Short notes on etiology, diagnosis and treatment of scyphilis

Short notes on etiology, diagnosis and treatment of scyphilis

This disease is a specific chronic infection caused by the microbe Tre­ponema pallidum. The microbe was first discovered by Shaudinn and Hoffmann (1905).

The microbe is a bacterium ranging in length from 5 to 24. The bacterium is sensitive to cold, dryness and detergents. Transmission of disease is through sexual intercourse. Disease is transmitted only in early stages.

Sometimes accidental wounding of the skin and introduction of the bacte­ria from the primary sores can also transmit the pathogen. Clinical features. The disease is manifested in three or four stages with a latent period (non disease producing) between each phase. The primary stage has an incubation period which ranges between 9 to 90 days with an average of 20 days when the symptoms start appearing.

Le­sions or sores appear at the site of contact on the genital organs including prepuce, labia, cervix, uteri etc. Extra genital regions where sores appear are lips, neck, cheek, shoulder and breasts. To start with, the sores are painless but gradually they swell leading to ulceration. In men, a painless hard sore called chancre develops on the penis and in women chancre develops in the vagina or in the uterine cervix.

Second stage starts with the appearance of rose coloured rashes after the primary sores. This may start appearing any time between 6 weeks to 6 months after the sexual contact with an infected individual. General symp­toms include discomfort, headache, sore throat, fever and general uneasi­ness. Eyes also may be affected sometimes. In the second stage the lesions or sores may be of the following types-

1. Cutaneous lesion. Found on chest, back, abdomen etc.

2. Lymphadenopathy. Lymph glands become rubbery, discrete and nontender (adenitis)

3. Snail tract ulcers. Found on the mucous membrane of the mouth; highly infectious.

4. Condylomata. Moist papillate outgrowths found on the labia majora in women.

5. Eye infection. Acute iridocyclitis of one or both the eyes may be seen.

6. Miscellaneous symptoms. Hepatitis, meningitis, epididymitis.

The third stage occurs between two to 10 years of infection. The leisons known as gummatous lesions are very destructive in character and involve visceral organs. Liver, heart, laryns, bone, tongue and testis may be af­fected. Fever is one of the important symptoms. Sometimes central ner­vous system may be affected.

The fourth stage or the final stage may start even after 20-30 days after the initial infection and at this stage there is involvement of almost all parts of the body. Complications include paralysis, blindness and even death. Syphilis may be congenital or acquired. Congenital syphilis is very rare. In this, the foetus gets the infection before birth.

The child may be still­born (dead at birth). In case the child survives, it will have several abnor­malities which includes papulo (eruptions on buttocks, palms and soles) bullous eruptions on the legs, plams and face. Acquired syphilis is through sexual contact.

Treatment:

Early diagnosis of the disease is very essential for treatment and it yields good results when treated during the first two stages. The bacteria are extremely sensitive to procaine penicillin which should be taken for a longer duration. Sometimes benzyl penicillin in a single mega dose may be enough to cure the disease. For patients who are sensitive to penicillin, tetracycline, erythromycin etc may be given in suitable dos­ages.