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Chapter 10 : Sequelae and Long-Term Consequences of Syphilis Infection

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Abstract:

This chapter briefly reviews the biology, epidemiology, and natural history of syphilis. Further, it characterizes the infectious complications and sequelae of untreated syphilis infection by organ system from natural history studies and more recent case reports. The clinical diagnosis of syphilis is based on characteristic findings on the skin and mucous membranes and confirmed with serologic assays measuring antibodies to nontreponemal (rapid plasma reagin [RPR] or venereal disease research laboratory tests) and treponemal antigens ( particle agglutination, fluorescent absorption, and enzyme immunoassays). Syphilis is transmitted through direct contact with an infectious lesion. The primary modes of transmission are sexual contact and maternal transmission during pregnancy. Chronic inflammation is characterized by lymphocytic infiltration, a high concentration of plasma cells, and increased fibroblastic activity. disseminates early within the body and localizes within the bone marrow and the richly vascularized periosteum and dependent areas of the long bones. Syphilis of the gastrointestinal system is generally much less common than syphilis of the skin or cardiovascular or nervous system. Involvement of the aortic root is the most common manifestation of cardiovascular syphilis. Stokes reported on 200 cases of syphilis and aortic disease. The clinical manifestations of untreated syphilis infection are due to a chronic inflammatory process with resultant fibrosis that can impact almost any body system. has a predilection for highly vascularized tissue, like the brain and heart.

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10

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Figures

Image of Figure 1.
Figure 1.

Reported incidence of primary and secondary syphilis and congenital syphilis, China 1988–2005. (Reprinted from the [ ] with permission from Elsevier.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 2.
Figure 2.

Primary chancre of the penis.

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 3.
Figure 3.

Gumma of the skin. (Reprinted from [ ] with permission from Lippincott Williams & Wilkins.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 4.
Figure 4.

Sternal bony lesion shown by magnetic resonance imaging (MRI). (Reprinted from [ ] with permission from Mary Anne Liebert, Inc.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 5.
Figure 5.

Fine-needle liver aspiration biopsy in hepatic tertiary disease. (Reprinted from [ ] with permission from Springer.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 6.
Figure 6.

Postmortem microscopic findings showing perivascular inflammatory infiltrate of the aortic wall (a) and higher resolution plasma cells and lymphocytes (b). (Reprinted from [ ] with permission from Elsevier.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 7.
Figure 7.

Magnetic resonance imaging MRI showing saccular aneurysm. (Reprinted from the [ ] with permission from Elsevier.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 8.
Figure 8.

Gross autopsy photograph showing coronary artery ostial narrowing by syphilitic aortitis. (Republished with permission of Joseph A. Prahlow, forensic pathologist, South Bend Medical Foundation and Indiana University School of Medicine, South Bend at the University of Notre Dame, South Bend, IN.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 9.
Figure 9.

MRI (a and b) showing multiple cerebral syphilitic gummas in patient with HIV and RPR titer of 1:32. Significant improvement shown after treatment with penicillin (c and d). (Republished from reference with permission from the .)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Image of Figure 10.
Figure 10.

Two-month-old baby with congenital syphilis showing (a) hepatomegaly and (b) skin rash. (Reprinted from [64] with permission from the American Sexually Transmitted Diseases Association.)

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10
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Tables

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Table 1.

Tabes dorsalis: signs and symptoms

Citation: Klausner J, Freeman A. 2009. Sequelae and Long-Term Consequences of Syphilis Infection, p 187-204. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch10

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