Syphilis Classification and Clinical Manifestations

According to the WHO, syphilis classification are early and late syphilis, with the time difference between the two is two years, and some even say four years. This classification is based on epidemiological considerations. Early syphilis can transmit the disease due to there is Treponema pallidum in skin disorders. Late Syphilis is no longer contagious because there are no bacteria in the lesion. In pregnant women, Treponema pallidum can enter the body of the fetus.

Clinically, Classification syphilis are congenital syphilis and aqcuired syphilis. Syphilis aqcuired divided as follows: Syphilis stage I, II, III, and IV, cardiovascular syphilis, and syphilis on the brain and nerves. Syphilis d'emblee is  a state if Treponema pallidum directly entry into the body through the blood of the prospective patient, for example, in blood transfusions.

clinical symptoms
1 In syphilis aqcuired
A. Syphilis stage I
Between 10-90 days (usually 3 weeks) after infection, lesions occur on the Treponema pallidum entry.
a. Primary Afect is a form of papules which infiltrates into the erosion surface peeling .Besarnya 1-2 cm long, are round or oval, basically clean, red, surrounding skin no signs of inflammation and in touch when there is hardening (induration), which is one layer as a button under the fabric or on a piece of thin cardboard, these abnormalities are not painful (indolent)
Primary affective in men can be found on the glans penis, prepuce, the base of the penis and urethra. Whereas in women, can be found on the labia major / minor, clitoris, urethra, cervix, and rarely in the vagina.
Moreover, it can also be located in areas such ekstragenital: lips, tongue, tonsils, fingers, nipples, and anus.
b. Durum ulcer which is the state where the original erosion can turn into ulcers occur perpendicular walls, while other properties such as the primary affect may be fagedenic when the ulcer extends to the side and into the.
c. Induratif edema, ie there is edema of the Treponema pallidum entrance, it is often found in the labia majora.
d. The primary complex Treponema enter the blood stream and lymph tissues and spread throughout the body, including the regional lymph nodes. The gland enlarges, solid, rubbery, painless on palpation, solitary and can be moved freely.
This disorder usually disappears spontaneously within 3 weeks but this does not mean that the patient is cured.
Lesions of syphilis stage I generally found on the genitals and can also ekstragenital. Syphilis stage I can heal spontaneously, fast or slow depends on the size of the lesion.

Two things are very important in the first stage of syphilis is
a. If the patient has received any form of treatment of locally specific or systematic, Treponema pallidum in the lesions will disappear so that the patient is not expected to suffer from syphilis. Academically to look for Treponema pallidum 3 times for 3 consecutive days turut.Bila still can not be proven, the diagnosis may be made clinically.
b. Generally on every lesion on the genitals though not syphilis, when given local treatment can occur induration false (pseudo induration). Therefore, a careful history is crucial.

B. Syphilis stage II
In general, when the symptoms of syphilis stage II appeared, siflis stage I, has been recovered. The time between the first and second stage of syphilis is generally 6-8 weeks. Sometimes it happens at the transition stage I syphilis is still present at the second stage of syphilis symptoms arise. The second stage of syphilis is called the great imitator of the skin disease because it can give the signs that resemble skin diseases. Another distinctive trait in the second stage of syphilis is no itching, if there is very rarely.
In clinical stage II syphilis are skin and mucous membrane disorder and lymphadenitis are generalized. Skin disorder consists of:
a. Macula: roseola, reddish, round / oval, especially on the chest, abdomen, back, and sleeves, color changes can occur, especially around the neck called leukoderma coli or colar of venus.
b. Papules: hair scattered on the border of the head is called the corona veneris. Kondiloma lata found in the folds of the skin is moist and warm state. Location of papules also present in hair follicles (follicular) and result in alopecia syphillis. Large papules may form a crust so the picture as it is called syphilis frambosiformis frambosia.
c. Pustular: usually start with papules that become pustules, which break down into ulcers covered by a crust that gives a picture like oysters.
d. Rupia: abnormalities of the mucous membrane in the form of white plaques that contain lots of Treponema pallidum.
e. Adenitis: common, especially in the suboccipital region is dense, chewy, not pain, separated from one another and with the surrounding.
f. Other organs are sometimes attacked on the second stage of syphilis is the eyes, heart, brain, bones and kidneys.

C. Syphilis stage III
The lesions were typical in this stage is the gumma may occur 3-7 years after infection. Gumma can occur in all tissues and organs, forming a central necrosis surrounded by granulation tissue and fibrous tissue on the outside, a destructive nature. Skin over at the beginning regardless then attached to the gumma. Gumma suffered suppuration and break and leave an ulcer with steep walls and deep, there are basically yellow white necrotic tissue.
Other disorders that can be shaped very big lymph nodes under skin. Generally form a circle or polycyclic configuration. Sometimes become ulcers with steep walls. Nodes can be scaly surface.
Syphilis in stage III nature can destroy all kinds of bone-cartilage tissues of the nose and palate and most often affects the liver. Another tool in the parotid gland can be affected is, stomach, spleen, pancreas, kidneys, heart, urinary bladder, uterine cervix, breast, testicular, and other.

D. Syphilis stage IV
Diseases in level IV became the principal diseases are as follows:
1 Dementia paralitika: mental paralysis, the disease takes place primarily in the brain, usually occurring between 5 and 20 years.
2 tabes dorsalis: Diseases that are attacked tactile nerve bundles (sensible) on the back (dorsal) to the spinal cord.
3 Tabo Paralis: this disease there are no symptoms in dementia paralitika, and tabes dorsalis.

2 Cardiovascular Syphilis
Generally manifests 10-40 years after infection. As many as 10% of patients will experience this phase of syphilis. Diagnosis based on clinical symptoms, X-rays and other auxiliary examination.
Men attacked more, than women. People with skin color more often attacked than white. The heart and blood vessels, especially large ones that are known. Death occurs in syphilis because these abnormalities in syphilis.

3 Neurosyphilis
This disease usually manifests within 10-20 years after infection with Treponema pallidum, although a direct move after infection to the nervous system and muscles. Symptoms are very variable, namely meningovascular, tabes dorsalis and dementia paralytica.
Neurosyphilis is divided into 3 types:
1 asymptomatic neurosyphilis
Serologically reactive. No signs and symptoms of central nervous system damage. Examination of the spinal fluid showed an increase of cells, total protein and reactive serologic tests
2 neurosyphilis meningovascular
Signs and symptoms of central nervous system damage, such as damage to cerebral blood vessels, infarction, and ensefalomalasia with signs of focal neurologic according to the size and location of the lesion.

3 parenchymatous neurosyphilis
a. paresis
The signs and symptoms of paresis very much and obtaining showed parenchymatous damage spread. Changes in the nature of self can occur from mild to psikotik.Terdapat focal neurological signs. Examination of the spinal fluid showed an increase of cells, total protein and reactive serologic tests
b. tabes dorsalis
The first signs and symptoms of tabes dorsalis due to degeneration of the posterior columns are paresthesias, ataxia, areflexia, bladder disorders, impotence and feelings like pain dismembered. Examination of the spinal fluid abnormal in almost all patients and serology showed reactive part.

4 Congenital Syphilis
Congenital syphilis is an infectious disease caused by Treponema pallidum and is transmitted from a mother to her unborn fetus, can cross the placenta (placenta larger and pale, not fresh, grayish and slippery) and entered into the fetal circulation.
Fetal infection rarely occurs before the moon to 4 and 5 to a rare disorder of pregnancy that organ formation. Infected tissue is bone, bone marrow, lung, liver and spleen.
Travelling together with syphilis congenital syphilis acquisita, Treponema pallidum straight into the blood circulation. Therefore, there is no stage I syphilis.
Congenital syphilis is divided into three, namely:
A. Early Congenital Syphilis
In congenital syphilis Early signs and symptoms typically present before the age of 2 years (generally 2-6 weeks). Earlier emergence of clinical manifestations means a poor prognosis.
Signs of early congenital syphilis are:
a. Rhinitis is typical with secret mucopurulent, sometimes bloody, upper lip peeling. Sometimes - sometimes there is ulceration of the nasal cartilage and eventually became a snub nose.
b. Abnormalities of the skin and mucous
1 round Maculopapule not itchy, slightly raised, at first pink and then crimson, scar when healed
2 in the form of pemphigus bullae were found everywhere but typically on the soles of the feet and hands then a secondary infection.
3 desquamation of the skin on the soles of the feet, hands and around the nail. Before or after exfoliation, the skin looks soles of the feet and hands are red.
4. Ragaden the corners of the mouth and the skin around the nose broke
5. condylomata are mainly located around the anus, vulva, and sometimes around the mouth
c. Pneumonia alba, found in infants who are born dead or die shortly after birth
d. Central nervous system is usually affected too, can be seizures, hydrocephalus, blindness, deafness, cerebrospinal liquor. In the majority of patients encountered spinal fluid abnormalities.
e. Usually there micrcystic and hypochromic anemia, lymphocytosis, lymphodenopathy and edema.

B. Advanced Congenital Syphilis
Usually occurs after the age of 2 years. Congenital syphilis is not transmitted further.
Sign - a sign of congenital syphilis:
a. The length and weigh less than usual, this may be caused by liver and kidney dysfunction.
b. Interstitial keratitis found at the age of 5-15 years, usually bilateral. Blurring of the cornea arise to resemble glass sclera accompanied vascularization.
c. Hutchinson triad is deaf
d. Ragaden in the corner of the mouth, dry skin, alopecia and sometimes there are ulcers.
e. Abnormalities meningovasculous with the mental deterioration, spastic paralysis, hydrocephalus, meningitis.

C. Stigmata
Congenital syphilis lesions early and late can heal and leave a scar and a typical abnormalities. Grate and such abnormalities are stigmata of congenital syphilis.
1 Early lesions Stigmata
a. Picture shows the face of the saddle nose
b. Teeth show picture  Hutchinson insisor teeth and dental mulberry
c. Ragades
d. Atrophy and abnormalities caused by inflammation
e. Choroido-retinitis, forming regions surrounded by white scar pigmentation in the retina.

2 Stigmata Late Lesions
a. Lesions of the cornea: corneal haziness
b. Lesions in bone: saber tibia, due osteoperiostitis
c. Artrofi optics, alone without iridoplegia
d. nerve deafness

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