Pathogenesis of Syphilis

A. Early Stage

         In acquired syphilis T.pallidum get into the skin through a micro-lesions or mucous membranes, usually through sex. The germs multiply, tissue reacts by forming infiltrates consisting of lymphocytes and plasma cells, particularly in the perivascular, small blood vessels proliferate, T.pallidum and surrounded by inflammatory cells. Treponema is located between the capillary endothelium and perivascular tissue around it. Loss of bleeding will cause erosion, on clinical examination appear as SI.

          Before SI appears, germs have reached the regional lymph nodes limfogen, and multiply. At that time there were also hematogenous spread and spread to all tissues in the body, but its manifestations will appear later. This multiplication, followed by reaction of the network as the SII, which occurred 6-8 weeks after SI.

       SI will recovered slowly because of germs in that place, the amount is reduced, then forming fibroblasts and eventually recovered in the form of cicatricial, SII also regresses slowly and then disappeared. Came the latent stage which is not accompanied by symptoms, although there is still an active infection. For example, at this stage a mother can give birth to babies with congenital sifillis.

         Sometimes the process of immunity fails to control the infection so that T, pallidum multiply again in the SI and cause recurrent lesions or bacteria are spread through the network causing a similar reaction with recurrent lesions of SII, the latter is more common than the former. The infectious lesions can be repetitive, but generally does not exceed two years. Syphilis was found in patients with low body resistance.

B. Syphilis Later Stage
      Latent stage can last for years, apparently dormant treponemes. Nevertheless there remains antibodies in the serum of patients. The balance between treponemes and networks can change suddenly, why is not clear, perhaps trauma is a factor of precipitation. By the time it comes in the form of gumma SIII. Although the gumma is not found T.pallidum, great reaction because it is destructive and lasts for years. After experiencing a latency period that varies gumma arise in other places.

         Treponema reach the cardiovascular system, and nervous system at an early time, but the damage occurs slowly so it takes many years to cause clinical symptoms. Patients with gumma usually do not get nervous and cardiovascular disorders, as well as better. Approximately two thirds of cases with latent stage does not give symptoms.


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