Background

Syphilis is a worldwide health problem since ancient times. It is caused by the bacterium, Treponema pallidum. The classic disease is divided into three stages.

STAGE	CHARACTERIZATION
PRIMARY	Occurs after incubation of 9-90 days Chancre at point of inoculation Painless, well circumscribed with a clean base Usually in anogenital and oral areas
SECONDARY	Develop 6-8 weeks after primary lesion Influenza like syndrome with enlarged lymph nodes Maculopapular erythrosquamous lesions of the skin Shallow ulcers with raised surface may be present on mucosal surfaces May present with patchy nonscarring alopecia Condyloma lata-papular lesions affecting moist areas of the body
TERTIARY	May develop as long as 5-10 years after secondary lesions Affect CNS, cardiovascular system, and bones Skin lesions may be nodular, nodularulcerative, or gummatous

OUTLINE

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/ Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERIZATION
SYNONYMS	Lues

 

GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
General
VARIANTS
SKIN	Unusual presentations include: Pustular Lichenoid Bullous Annular Follicular Rupial Ulcerative

 

HISTOLOGICAL TYPES	CHARACTERIZATION
General
SKIN
Primary	Ulcer with necrotic material and cellular debris Base of ulcer with increased vessels and prominent endothelial cells with plasma cell predominant inflammatory cell infiltrate
Secondary	Psoriasiform dermatitis with superficial and deep mixed infiltrate with plasma cells Epidermis may have collections of neutrophils, parakeratosis, and spongiosis Rarely granulomatous,neutrophilic dermatosis, or pseudolymphoma
Tertiary	Gummatous lesions with histiocytes, plasma cells, and lymphocytes surrounding areas of central necrosis

 

SPECIAL STAINS/ IMMUNOPEROXIDASE	CHARACTERIZATION
Special stains	Warthin-Starry stains or other silver stains are usually positive for the organisms Silver stains may be negative in tertiary disease
IMMUNOPEROXIDASE
Secondary syphilis: a histologic and immunohistochemical evaluation. Hoang MP, High WA, Molberg KH. Department of Pathology, The University of Texas Southwestern Medical Center, Dalls, TX, USA.	J Cutan Pathol. 2004 Oct;31(9):595-9. Abstract quote   The usual method for detecting spirochetes in tissue sections is the silver stain; however, they are often difficult to detect due to marked background staining commonly seen with this technique. In certain clinical settings, such as neurosyphilis, congenital syphilis, and immunosuppressive conditions including human immunodeficiency virus (HIV) infection, a better method of detecting spirochetes in tissue sections is needed. We compare immunohistochemistry (IHC) with a monoclonal antibody to Treponema pallidum to silver staining in 19 biopsies from 17 patients with serologic evidence of secondary syphilis. IHC demonstrated a sensitivity of 71%, which was superior to the 41% sensitivity of the silver stain (p = 0.084). Furthermore, specificity was improved with IHC, as background artifacts were markedly reduced. Dermal spirochetes were visualized in all 12 positive cases, while epidermal organisms were seen in only eight cases. This finding lies contrary to accepted teaching that organisms are most commonly seen at the dermal epidermal junction. Of interest, perineural plasmacellular infiltrates were frequently seen in our cases (74%). Spirochetes were not seen in any of 14 control cases with similar histopathologic patterns. Although serologic studies remain the gold standard, IHC is more sensitive and specific than silver stain for detecting T. pallidum in biopsies of secondary syphilis.

Am J Dermatopathol 1988;10:399-409.
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.

Bacteria

Infectious and Microbiology

Basic Principles of Disease
Learn the basic disease classifications of cancers, infections, and inflammation

Commonly Used Terms
This is a glossary of terms often found in a pathology report.

Diagnostic Process
Learn how a pathologist makes a diagnosis using a microscope

Surgical Pathology Report
Examine an actual biopsy report to understand what each section means

Special Stains
Understand the tools the pathologist utilizes to aid in the diagnosis

How Accurate is My Report?
Pathologists actively oversee every area of the laboratory to ensure your report is accurate

Got Path?
Recent teaching cases and lectures presented in conferences

Pathologists Who Make A Difference
Search for a Physician Specialist
Gross or Clinical Photo of Congenital Syphilis
Gross or Clinical Photo of Primary Syphilis
Gross or Clinical Photo of Secondary Syphilis
Gross or Clinical Photo of Tertiary Syphilis

Last Updated October 1, 2004

Send mail to The Doctor's Doctor with questions or comments about this web site.
Copyright © 2004 The Doctor's Doctor