Syphilis is a bacterial STD.

• Syphilis, is caused by T. pallidum. Treponema pallidum is a spirochaete bacterium with subspecies that cause treponemal diseases e.g. syphilis, bejel, pinta and yaws. It has a cytoplasmic and an outer membrane. Using light microscopy, treponemes are only visible using dark field illumination. They are Gram negative, but some regard them too thin to be Gram stained
• The primary route of transmission is through sexual contact, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis

The Sx of syphilis vary depending on which of the 4 stages it presents:

• Primary, which classically presents with a single chancre (a firm, painless, non-itchy skin ulceration)
• Secondary, a diffuse rash which frequently involves the palms of the hands and soles of the feet

Source: 2013/08/2ndarysyphilis.jpg">Jeffrey Sterling MD

• Latent, with little to no Sx
• Tertiary, with gummas, neurological, or cardiac Sx

It has been known as the great imitator, due to its frequent atypical presentations

• Blood tests, which are divided into:
  • Nontreponemal tests, which are used to screen (i.e. they require confirmation w/ the treponemal tests), including:
    • VDRL (venereal disease research laboratory)
    • Rapid plasma reagin tests
  • Treponemal tests, including:
    • TPHA (treponemal pallidum particle agglutination)
    • FTA-Abs (fluorescent treponemal antibody absorption test)
• Serous fluid from a chancre, conducting:
  • Dark ground microscopy
  • Direct fluorescent antibody testing → uses antibodies tagged w/ fluorescein, which attach to specific syphilis proteins
  • NAAT → uses PCR to detect presence of specific syphilis genes
• LP, showing high leukocytes (especially lymphocytes) and proteins in CSF (on top of a known syphilis infection) → neurosyphilis

• Antibiotics, with either penicillin or ceftriaxone, or in Pt's with a penicillin allergy, doxycycline or azithromycin

• Notifiable disease

• Gonorrhea
• Chlamydia