00:02
Syphilis.
00:03
A few words about syphilis
when dealing with dermatology.
00:06
Infectious.
00:07
Treponema pallidum.
00:09
Diagnosis by RPR and the stages is
where I want to spend a minute.
00:14
If it’s a primary chancre,
remember that a
chancre is painless.
00:19
A chancre is a painless ulcer
in either the oral
or genital region
as opposed to or
compared to chancroid.
00:27
A chancroid, ouch, it hurts
so much so that I will be crying,
referring to
Haemophilus ducreyi.
00:39
So Haemophilus ducreyi
will be chancroid,
D and D.
00:45
And you’re crying
because it hurts.
00:49
Chancre is painless
and this also might be located
in the genital regions
or maybe perhaps around
the oral regions.
00:58
The secondary:
The rash should be on
the palms and soles,
may or may not be on the trunk.
01:03
And tertiary,
may involve the bone and
some of the soft tissue
and this then referred to as
being your necrotic type of ?
Good.
01:12
Granulomas.
01:14
And you have your CNS.
01:16
Gumma is what we’re talking
about for tertiary.
01:19
Remember please, secondary:
Rash on the palms and the soles,
don’t forget those for secondary.
01:27
For syphilis,
we’re showing you penis in
which you’d find your ulcer,
in which in this patient,
was not expressing pain because
a chancre is painless.
01:41
Guess what you’re going to find?
You’re going to find these spirochetes on
dark field microscopy and positive for RPR.
01:49
Two to three weeks
after exposure.
01:54
Occurs weeks to month
after infection.
01:56
The palms and soles
would be the targets
if you’re referring to
secondary type of syphilis
and if you have alopecia,
it will be like a moth-eaten
alopecia and condyloma lata.
02:13
Remember lata is syphilis.
02:15
“I want a lata syphilis.”
I'm just joking,
but condyloma lata would be
the infection on the skin
that you would be looking for
in syphilis, usually secondary.
02:27
If it’s late and tertiary, take
a look at what happens here.
02:30
We’re talking about two years
on average after infection.
02:34
It’s the gumma plus a granulomatous type
of ulcer, a necrotizing type of granuloma.
02:39
This is referred to
as being your gumma.
02:41
CNS involvement with
dementia and confusion.
02:44
Remember tabes dorsalis
could be an obvious
manifestation and you could
also affect your pupil
and we call this being
Argyll Robertson type pupil.
02:56
Aortic involvement could take place in
which your patient has or undergoes
endarteritis obliterans
of the vasa vasorum,
resulting in aortitis and
therefore aortic regurgitation.
03:07
And these are all items and symptoms
that we’ve discussed earlier.
03:12
Syphilis is a wonderful medical
situation or clinical situation
in which you can truly
move from head to toe
and kind of integrate
the very subjects.
03:26
Management:
Primary, secondary, early latent:
a single dose of your penicillin.
03:32
Latent disease:
You’re thinking about three
doses at one-week intervals
and during penicillin, patients
develop what’s known as a reaction.
03:42
I want to make sure that
we’re clear about this.
03:44
So let’s say that the patient is put on
penicillin during a syphilitic infection.
03:50
I’m not going to spend too much time on
management, but this one’s important.
03:53
It’s called Jarisch-Herxheimer reaction.
03:58
So what happens is that during
the penicillin therapy,
an acute febrile reaction
frequently accompanied by headache,
weakness in the joints with
24 hours of treatment.
04:10
And what ends up happening is
the fact that the penicillin
is in certain patients breaking down
the syphilis or spirochete so quickly,
that this then causing
a secondary reaction
in which now you’re patient has developed,
post penicillin, an acute febrile illness.
04:28
Along with this, myalgia.
04:31
When?
Within one day of that
treatment on average.
04:36
Most common among patients
with early syphilis
because of maybe the abundance
of the organisms is the theory.