Epidemiology

There is no animal reservoir. Syphilis is usually transmitted by sexual intercourse, but infection can be contracted from kissing. Elimination of transmission in the United States is within reach, but depends on identifying and treating cases within high-

Table 25.10 Stages of Syphilis

Stage of Disease

Main Characteristics

Infectious?

Primary

Firm painless ulcer (hard chancre) at site of infection; lymph node enlargement

Yes

Secondary

Rash, aches and pains; mucous membrane lesions

Yes

Tertiary

Gummas; damage to large blood vessels, eyes, nervous system; insanity

No

Nester-Anderson-Roberts: I IV. Infectious Diseases I 25. Genitourinary I I © The McGraw-Hill

Microbiology, A Human Infections Companies, 2003

Perspective, Fourth Edition

Table 25.11 Syphilis

25.6 Bacterial STDs 651

© Treponema pallidum enters the body through a microscopic abrasion or mucous membrane, usually genitalia, mouth, or rectum

(2 A chancre develops at site of entry

@ Organisms multiply locally and spread throughout the body by the bloodstream

@ Infectious mucous patches and skin rashes of secondary syphilis appear. A fetus will become infected, resulting in miscarriage or a live-born infant with congenital syphilis

© An asymptomatic latent period occurs. T. pallidum disappears from blood, skin, and mucous membranes

© After months or years, symptoms of tertiary syphilis appear:

heart and great vessel defects gummas strokes eye abnormalities general paresis insanity

Symptoms Chancre, fever, rash, stroke, nervous system deterioration; can imitate many other diseases

Incubation period 10 to 90 days

Causative agent Treponema pallidum, a non-culturable spirochete

Pathogenesis Primary lesion, or chancre, appears at site of inoculation, heals after 2 to 6 weeks; T. pallidum invades the blood vessel system and is carried throughout the body, causing fever, rash, mucous membrane lesions; damage to brain, arteries, and peripheral nerves appears years later

Epidemiology Sexual contact with infected partner;

kissing; transplacental passage

Prevention and Monogamous relationships, use of treatment condoms, treatment of sexual contacts, reporting cases.Treatment: penicillin incidence groups such as prostitutes, promiscuous homosexual men, and jail inmates, and guarding against reintroduction of the disease from countries where it is still rampant. Effective screening to detect infected individuals can easily be accomplished using a blood test.

Figure 25.15 Hutchinson's Teeth Notice the notched, deformed incisors, a late manifestation of congenital syphilis.

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