Syphilis

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.