Syphilis and Congenital Syphilis Quiz

Spirochetes

• Spirochetes are long, slender, helically tightly coiled bacteria.
• They are Gram-negative.
• They can be aerobic, microaerophilic, or anaerobic.
• Spirochetes exhibit corkscrew motility.
• They can be free-living or parasitic.
• Important examples include those causing syphilis and Lyme disease.
• Spirochetes have axial filaments, similar to bacterial flagella, enabling their distinctive movement.

Spirochaetales Associated Human Diseases

• Treponema species:
  • T. pallidum ssp. pallidum: Syphilis
  • T. pallidum ssp. endemicum: Bejel
  • T. pallidum ssp. pertenue: Yaws
  • T. carateum: Pinta
• Borrelia species:
  • B. burgdorferi: Lyme disease
  • B. recurrentis: Epidemic relapsing fever, Endemic relapsing fever
• Leptospira species:
  • L. interrogans: Leptospirosis (Weil's Disease)

Genus Treponema

• Treponema are coiled bacteria longer than Leptospira.
• Several Treponema species are human pathogens, some are part of normal mouth flora.
• T. pallidum and its subspecies are most important.
• Individual Treponema cells are very small, best visualized using dark-field microscopy, silver impregnation, or immunofluorescence.
• They are actively motile using flagella contained within the periplasmic.

Laboratory Identification of Treponema

• T. pallidum and closely related species cannot be grown in standard lab media.
• Diagnosis depends on microscopic examination of fluids from primary lesions and serological tests.
• Syphilis (T. pallidum) is diagnosed using microscopic examination of fluids from primary lesions and serological tests. T. pertunue and T.caratenum cause yaws and pinta respectively (non-sexually transmitted).

Transmission of Treponema

• Spirochetes are susceptible to heat and drying, successful transmission requires close contact.
• T. pallidum is spread by close sexual contact and can be passed from mother to fetus.
• Yaws and pinta spread by direct contact with infected skin lesions. These diseases do not have animal reservoirs.

Stages of Syphilis

• Primary
• Secondary
• Latent
• Tertiary
• Congenital Syphilis

Primary Syphilis (Chancre)

• Chancre is commonly found on external genitalia, vagina, or cervix.
• In males, it can appear inside the urethra, resulting in a discharge.
• The chancre heals spontaneously after 1-5 weeks.
• Spirochetes can be found in a swab of the chancre using dark-field microscopy.
• Syphilitic serological tests become positive in about one week after chancre appearance, reaching near 90% positivity within a few weeks.
• Chancre differs from a chancroid, which is a painful, softish lesion caused by different bacteria.

Secondary Syphilis

• Appears 6-8 weeks after the primary chancre.
• It becomes systemic and highly infectious.
• Characterized by mucocutaneous lesions, often with generalized lymphadenopathy.
• The primary chancre may still be present.
• Secondary lesions typically subside within 2-6 weeks.
• Serological tests almost always confirm the presence of the infection.
• The skin rash, resembling psoriasis or pityriasis rosea, frequently involves the hands and should be evaluated for secondary syphilis.
• Back lesions are also a common symptom.

Latent Syphilis

• A stage where organisms persist in the body, without causing apparent symptoms.
• It can last for years.
• About one-third of untreated latent syphilis cases will progress to tertiary syphilis.
• After four years, it is rarely sexually transmissible, but passing from mother to fetus remains possible.
• Latent syphilis can be subdivided into early latent (infection within the last 12 months) and late latent (infection more than 12 months past).

Tertiary Syphilis

• Manifestations include gummas (localized granulomatous inflammation), cardiovascular syphilis (aortic wall scarring), and neurosyphilis.

Tertiary Syphilis - Gummatous Syphilis

• Localized areas of granulomatous inflammation in bones, skin, and subcutaneous tissue.
• Lesions can be single or multiple, generally asymmetric, and grouped together.
• Visceral involvement can cause significant local destruction of affected organs.
• Lesions contain lymphocytes, plasma cells, and perivascular inflammation.

Tertiary Syphilis - Cardiovascular Syphilis

• Appears 20+ years post-infection.
• Primarily affects the aorta, leading to scarring of the tunica media.
• Long-term inflammatory scarring weakens the aortic wall, potentially causing aneurysm formation.
• Complications include aortic valve incompetence and coronary artery narrowing.
• Antibiotic treatment can stop further progression of the disease but may not reverse existing damage.

Tertiary Syphilis - Neurosyphilis

• Caused by CNS invasion of organisms.
• Characterized by progressive loss of mental and physical function that is accompanied by mood alterations.
• The "General paresis of the insane" form features forgetfulness, personality changes, and psychiatric symptoms.
• Onset usually occurs 10-20 years after the initial infection.
• Treatment may be unsuccessful in reversing symptoms
• Neurological complications include generalized paresis of the insane (personality and emotional changes, hyperactive reflexes), and tabes dorsalis (degeneration of lower spinal cord, general paresis, chronic progressive dementia, a characteristic shuffling gait).
• Diagnosis relies on serological tests like VDRL.
• Cerebral atrophy (primarily in frontal lobes) can occur as a component of this form.

Congenital Syphilis

• Transmitted from a mother to a fetus during the second or third trimester.
• Congenital syphilis can result in stillbirth, which is a significant risk occurring in 40% of cases when the mother has untreated syphilis during a 20-week gestation.
• In those that survive, 40-70% can be infected, with 12% subsequently dying prematurely.
• Death is often due to pulmonary hemorrhage.
• Characteristics include bone deformities, blindness, deafness, deformed faces, dental deformities, skin rashes.
• Live-born infants who survive can present few apparent symptoms for weeks, followed by rhinitis (clear/hemorrhagic), skin eruptions (mouth, palms/soles), and Hutchinson's incisors.

Diagnosis of Syphilis

• Diagnosis is based on a combination of factors:
  • Clinical findings
  • Demonstration of spirochetes (dark-field microscopy)
  • Presence of antibodies (serological tests, such as VDRL and RPR)

Laboratory Testing of Syphilis

• Direct examination of clinical specimens via dark-field microscopy or fluorescent antibody testing.
• Non-specific, non-treponemal serological tests (e.g., reagin tests) are used for screening.
• Specific treponemal antibody tests (e.g., FTA-ABS, Microhemagglutination) are used to confirm positive reagin tests.

Nontreponemal Reagin Tests (for Syphilis)

• Non-specific serological tests detecting reagin (antibody against cardiolipin).
• Found in sera from syphilis but also other diseases.
• Common tests include VDRL and RPR.
• Nontreponemal tests become positive 1–4 weeks after the primary chancre appears.
• False negatives can occur during the secondary, or later tertiary phases of the disease (sometimes 25%) after treatment success.
• Testing results often become non-reactive within 1-2 years of effective treatment.

Treatment and Prevention of Syphilis

• Penicillin is the treatment of choice.
• Tetracycline is an alternative for penicillin-allergic patients.
• Prevention focuses on detecting and treating cases, tracing contacts, and testing pregnant people.
• Potential cross-reactions between T. pallidum and other Treponema species (like yaws and pinta) must be considered.

Genus Borrelia

• Includes species critical in Lyme disease (B. burgdorferi) and relapsing fever (B. recurrentis).

Borrelia Characteristics

• Less tightly coiled than leptospires.
• Visible via light microscopy, though specific staining may be required.

Borrelia Laboratory Identification

• Microaerophilic, necessitating complex nutritional requirements.
• Culturing is less common; diagnosis is often serological. Blood samples are often used for Giemsa or acridine orange staining to detect B. recurrentis. For B. burgdorferi, biopsy material may be necessary.

Borrelia Diseases

• B. burgdorferi causes Lyme disease – a skin lesion (erythema migrans), commonly followed by joint pains and fatigue. In untreated cases, neurological/cardiac manifestations can occur.
• B. recurrentis causes relapsing fever. Recurring symptoms result from changing antigens of the organism, rather than from a repeating infection.

Borrelia Transmission

• B. recurrentis is spread by lice.
• B. burgdorferi is transmitted by Ixodes ticks.

Borrelia Pathogenesis

• Limited knowledge about either disease's exact pathogenesis.
• B. recurrentis presumably employs antigen-switching to evade host antibody responses

Borrelia Treatment and Prevention

• Doxycycline, erythromycin, and penicillin are effective.
• Prevention largely depends on avoiding tick encounters for Lyme disease.

Genus Leptospira

• Contains two major species: L. interrogans (parasitic) and L. biflexa (free-living).
• Various serogroups within L. interrogans, are responsible for human and animal diseases.

Leptospira Characteristics

• Fine spirals with hooked ends (different from other spirochetes)
• Small, requiring special (silver impregnation or immunofluorescence )staining for visualization.
• Rotational and directional motility via periplasmic flagella.

Leptospira Laboratory Identification

• Leptospira can be found in urine and blood.
• Microscopy is possible, but difficult to interpret.
• Culture is challenging but can be grown in special serum media.
• Serological tests are commonly used for diagnosis.

Leptospira Diseases

• Leptospira causes leptospirosis (Weil's Disease) in humans/animals.

Leptospira Transmission

• Leptospirosis is transmitted from animals to humans through urine-contaminated food/water.
• Humans are generally infected through direct contact with urine contaminated surfaces.

Leptospira Pathogenesis

• Initial infection involves hematogenous spread throughout the body, leading to organ localization (especially liver and kidneys).
• Subclinical infection (no obvious symptoms) is common in endemic areas.

Leptospira Treatment and Prevention

• Penicillin/doxycycline useful.
• Preventive measures include avoiding contact with animal urine-contaminated material.

Genus Neisseria

• N. meningitidis and N. gonorrhoeae are particularly important human pathogens.

Neisseria Characteristics

• Non-motile.
• Gram-negative diplococci.
• Fastidious growth requirements; often need CO2 rich environments.
• N. meningitidis is encapsulated; N. gonorrhoeae is not.
• Capsules help both species evade phagocytosis.

Neisseria Laboratory Identification

• Gram staining of pus or cerebrospinal fluid reveals Gram-negative kidney-shaped diplococci.
• The organisms grow best on supplemented agar plates containing antibiotics.
• Neisseria species can be differentiated using sugar utilization tests.
• Testing of oxidase activity is positive for most relevant Neisseria Species.
• The carbohydrate pattern differentiating the species is that N. gonorrhoeae can only oxidize glucose while others use other sugars.
• Latex agglutination testing can differentiate specific N. meningitidis serotypes.

Neisseria Diseases (caused by the two previously mentioned species)

• N. gonorrhoeae: Causes gonorrhea. Urethritis, cervicitis, salpingitis, pelvic inflammatory disease, proctitis, bacteremia, arthritis, conjunctivitis, pharyngitis.
• N. meningitidis: Causes meningitis, meningoencephalitis, bacteremia, pneumonia, arthritis.

Gonorrhea Symptoms

• Males: Frequent urination and pus-like discharge from penis; swelling or redness around the penis or testicles; persistent sore throat.
• Females: Vaginal discharge, painful urination, increased menstrual flow or spotting, sharp pain in the lower abdomen; pain during sexual activity, persistent sore throat.

Complications of Untreated Gonorrhea

• Untreated gonorrhea can lead to pelvic inflammatory disease (PID) in women.
• PID can cause significant damage to reproductive organs, potentially impacting future fertility.
• Scarring of the urethra/and fallopian tubes is possible,
• Abscesses may form.
• Infants can be infected during childbirth.

Gonorrhea Treatment and Prevention

• Treatment typically involves antibiotics.
• Beta-lactamase-stable cephalosporins (e.g., ceftriaxone) are often effective.
• Gonorrhoea prevention depends on education, contact tracing, and, where applicable, efforts to prevent or reduce exposure. There is not yet a vaccine to prevent this infection..

Additional Notes

• Thank you for your participation.

Test your knowledge on syphilis, its stages, and the impact of congenital syphilis on affected individuals. This quiz covers key characteristics, symptoms, and treatment options related to this sexually transmitted infection. Perfect for students studying medical science or public health.