CONGENITAL SYPHILIS

EARLY CONGENITAL SYPHILIS:

Manifestations Stigmata
Bullous rash (mainly palms and soles)
Other rashes of secondary syphilis (papular and Rhagades
papulosquamous).
Old man look
Café au lait tint
Syphilitic alopecia
Syphilitic wig
Syphilitic onychia onychia
Mucous patches, syphilitic aphonia
Syphilitic rhinitis, nasal obstruction, perinasal syphilitic Syphilitis facies ---- saddle nose, high
papaules arched palate, underdevelopment of
maxilla and prominent mandible (bulldog
jaw)
Lymphadenitis
Hepatospelomegaly and splenomegaly
Kidney ---- slight proteinuria
Lungs ---- white pneumonia
Testis --- orchitis
Nervous system ---- meningeal involvement
Bones --- 1st 6 months ---- osteochondritis of long bones Huchinson’s teeth (upper central insicors).
(upper end of tibia, lower end of radius and ulna) --- Mulberry Molars (Lower 1st molar)
syphilitic pseudoparalysis, Wimberger’s sign. 2nd 6 months
---- periostitis (saber tibia and dactylitis)

Choriodoretinitis Salt and pepper fundus

LATE CONGENITAL SYPHILIS:

MANIFESTATIONS STIGMATA
Interstitial keratitis---- corneal scarring Corneal scarring, ghost vessels
Bone ---- gummatous osteoperiosteitis (destruction of destruction of palate and nasal septum,
palate and nasal septum, parrot’s nodes, saber tibia, parrot’s nodes, saber tibia, inner end of
inner end of clavicle, dactylitis) clavicle, dactylitis, frontal bossing, bulldog
facies (frontal bossing, saddle nose and
bulldog jaws), natiform or ‘ hot cross bun’
skull.
Joints (diffuse arthralgia, Clutton’s joints)
Ears ( low grade otitis media, involvement of bones of Nerve deafness
middle ear, partial conductive deafness, involvement of
terminal fibres of cochlear portion of VIII nerve ---
perceptive deafness)
Gummata of SC and submucosal tissues (mainly in soft
palate and nasopharynx)
Gumma of liver
CNS syphilis
CVS syphilis Primary optic atrophy.
Paroxysmal cold hemoglobinuria

HUTCHINSON’S TRIAD: Huchinson’s teeth, Interstitial keratitis and VIII nerve deafness.
 TERTIARY SYPHILIS (after 3-10 years)

SYSTEM/ORGAN MANIFESTATIONS
SKIN Nodular, squamous/psoriasiform and SC gummata --- heal with tissue paper
scarring.
MUCOSA Localized gummata breaking into punched out ulcers with “wash leather base”
over mouth, throat, palate, nasal septum, pharynx, larynx --- may cause
steonosis, leukoplakia, SCC.
Diffuse gummata mainly in the TONGUE (CHRONIC SUPERFICIAL GLOSSITIS) ---
precancerous. The tongue appears in 3 ways ---- smooth/leukoplakia/deep
irregular fissures. The patient presents with a odd looking tongue/with cancer
tongue/ with discomfort on eating hot spiced food.
BONES 5-25 years after original infection --- osteoperiostis . in long bones --- thickening>
destruction leading to saber tibia (symptoms --- deep seated boring pain worst at
night). In cranial bones, destruction> thickening --- worm eaten skull, perforation
of palate and nasal septum.
CARTILAGE Perichondritis of costal cartilage, external ear and nasal septum.
JOINTS, BURSA, Rare. Parts most affected are those exposed to stress and strain like the knee
TENDON SHEATHS joint and prepatellar bursa. The swelling is soft, rubbery with no signs of active
inflammation. Occasionally hard fibrous nodules, the so called juxta articular
nodes are found along tendon sheaths or SC near joints.
MUSCLES RARE. May extend from the SC tissue or bones.
STOMACH Gumma is rare ---- signs of indigestion or peptic ulcer. Filling defect on barium
meal or there may be distortion of cardiac end of the stomach.
INTESTINE Rare.
LIVER Most frequent type of abdominal syphilis ---- presents in 2 ways --- (i) diffuse
interstitial cirrhosis and (ii) focal gumma with or without subsequent amyloidosis.
Mostly presents as LARGE FIRM IRREGULAR MASS (left lobe> right lobe) with or
without symptoms.
LUNG Solitary or multiple gummata ---- fibroid lung and bronchiectasis
URINARY TRACT Gumma of kidney, bladder and prostate are rare.
TESTIS Diffuse or localized gummata ---- testis enlarges painlessly, sensation is lost,
consistency is altered and there is dragging sensation ---- enlarges testis has
regular surface ---- Billiard ball testis --- unilateral heaviness with secondary
hydrocele.

GUMMA: The characteristic lesion of tertiary syphilis is a gumma. GUMMA ARE USUALLY LOCALIZED
LESIONS, SOMETIMES THERE MAY BE DIFFUSE TISSUE INFILTRATION.
The most typical feature is central area of tissue necrosis (which is usually granular, may be
caseous) surrounded by a zone of granulation tissue dull red in color. This zone contains endarteritis
obliterans of vessels, perivascular cuffing of lymphocytes and plasma cells, few giant cells and epitheloid
cells. Outside this is a narrow zone of tough fibrous tissue.
THE GUMMATOUS LESION IS NOT NECESSARILY SELF LIMITING AND IT IS COMMON TO FIND THAT
INITIAL LESIONS HEAL WITH SCAR TISSUE AND OTHER LESIONS OCCUR IN THE PERIPHERY.
T.pallidum cannot be isolated by DGI but can be demonstrated by inoculation of gummatous
material into susceptible animals. Probably gumma represents local tissue allergy in host.

SECONDARY SYPHILIS

SYSTEM MANIFESTATIONS
Skin Rashes – macular, papular (corona veneris, annular, follicular, corymbose,
condyloma acuminata), papulosquamous, pustular (rupia) , pigmentation and
depigmentation (collar of venus), syphilitic onychia, syphilitic alopecia (sides
and back of scalp as patchy hair loss)
Mucosa Dull red erythemas, mucous patches (grey white patches with dull red areola)
with snail track ulcers (oral mucosa, pharynx, larynx, genitalia), fissuring at the
angle of mouth.
Lymph nodes Enlarged, discrete, non tender
Eye Anterior uvietis usually silent, choriodoretinitis
Liver Hepatitis (mild jaundice/enlargement of liver/elevation of enzymes)
Kidney Nephrotic syndrome
Arthritis bursitis, Swelling without pain/limitation of movement/painful joints/aching pain in long
periostitis bones/tendon sheaths may be affected.
Neurologic and cardiac Only CSF abnormalities/evidence of raised intracranial pressure/meningitis/
involvement cranial nerve palsies/ECG abnormalities.