definition

Syphilis is an infectious disease

caused by Treponema pallidum, is a
chronic and systemic disease, during
the course of the disease can affect
all organs of the body

Cont..
Syphilis is divided into congenital syphilis
and syphilis akuisita (acquired). Syphilis
akuisita divided clinically and
epidemiologically.
Clinically, divided into three stages, namely
stage I (SI), stage II (SII), and stage III (SIII).
In epidemiological according to the WHO,
syphilis stage I and II are included in the
early stage are infectious.

Pathogenesis
The incidence of syphilis in various
countries around the world in 1996
ranged between 0.04 -0.52%. The
incidence is lowest in China, while
the highest in South America. In
Indonesia, the incidence of 0.61%

 In 1905 the cause of syphilis found

by Schaudinn and Hoffman is
Treponema pallidum, which includes
the order Spirochaetales, familia
Spirochaetaceae, and the genus
Treponema

 T. pallidum into the skin through

microlesion or mucous membranes,
usually through sexual intercourse.
Germs multiply infiltrat in the
perivascular, small blood vessels
Enarteritis obliteration of small
blood vessel lumen (enarteritis
obliterans).
bleeding will cause erosi SI

 Then the bacteria reach the regional

lymph nodes by limfogenic pathway
and multiply hematogenous
propagation S II, which occur 6-8
weeks after S I.
S1 will recover slowly because of the
amount of germs in places was
decreased fibroblast forming
cured with cicatricial fibroblasts.

Clinical Manifestation of Primary Syphilis

incubation period that ranges from 10 to 90
days (average, 3 weeks)
Skin or mucous membrane, usually external
genitalia.
Initial lesions are papular, but rapidly ulcerate.
ranges in diameter from a few millimeters to 2
cm and is sharply demarcated with regular,
raised borders that are indurated.
The base is usually clean, and the chancre is
classically not painful.
The lesion may be crusted due to drying of
serous exudate.

Chancre in the perianal area . Fecal

area is also present in the area.

Multiple chancres on the glans and

Common
genital
foreskin

locations for a chancre

in men
include the glans, the
coronal sulcus, and the
foreskin.

Common genital locations in

women, include the cervix, labia
majora, labia minora,
fourchette, and urethra
Chancres in women can be more
edematous than indurated
Edema indurativum is a unilateral
labial swelling with rubbery
consistency and intact surface,
indicative of a deep-seated
chancre.

Chancre in female. An ulcer

coverated with fibrin and
necrotic slough at the orifice of
the urethra

cont
In 60%70% of cases of primary
syphilis,
painless
regional
lymphadenopathy arises 710 days
after the chancre appears, especially
when the chancres location is
genital.

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

Clinical Manifestation of Secondary Syphilis

Secondary syphilis is the stage when

manifestations occur on the skin and
mucous membranes.
Constitutional symptoms consist of
fever, headache, and bone and joint
pains.
Rashes are the commonest feature. They
are initially macular and become papular
by 3 months.
Kinghorn GR. Syphilis and Bacterial Sexually Transmitted Disease.
In. Burns T, Breathnach S, Cox N. Rooks Textbook of Dermatology. 8
th Edition. UK: Blackwell. P 1571-1594

cont
Syphiloderm (3-12 weeks after the
chancres appears)
Erythematous
macules
(roseola
syphilitica) or maculopapules are
commonly present symmetrically on
the trunk and extremities in 40%70%
of
cases
with
papular,
papulosquamous, or lichenoid
Lesions are not usually pruritic

Macular syphilis with a

more florid
presentation
of nonscaling, oval
pink, ill-defined
macules and
patches on the trunk.

Papulosquamous
syphilitic eruption
with erythematous,
well-demarcated,
flattened plaques
covered with scales
(Biettes collarette).

cont
Erythematous to copper-colored round
papules, well demarcated and sometimes
with an annular scale, are present on the
palms and soles in nearly 75% of cases.
Other
dermatologic
manifestations
include a patchy nonscarring alopecia,
described as moth-eaten or, less
commonly, a diffuse alopecia of the
scalp.

Characteristic secondary syphilis lesions on the palms

(A) and soles (B). Palmoplantar lesions may be
macular or papular, discrete or diffuse, and
nonscaling, slightly scaly, or hyperkeratotic (syphilitic
corn).

Moth-eaten alopecia of secondary syphilis,

which is more common than diffuse
alopecia
Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

Additional Examination
1. Direct Detection of Treponema
pallidum
It appears as a pale, white,
Darkfield microscopy

fine, corkscrew organism

with close and very regular
coils. It contains a
periplasmic
flagellum and is actively
motile. The movements of
the T. pallidum
are pathognomonic. It
rotates around its long axis
and thus appears
to quiver and screw slowly
backwards and forwards; it
shows

2. Serological Test
Nontreponemal Serologic Test
. Veneral Disease Research
Laboratory test (VDRL)
. Rapid Plasma Reagin test (RPR)

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

Treponemal Serologic Test

T. pallidum particle agglutination (TPPA)
test
Microhemagglutination Assay for T.
pallidum (MHA-TP)
Fluorescent Treponemal Antibody
Absorption Assay (FTA-ABS)
T. pallidum Haemagglutination test (TPHA)
Various Treponemal Enzyme
Immunoassays (EIAs)
Immunochemiluminescence Assays.
Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

Primary Syphilis
Herpes simpleks

Primary Genital Herpes with

vesicle
Katz KA. Syphilis. In:
Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

 Chancroid

Early sharply
circumscribed ulcer in
the coronal sulcus

Vulvar chancroid with

undermined edges

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

 Granuloma inguinale

Nodular variety evolving

into a large, exuberant ulcer

Large ulcerovegetative type

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

 Lymphogranuloma venerum

Soft painless erosion

on the prepuce

Bilateral, firm, immoveable,

masses above Pouparts
Ligaments

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:
McGraw Hill. p 2472-2492

Secondary Syphilis
Pityriasis rosea

A non scaly purpuric

primary plaque of
pityriasis rosea

Typical distribution of secondary

plaques along the line of cleavage on
the back in the Christmas tree pattern

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:

 Condyloma akuminata

Multiple confluent
condylomata on the labia
majora and minora

Multiple condylomata
acuminata on the shaft of the
penis

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:

 Drug eruption

Exanthematous drug eruption: ampicillin. Symmetrically arranged,

brightly erythematous macules and papules, which are discrete in some
areas and confluent in others on the trunk and discrete on the
extremities.
Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:

 Psoriasis

Chronic plaque psoriasis located at typical sites. Note marked

symmetry of lesions.
Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:

Treatment

CDC Recommendations for Treatment and Follow-up of Adults with Primary, Secondary, or
Early Latent Syphilis

Complication of treatment
The JarischHerxheimer reaction is a selflimited clinical syndrome consisting of fever,
headache, flare of mucocutaneous lesions,
tender
lymphadenopathy,
pharyngitis,
malaise, myalgias, and leukocytosis. It
occurs within 12 hours of initiating therapy
and resolves within 2436 hours. The fever
peaks 68 hours after the onset, usually
around 39C , but it can be as high as 42C
Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York:

Cont ..
Acetaminophen can be used to attempt to
diminish the reaction, although very little
evidence of its effectiveness exists.
Anaphylaxis form reaction managed by
intramuscular injection of epinephrine and
diphenhydramine with hydrocortisone
intravenously

Katz KA. Syphilis. In: Goldsmith LA, Katz S, Gilchrest BA. 2008.
Fitzpatricks Deramatology in General Medicine. 8 th Edition. New York: