Treponema Pallidum

• Treponema pallidum

  The organism responsible for syphilis
• Dark field microscopy


  Can identify treponema pallidum
• Syphilis is a sexually transmitted infection
• Jarisch-Herxheimer reaction


  Febrile reaction that may occur following treatment of syphilis, due to release of cytokines, lipoproteins, and immune complex formation
• Jarisch-Herxheimer reaction begins following treatment with penicillin
• Stages of syphilis

  • Primary
  • Secondary
  • Tertiary
• Primary syphilis


  Presents with a painless genital chancre
• Primary syphilis chancre


  • Painless genital chancre on the shaft of the penis
• Non-treponemal tests


  Screening tests for syphilis, detect anti-cardiolipin antibodies
• Treponemal tests


  Confirmatory tests for syphilis, detect antibodies against treponema pallidum antigens
• VDRL and RPR tests


  Non-treponemal tests that detect anti-cardiolipin antibodies
• FTA-ABS test


  Treponemal confirmatory test that detects antibodies against treponema pallidum
• Both a non-treponemal and treponemal test must be positive to confirm active treponema pallidum infection
• If neurological symptoms are present, CSF should also be tested
• VDRL and RPR test
• Anti-cardiolipin antibodies


  Detected in non-treponemal tests like VDRL and RPR
• the fluorescent treponemal antibody absorption (FTA-ABS) test
• Secondary syphilis


  Presents with a maculopapular rash on the trunk, palms, and soles
• Secondary syphilis rash


  • Maculopapular rash on the trunk
  • Maculopapular rash on the palms
• Condylomata lata


  Warty lesions that may occur in secondary syphilis
• Condylomata lata


  • Warty lesions surrounding the female genitalia
• Lymphadenopathy


  • Large network of lymph nodes that resemble beads on a net
• Patchy hair loss

  • Patches of hair loss on trunk
• Gumma


  Unique type of granuloma seen in tertiary syphilis, characterized by inflamed tissue surrounding a firm necrotic center
• Neurosyphilis


  • Invasion of the central nervous system, may result in meningitis, meningovascular disease, or damage to the spinal cord
• Tabes dorsalis


  • Damage to the dorsal columns of the spinal cord, causing abnormal proprioception and vibration
• Tertiary syphilis


  May cause aortitis resulting in a tree bark appearance of the aorta
• Argyll Robertson pupils


  • Pupils that accommodate or reduce in size when focused on a close object, but do not reduce in size in the presence of bright light
• Neuropathic arthropathy (Charcot joint)


  • Decreased sensation to the joint due to neuropathy, resulting in joint damage
• Congenital syphilis


  • May cause notched teeth, mulberry molars, hearing loss, saddle nose, snuffles, and saber shins
• Congenital syphilis

  Can be prevented if the mother is treated with penicillin early during pregnancy
• Penicillin is the treatment for syphilis in general
• Diagnosis of syphilis


  Perform non-treponemal test (e.g. VDRL, RPR) followed by confirmatory treponemal test (e.g. FTA-ABS)