Agent

Defining
Characteristics

Clinical Diseases

Laboratory Diagnosis

Treatment

Morphology:
5 to 20 m in length;
0.09 to 0.5 m in
width.
Ends finely tapered
Appear as helical coils
8-14
Evenly distributed
waves per cell
Motile and sluggish
with drifting motion
and graceful flexuous
movement
It rarely rotates

Clinical infection:
Epidemiology
Initially called italian disease or
French Disease and Great Pox
John Hunter inoculated himself with
exudate in 1776 (unfortunately contains
with GC & Sy). His conclusions both
diseases are the same
Ricord in 1838 establish separate
nature
Schandinn and Hoffman 1905
discovered the causative agent
Wasserman in 1906 introduced the
blood test named after himself
Chances of getting the disease from
infected person is 1 out 10.
Characteristic of one with syphilis
usually young and promiscuous
Peak 20-24 years old and gradually
declines
Common source: prostitutes but in
developed countries replaced by casual
partners called call girls.
Also common among homosexuals

Laboratory diagnosis
1. Direct visualization by Darkfield, FAT
or special stain of infected tissues
2. Animal inoculation
3. Serologic reaction serologic test
classified into:
a. Non-treponemal antigen test
b. Treponemal antigen test may
cross-react with others than
T.pallidum. Therefore, no test
is specific for syphilis
Non-Treponemal test
1. Use of cardio-lipin lecithin as
antigen (extract of beef heart)
2. CFT Wassermann and
Kolmer Test
3. Flocculation test VDRL
Hinton and Rapid Reagin Test
Disadv: false (+)
reactions
Treponemal Test
1. Treponema pallidum
immobilization test (TPI)
Basis Reaginic Ab and
complement with
motile Treponema
from testes of rabbits
Effects of motility

Treatment:
1. Penicillin for 10 days for
early stage
2. Beyond early stage 21 days
Rx
3. Tetracyclines, Erythromycin
and Cephalosphorins not
suitable for pregnant mothers
( cannot pass placental
barriers)

SPIROCHETES
FAMILY: Spirocheataceae
GENERA:
Treponema
Leptospira
Borrelia
TREPONEMA
Of about 10 species, 3 are major
human pathogens:
Treponema pallidum =
syphilis
Treponema pertenue =
Yaws
Treponema carateum =
Pinta
Treponema pallidum:
Treponema derived from a greek
word meaning turning thread.

Structure:
Capsule-like outer coat
(not present in nonpathogenic species)
6 flagella-like fibrils
between cell wall and
cytoplasmic membrane
Cultural
characteristics:
Cannot be grown in
vitro
Propagated by

Transmission:
Sexual contact (most common)

Jarish -Herxheimer Reaction 2

to 12 hours ff Rx of active
syphilis. Occurence of focal and
systematic reaction: headache,
malaise, fever and resolved within
a day (no effect on course of
recovery).
Prevention:
No contact with prostitutes or
call girls
Follow-up and treatment of
contacts

infratesticular
inoculation in rabbits
May survive 4-7 days
at 25C in an anaerobic
medium
Division time: about
30 hours by transverse
fission

Contact with mucus membranes (lips)

Skin in areas with abrasions
Direct inoculation is necessary (seldom
survive outside)

Pathogenesis and Pathology:

Spread is thru perivascular lymphatics
and then systemic circulation
o Primary Lesion: Chancre
with profuse discharges of
spirochetes accumulation of
mononuclear leukocytes,
lymphocytes and plasma cells.
Swelling of capillary
endothelia.

Regional lymph nodes

enlarged.
Resolution is by fibrosis
o Secondary lesion:
Tissues of ectodermal origin,
skin, mucus membranes and
CNS, participate in
inflammatory process.
Cellular infiltrate resembles
primary lesion with
predominance of plasma cells.
Little necrosis
Healing is by scarring with
pigmentary changes.
o Tertiary Syphilis
Involve any organ system.
Often asymmetrical
Gummas occuring in internal
organs bones, brain, CV, etc
few giant cells, --- of
microorganisms
Those without caseation
results to aneurysm of aorta,

2.

3.

seen by Darkfield
microscopy
Disadv: difficult,
requires living
spirochetes. (+)also in
non-venereal: yaws,
pinta and Bejel)
Reiters Protein CF
Ag from non-virulent
Treponema Reiters
stain.
Disadv: false (+) and
(-) common and nonreactive in late stage
FAT
Ag lyophilized
Nichols stain fix to a
slide and test serum
applied and layered
with Flourescinisothiocynate labeled
anti-human gamma
globulin.
Presence or absence of
Ab is determine by
Fluorescent
Microscopy.
Modification: FTAABS (Fluorescent
Trep. Ab Absorption
Test)
Test sera is
pre-absorbed
to eliminate
group
autobody.
Preabsorbed
by a solvent
sonicate of

paralytic dementia and Tabes

dorsalis. Characteristic lesion
is chronic swelling of capillary
endothelium and fibrosis.
Clinical Manifestations:
Incubation period normally 3-4 weeks
(10 to 90 days)

Primary disease:
o Chancre
Typically single
lesion, non tender,
firm, raised borders
and reddish in color.
Systemic signs
absent but draining
lymph nodes usually
enlarged and tender
Secondary disease:
2 10 weeks after primary
lesion
o Fever, sorethroat, headache,
general lymphadenopathy and
rash
o Frequent involvement of palm
and soles
o Mucus membrane white
mucus patches
o Condylomata lata anus and
vagina
o Still highly infectious
o Latent stage may fall out.
Tertiary stage:
o Gummas 3 to 10 years
following last evidence of
secondary stage.

reiters Trep
and others
used.
FTA-ABS
most
sensitive but
expensive
and time
consuming.
IgM- ABS test for
congenital syphilis
IgG pass but
not IgM. So
detection of
IgM indicates
Ab
production by
the fetus.
(Hemagglutination
Test - as sensitive as
FTA-ABS)

Lesions may be selectively

quiescent Benign Tertiary
Syphilis.
o Classical manifestation may
later occur as follows:
Neurosyphilis in the
form of:
Paralytic
dementia
Tabes
dorsalis
Amyotropic
lateral
sclerosis

Meningovascular
syphilis
Seizures
Optical
atrophy
Cardiovascular
syphilis 10-40
years after primary
syphilis
Aneurysm
or stenosis
of the aortic
and
pulmonary
artery
angina and
myocardial
insufficienc
y
Congenital Syphilis transplacental
infection of developing fetus from
untreated primary syphilis of pregnant
women:
o Hepato splenomegaly
o

o
o
o
o
o
o

common

Immunity:
Protection in syphilis only relative
and unreliable
Acquired immunity
o The untreated ones rel.
resistant to reinfection
Presence of IgG, IgM in Chancre stage
(not protective)
Presence of cell mediated immunity
non-specific.

Treponema pertenue
Cause of yaws
Morphologically and
serologically
indistinguishable from
T.pallidum
Transmission direct contact:
not sexual, rarely congenital

Treponema carateum
Pinta a tropical disease of
Central and South America

Jaundice
Hemolytic anemia
Bone involvement
Snuffles
Skin lesions
Testicular masses

Morphology similar to
T.pallidum

Course:
1. Initial lesion
- Mother yaws or Framboise occur
about a month after primary
infection ( painless erythromatous
papule that heals in 1 to 2 months
ulcerate and heals)
2. Secondary lesion
- 1 to 3 months later resembling
primary lesion recurrent and
continue to occur for several years.
3. Tertiary lesions
- May involve skin and bones with
gummatous ulceration.
- Infecton of feet causes crippling
disease called crab yaws.

Treatment Penicillin
Prevention General improvement in
sanitation and standard of living

Treatment Penicillin.

Bejel

resembles yaws
epidemiologically and
clinically.
Considered an
Endemic Syphilis,
occuring in Middle
East.
Transmission: Direct
contact
Treatment: Penicillin
Prevention: Improve
hygienic conditions

Transmission person to person contact, rarely

sexual contact
Clinical manifestation:
- Only Primary and Secondary, rarely
Tertiary lesions
- Flat erythematous, non-ulcerating
becoming hyperpigmented on healing
and later scaring occurs in hands, feet
and scalp.
- Depigmented eventually