Contagious, systemic disease caused by Treponema pallidum

Aetiology

• T. pallidum enters via abraded skin or intact mucous membrane and distributes via the bloodstream and lymphatics after an incubation period of around three weeks

Pathophysiology

Acquired syphilis

• Infectious:
  • Primary syphilis: incubation period 2-3 weeks (range 9-90 days): local infection
  • Secondary syphilis: incubation period 6-12 weeks (range 1-6 months): generalised infection
  • Early latent syphilis: asymptomatic syphilis of less than two years' duration
• Non-infectious:
  • Late latent syphilis: asymptomatic syphilis of two years' duration or longer
  • Late symptomatic syphilis (tertiary syphilis)

Congenital syphilis

• Mother to child transmission

Clinical features

Primary syphilis - 9 to 90 days

• Lesion traditionally known as a primary chancre (painless)
• Lesions appear at the site of inoculation
• Non-tender local lymphadenopathy

Secondary syphilis - 6 weeks to 6 months

• Skin (macular, follicular or pustilar rash on palms + soles)
• Lesions of mucous mebranes
• Generalised lymphadenopathy, fever, sore throat
• Malaise
• Anterior uveitis