condylomata may occur over
the moist surfaces of the body around the anus, vulva or the under surface of
the breasts.
d.
Typical lesions may be seen over the mucous membrane
of the buccal cavity. Linear streaks or furrows, grayish white in colour may be
present over the fauces or the soft palate. The tongue is swollen, red and
often fissured.
e.
Hairs may fall out resulting in either generalized
or localized alopecia.
f.
Features of syphilitic meningitis or Meningo vascular
syphilis may be present, later often causing cerebral thrombosis.
3.
TERTIARY STAGE:-
Tertiary stage appears 2-15 years
after the primary infection. The typical lesion during this stage is a hard, localized
swelling known as gumma. Gumma can form simultaneously at various sites and
causes localized destruction of the affected organs.
a.
Skin gumma may form over the legs or elsewhere
over the skin surface producing deep sated punched out ulcers. Painless perforating
ulcers may develop in the soles.
b.
Bones – syphilitic involvement of the bones is
the nature of a chronic inflammation. Long bones are more commonly affected. A
deep boring pain occurs which is worst at night. Gumma may form over the bones
of the face and the nose leading to their destruction and disfigurement.
c.
Internal organs - gumma may form inside any of
the internal organs such as the liver, testes, lungs, heart, tongue, pituitary
or adrenal glands. In the heart formation of gumma may be responsible for
conduction defects or localized degeneration of the myocardium. Chronic inflammatory
changes may affect the aortic valve.
d.
Neurological changes – these include basal
meningitis and menigovascular syphilis, general paralysis of insane and
formation of a gumma inside the brain that behaves like a cerebral tumour.
INVESTIGATIONS:-
1.
During primary or secondary stage, Treponemes can
usually be isolated from the exudates and identified by dark ground
illumination.
2.
Wassermann reaction and khan tests.
3.
The venereal disease research laboratory test (VDRL)
– it is a flocculation test that detects a non-specific antibody like reacting
substance present in the serum of syphilitic persons. Though the test is
non-specific, it is still an easy, cheap and fairly reliable test for syphilis.
4.
Tests using specific treponemal antigens.
DIAGNOSIS:
The
diagnosis is based on
-
History of an irregular sexual contact.
-
Typical clinical features or symptoms and
-
Positive Wassermann reaction and VDRL test.
-
During the primary stage, a chancre may be
confused with a chancroid. During the secondary stage, syphilitic skin rashes
may be confused with several skin disorders. During the tertiary stage, A gumma may
be confused with a carcinomatous lesion.
TREATMENT:-
-
Treatment should be started as early as
possible, even without waiting for the Wassermann test to become positive.
-
Pencillin is still the best drug for syphilis.
-
Pencillin twice a day for 8-10 days should be
given unless the patient is sensitive to pencillin.
HOMEOPATHIC TREATMENT:-
Some of the main remedies for
syphilis in homeopathy are given below.
1.
ARSENICUM IODUM.
2.
AURUM METALICUM.
3.
AURUM MURATICUM.
4.
KALI IODUM.
5.
KALI SULPH.
6.
LAUROCERASUS.
7.
MERC SOUL.
8.
MERC COR.
9.
NITRIC ACID.
10.
PHYTOLACCA.
11.
SILICEA.
12.
STILLINGIA SYLVATICA.
13.
SYPHILINUM.
14.
FLOURIC ACID.
15.
GRAPHITIS.
16.
LYCOPODIUM.
17.
STAPHYSAGRIA.
18.
SULPHUR.
