SYPHILIS
Syphilis is a STD (sexually transmitted disease) caused by a spirochaete called TREPONEMA PALLIDUM.
Treponema palladium is a slender, spiral-shaped, thread like, actively motile organism measuring 6-14 in length. It is identified under the microscope by a special technique known as a dark ground illumination.
EPIDIMIOLOGY:-
The disease is widely prevalent especially in large cities, industrial areas and sea ports. The northern parts of India especially Kashmir, himachal Pradesh and uttar Pradesh are heavily infected. It has been estimated that nearly 5 percent of the population in India is infected with syphilis. The infection rate varies from 4 to 7.5 percent to a maximum of 13 percent in different parts of the country.
The disease may be either congenital or acquired.
CONGENITAL SYPHILIS:-
Syphilis transmitted to the foetus during intrauterine life is called congenital syphilis. During the early months of pregnancy, syphilis may cause still birth. If the child is born full term, certain stigmata of the disease are either present at birth or develop subsequently during early childhood.
Stigmata during 1-2 years of age.
1. The child may be born premature or fails to gain weight afterwards.
2. A scaly yellow or copper coloured rash may be present over the napkin area or around the genitals. Such rashes may sometimes be present over the palms and soles.
3. Syphilitic rhinitis (snuffles) develops within a month or two and is persistant. This ultimately leads to failure of development of the nasal bones producing the typical depression of the bridge of the nose (saddle shaped nose).
4. Cracks and fissures (rhagades) appear at the angles of the mouth. These heal leaving behind prominent scars radiating from the angles of the mouth.
5. Condylomata may appear over the perineum or under the arms.
6. Spleen and liver may be a palpable.
7. Syphilitic basal meningitis may occur producing hydrocephalus.
STIGMATA APPEARING LATER IN CHILDHOOD:-
1. Bony changes – periostitis with bowing produces the typical sabre shaped tibia. Localized elevations over the frontal and parietal bones produce frontal and parietal bossing (also known as parrot’s nodes or hot cross bun appearance).
2. Hutchinson’s teeth – the teeth are widely separated. The permanent upper central incisors are peg-shaped, tapering from the gum margins with notches present over the cutting edge.
3. Eye changes – interstitial keartitis may occur and cause blindness.
4. Otitis media or gummatous destruction of the internal ears may occur resulting in deafness.
5. Nervous lesions – juvenile tabes dorsalis and general paralysis of the insane are possible but extremely rare. Mental deficiency or dementia may occur but is rare.
6. Cardiovascular lesions – syphilitic aortitis and aortic incompetence are rare manifestations of congenital syphilis.
7. Joints – painless effusion may occur inside the bigger joints.
ACQUIRED SYPHILIS:-
The infection is almost always acquired through sexual intercourse. Rarely, the infection may be acquired by handling infected material or implanted during kissing by an infected person.
The incubation period varies from 10 days to 3 months. The disease occurs in all age groups but is more common in adults. It passes through three well defined stages primary, secondary and tertiary.
PATHOLOGY:-
Syphilis is a notorious disease in the sense that it can affect almost any organ in the body and that the lesions, though apparently looking healed, are essentially chronic and slowly progressive. Syphilis is a chronic granuloma infiltration of round cells occurs around a central zone of necrosis. The arteries are particularly affected causing endarteritis obliterans and possibly thrombosis.
The primary lesion, known as primary sore or chancre is a hard, indurated, exudative and painless lesion. The organism is present in the exudates. A chancre heals in 6-8 weeks but always leaves behind extensive scar. A chancre occurs usually on the genitalia but may occur on the lips, fingers or elsewhere. Treponemes thereafter, pass to the regional lymph nodes and then invade the blood stream.
During the secondary stage, the infection is generalized. Lymph nodes, especially the posterior cervical group, axillary and the epitrochlear glands are enlarged. Various types of rashes appear due to chronic inflammatory reaction around the cutaneous blood vessels.
The tertiary stage is marked by formation of gummas. Gumma is a chronic granuloma which is comparatively avascular due to endarteritis obliterans affecting the small blood vessels. A gumma heals by extensive scarring and destroys part of the organ at the site of its formation.
SYMPTOMS:-
1. PRIMARY STAGE:-
There is history of sexual contact, after a period varying from 3 weeks to 3 months, a red small indurated lesion forms on the penis or the labia. In the following 2 – 3 weeks, the lesion becomes harder and more indurated. This is the primary chancre. The regional lymph nodes are enlarged. The primary chancre heals in about 2 months time leaving behind a scar.
2. SECONDARY STAGE:-
The secondary stage usually starts 4 weeks after the appearance of the primary chancre and lasts up to 2 years. This is the stage during which the infection becomes generalized.
a. Generalized, painless enlargement of the lymph nodes, especially the posterior cervical, axillary and the epitrochlear glands.
b. Various types of papular or maculopapular rashes appear over the trunk and the limbs. The rashes are symmetrical in distribution, brownish in colour and with no itching.
c. Warty lesions called Condylomata may occur over the moist surfaces of the body around the anus, vulva or the under surface of the breasts.
d. Typical lesions may be seen over the mucous membrane of the buccal cavity. Linear streaks or furrows, grayish white in colour may be present over the fauces or the soft palate. The tongue is swollen, red and often fissured.
e. Hairs may fall out resulting in either generalized or localized alopecia.
f. Features of syphilitic meningitis or Meningo vascular syphilis may be present, later often causing cerebral thrombosis.
3. TERTIARY STAGE:-
Tertiary stage appears 2-15 years after the primary infection. The typical lesion during this stage is a hard, localized swelling known as gumma. Gumma can form simultaneously at various sites and causes localized destruction of the affected organs.
a. Skin gumma may form over the legs or elsewhere over the skin surface producing deep sated punched out ulcers. Painless perforating ulcers may develop in the soles.
b. Bones – syphilitic involvement of the bones is the nature of a chronic inflammation. Long bones are more commonly affected. A deep boring pain occurs which is worst at night. Gumma may form over the bones of the face and the nose leading to their destruction and disfigurement.
c. Internal organs - gumma may form inside any of the internal organs such as the liver, testes, lungs, heart, tongue, pituitary or adrenal glands. In the heart formation of gumma may be responsible for conduction defects or localized degeneration of the myocardium. Chronic inflammatory changes may affect the aortic valve.
d. Neurological changes – these include basal meningitis and menigovascular syphilis, general paralysis of insane and formation of a gumma inside the brain that behaves like a cerebral tumour.
INVESTIGATIONS:-
1. During primary or secondary stage, Treponemes can usually be isolated from the exudates and identified by dark ground illumination.
2. Wassermann reaction and khan tests.
3. The venereal disease research laboratory test (VDRL) – it is a flocculation test that detects a non-specific antibody like reacting substance present in the serum of syphilitic persons. Though the test is non-specific, it is still an easy, cheap and fairly reliable test for syphilis.
4. Tests using specific treponemal antigens.
DIAGNOSIS:
The diagnosis is based on
- History of an irregular sexual contact.
- Typical clinical features or symptoms and
- Positive Wassermann reaction and VDRL test.
- During the primary stage, a chancre may be confused with a chancroid. During the secondary stage, syphilitic skin rashes may be confused with several skin disorders. During the tertiary stage, A gumma may be confused with a carcinomatous lesion.
TREATMENT:-
- Treatment should be started as early as possible, even without waiting for the Wassermann test to become positive.
- Pencillin is still the best drug for syphilis.
- Pencillin twice a day for 8-10 days should be given unless the patient is sensitive to pencillin.
HOMEOPATHIC TREATMENT:-
Some of the main remedies for syphilis in homeopathy are given below.
1. ARSENICUM IODUM.
2. AURUM METALICUM.
3. AURUM MURATICUM.
4. KALI IODUM.
5. KALI SULPH.
6. LAUROCERASUS.
7. MERC SOUL.
8. MERC COR.
9. NITRIC ACID.
10. PHYTOLACCA.
11. SILICEA.
12. STILLINGIA SYLVATICA.
13. SYPHILINUM.
14. FLOURIC ACID.
15. GRAPHITIS.
16. LYCOPODIUM.
17. STAPHYSAGRIA.
18. SULPHUR.
