Classification of Syphilis : 

 A. Acquired syphilis :

1. Early :

• primary syphilis.
• Secondary syphilis.
• Latent syphilis.

2. Late: 

• Latent syphilis
• Benign tertiary.
• Quaternary.

B. Congenital syphilis :

1. Early : 

• Clinical syphilis
• Latent syphilis.

2. Late : 

• Clinical syphilis
• Latent syphilis
• Stigmata syphilis.

Clinical features of syphilis : 

1. Early stages : 

  A. Primary syphilis  :    

• History of exposure usually 2-4 weeks back.
• Chancre develops at the site of infection, usually on the genitals, anus and rectum. 
• Regional lymph nodes : Moderately enlarged, mobile, discrete, rubbery, painless and tender.
• The primary chancre heals without treatment.

B. Secondary syphilis : 

1. Develops 6-8 weeks after the appearance of primary chancre.
2. Mucosal ulceration.
3. Rash
4. Lymphadenopathy.
5. Condylomata – lata.

2. Late stages :

A. Latent syphilis : May persists for many years.

B. Tertiary syphilis : 

• Usually develops within 3 to 10 years of infection.
• The mainly affect skin and subcutaneous tissues, mucous membrane.

C. Quartentary syphilis : Cardiovascular and neurosyphilis take longer to develop and may lead to the patient death.

Investigation of Syphilis : 

A. Microscopic examination : 

• Dark ground illumination test.
• Immunofluorescent test.

B. Serological test : 

 1. Non specific or lipoid antigen test : 

• VDRL  (Venereal disease research laboratory) test.
• RPR ( Rapid plasma regain).

2. Specific antibody tests :

•  TPHA ( Treponema pallidum haemagglutination test).
• FTA – abs (Flurescent treponemal  antigen absorbent test).
• ELISA (Treponemal enzyme linked immune sorbent assay).

Treatment of Syphilis : 

Treatment : ( CDC recommendation – 1998) : 

A. Early syphilis (Primary, secondary and early latent syphilis of less than 1 year of duration) : 

1. Benzathine penicillin G 2.4 million units IM, single dose, half to each buttock.
2. IN penicillin hypersensitive cases : Tetracycline or Erythromycin 500 mg 4 times daily orally for 14 days.

B. Late syphilis : 

1. Benzathine penicillin G 2.4 million units IM, weekly for 3 weeks.
2. Alternative regimen : Doxycycline 100 mg orally twice daily or Tetracycline 500 mg 4 times daily orally for 4 weeks.

Treatment of syphilis in pregnancy : 

1. The treatment is the same as above.
2. The women who is allergic to penicillin should be treated with Certriaxone.
3. The baby should be assessed at birth and at 6 weeks and 3 months after birth.

Complication of syphilis in Pregnancy : 

1. Miscarriage.
2. Premature birth.
3. Fetal growth restriction ( also called growth- restricted, small for gestational age or small for date) and low birth weight.
4. Problems with the placenta and the umbilical cord.
5. Stillbirth.

Prevention of Syphilis :

1. People should be educated about dangers of syphilis.
2. Advice regarding nutrition, sanitation and personal hygiene.
3. Use of condom, diaphragm, intravaginal jellies and cream.
4. Genital wash after intercourse.
5. Provision of decent living condition.
6. Marriage counseling and pre-marital examination.
7. Motivation of sexual behaviour.
8. Education to rise the responsibility that his or her partner should attend the venereal disease clinic.
9. Education informing the importance of completing treatment and follows up.