Syphilis is a type of sexually transmitted infection that is caused by a type of bacteria known as Treponema Pallidum. One of the first si...

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Syphilis is a sexually transmitted disease (STD) that is caused by Treponema pallidum infection. The most common way to transmit T. pallid...

SYPHILIS Syphilis has been well described in the literature since the late 1400s. The history behind the discovery and treatment of the disease is a story of perseverance and the willpower of many scientists working separately and together to help treat one the most deadly diseases of their time. Philip Ricord, a French scientist, is given credit for describing the three stages of syphilis and differentiating it from other diseases such as gonorrhea. The infectious organism, Treponema pallidum, was described in 1905 by Fritz Schaudinn, a German zoologist, and Erich Hoffman, a German dermatologist. Soon after this discovery, the German scientist Paul Ehrlich developed the first specific therapy for syphilis. The oral medication he and his team discovered was initially called 606, because it was the 606th compound they had attempted to use to treat the disease. This organoarsenic molecule was soon renamed salvarsan. This medication is highly effective against T. pallidum. T. pallidum is classified as a spirochete. Spirochetes are gram-negative bacteria that have a winding or coiled linear body. There are three subspecies of T. pallidum; the one responsible for syphilis is named Treponema pallidum pallidum. The other subspecies of T. pallidum cause endemic syphilis or bejel, pinta, and yaws. Syphilis is a highly infectious disease that is trans- mitted via sexual contact or vertically from an infected mother to her unborn child. Syphilis has been recognized to progress through three stages: primary, secondary, and tertiary. Not all cases progress through all of the stages, and only about one third of untreated cases eventually progress to tertiary syphilis. The secondary and tertiary phases are interrupted by a latent phase of variable length. SYPHILIS OF GENITALIA Clinical Findings: Both historically and today, most cases of syphilis have been transmitted via sexually intercourse. The disease is often seen in conjunction with other sexually transmitted diseases (STDs), especially human immunodeficiency virus (HIV) infection. The two infections may actually facilitate each other’s infectious potential. There is no race or sex predilection; the organism is able to infect any host with whom it comes in contact. The initial infection in most cases results in clinical findings in the genital region. Primary syphilis is marked by a nonpainful ulceration that begins as a red papule and ulcerates over a period of a few days to weeks. The average time to onset of the ulcer is 3 to 4 weeks after exposure, but it can occur 3 to 4 months later. This primary ulcer, called a chancre, is firm to palpation. The ulcer can be found anywhere on the genitalia, including the labia, vaginal introitus, and mons in females and the glans, foreskin, and penile shaft in males. Lesions on the foreskin of males often show the Dory flop sign. This occurs when one grasps the area of the prepuce containing the ulcer and slowly retracts the proximal edge; after a critical angle has been achieved, the entire ulcer flops over. This occurs because the ulcer is firm and does not bow under pressure. If left untreated, these ulcers self-resolve within 1 to 3 weeks. After this occurs, the bacteria hematogenously disseminate to other organ systems. The timing of secondary syphilis is variable: It can occur immediately after primary syphilis or up to 6 months after the chancre of primary syphilis has healed. The average time frame is approximately 6 weeks after healing of the primary ulcer. Without treatment, most if not all patients experience symptoms and skin lesions of secondary syphilis. Patients universally complain of constitutional symptoms such as malaise, fever, chills, fatigue, and weight loss. Cutaneous findings can be multifaceted. The most prevalent skin finding is that of skin-colored to red to slightly hyperpigmented papules and patches. The palms and soles are characteristically involved, and this is a clue that the diagnosis of syphilis should be entertained. Condylomata lata is the name given to the moist plaques that develop in the groin region from secondary syphilis. These lesions contain numerous T. pallidum organisms. Adenopathy is almost always present. Some rare findings of secondary syphilis include ulcers in the mouth, which can mimic aphthous ulcerations, and a nonscarring alopecia. The alopecia has been described as having a “motheaten” appearance. This is in reference to the random arrangements of patches of alopecia. All the lesions of secondary syphilis contain the bacteria, and samples can be taken and directly observed under darkfield microscopy. The organisms are seen as mobile spirochetes with a spiral configuration. Patients with secondary syphilis may have early central nervous system (CNS) involvement and may complain of head- aches and other meningeal signs. Approximately 3 to 4 months after the first signs and symptoms of secondary syphilis appear, they spontaneously resolve. This is the beginning of the latent phase, which is a phase of wide variability. Some patients never develop tertiary syphilis, and approximately 1 in 5 develop a recurrence of secondary syphilis. SYPHILIS OF ORAL CAVITY Tertiary syphilis follows the latent phase of syphilis in 30% to 40% of untreated individuals. The average time from initial development to tertiary syphilis is approximately 4 years. Tertiary syphilis can affect the skin, bone, and mucous membranes. The characteristic skin finding is the gumma. Gummas appear frequently as individual lesions, although a multitude of gummas may occur at the same time. The gumma starts as a papule and then evolves into a nodule, which ulcerates over the course of a few days to weeks. The ulceration is caused by significant necrosis of the involved tissue. This leads to deep ulcers with well-defined borders. The surface of the ulcer may be covered with gelatinous exudates. Another form of tertiary syphilis is the nodular syphilid skin lesion. These lesions are red to red-brown nodules that slowly enlarge and can develop various configurations, including serpiginous and annular formations. These lesions rarely, if ever, ulcerate. Unique forms of syphilis that do not fit neatly into one of the categories already described include neuro- syphilis, congenital syphilis, and late syphilis. Involvement of the CNS by T. pallidum is termed neurosyphilis. Neurosyphilis can occur during any of the numerous forms and stages of syphilis. It is caused by direct infection of the CNS by the spirochete. Most patients with syphilis exhibit no signs of CNS involvement, even when the bacteria can be isolated from the CNS. However, almost all of these cases of asymptomatic neurosyphilis eventually progress to symptomatic clinical illness. Some of the common symptoms of neurosyphilis are headache, hearing difficulty, neck stiffness, and muscle weakness. As the disease progresses untreated, patients develop seizures, delirium, and tabes dorsalis. Tabes dorsalis results from degeneration of the posterior columns of the spinal cord. The posterior columns are critical for proper sensation, and patients with tabes dorsalis develop gait disorders, diminished reflexes, proprioception abnormalities, pain, paresthesias, and a host of other neurological symptoms. If neurosyphilis remains untreated, the patient dies of the disease. Therefore, any patient who exhibits signs or symptoms of neurosyphilis should undergo a spinal tap to evaluate the cerebrospinal fluid for involvement with T. pallidum. Congenital syphilis occurs as the result of vertical transmission from an infected mother to her unborn fetus. Up to one third of infected neonates die of the disease. In neonates who survive, the disease manifests in many ways. Neonates may present with macerated erosions associated with cachexia and failure to thrive. “Snuffles” is the term used to describe the chronic runny nose with a bloody purulent discharge. Rhagades are one of the most common signs seen in congenital syphilis; they appear as scarring around the mouth and eyes. Many bony abnormalities have been reported, including a saddle-nose deformity, the Higoumenakis sign (medial clavicular thickening), saber shins, and Clutton’s joints. Teeth abnormalities include Hutchinson’s teeth (notched incisors) and, less frequently, mulberry molars. Histology: Skin biopsies of syphilis that are evaluated with routine hematoxylin and eosin (H&E) staining show varying features depending on the stage and form of disease being biopsied. A universal finding in all forms is the presence of numerous plasma cells within the inflammatory infiltrate. Ulceration, granulomas, and vasculitis are often encountered. The spirochetes cannot be appreciated with routine H&E staining; special staining techniques are required. The Steiner stain and the Warthin-Starry stain are the two most commonly used stains. Immunohistochemical stains can also be used, and they have been shown to be highly sensitive and specific. SYPHILIS IN PREGNANCY Pathogenesis: Syphilis is caused by the spirochete, T. pallidum pallidum. This bacteria is highly infective and is predominantly spread by sexual contact and by transmission from an infected mother to her unborn child. Treatment: The T. pallidum organism has very little antibiotic resistance, and the therapy of choice is still penicillin. A single intramuscular dose of 2.4 million IU of benzathine penicillin G is recommended, and some now recommend a follow-up dose—the same as the initial dose—at 1 or 2 weeks. Patients who develop neurosyphilis need to be treated with intravenous penicillin for at least 2 weeks. Most patients who are treated for syphilis develop the Jarisch-Herxheimer reaction. This reaction is the result of the decimation of the T. pallidum organisms due to therapy with penicillin. As the scores of bacteria are killed, the dead spirochetes induce an inflammatory reaction. This reaction may manifest as fever, chills, fatigue, malaise, and rashes of varying morphology. It can often make the rash of secondary syphilis appear worse for a period of time. This reaction is not specific to T. pallidum and has been reported with other infectious agents. It is critical to follow patients long enough after therapy ensure adequate treatment as measured by titers on rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) testing. All patients with syphilis should be tested for HIV.

Syphilis - Primärstadium (Foto: Nau Nau | Shutterstock)

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Syphilis is a sexually transmitted disease (STD) caused by the bacteria Treponema pallidum. Learn more about syphilis causes, symptoms, and treatment options.

Oral Manifestations in Various Skin Conditions A great number of pathologic conditions of the skin have accompanying oral manifestations that may precede or occur concurrently with or independent of the cutaneous eruption. In general, such lesions do not bear strict comparison with the skin lesions, because of the considerable difference in moisture, temperature, exposure to trauma, lack of a keratin layer, and the presence of secondary infection. In the differential diagnosis the prevalence of purely local lesions of a vesicular or bullous type (e.g., recurrent aphthous ulcers) should be kept in mind. One of the familiar dermatoses in which the oral mucosa may participate is lichen planus, which is a chronic inflammatory disorder with no malignant potential. It has the appearance most commonly of rectangular white plaques associated with erythema and erosions; less often seen are ulcerations and hyperkeratotic plaques. The pathogenesis has not been completely elucidated, but it involves a T cell–mediated immune response causing a cytotoxic reaction by activating CD8 T cells against epithelial basal cells. The diagnosis is confirmed through a review of the patient history, physical examination, and histologic findings. The presence of the purplish, polygonal, or angular skin papule eruptions improves the accuracy of the diagnosis. In a majority of cases, however, the oral lesions precede those of the skin surfaces, and, not infrequently, the disease may remain confined to the mouth. Most often, the cheek mucosa displays the characteristic fine, lacelike pattern of bluish white lines and small, pinhead-size, elevated papules, although the tongue, palate, and gingiva may be similarly affected. The latter locations, as compared with the cheek, usually show coarser plaques and aggregated papules. The lips are least commonly involved. Occasionally, an erosive form may be observed, which is painful and characterized by a caked, whitish material covering a red base in which bleeding is easily induced. The radiating and interlaced grayish white lines are the most significant signs in the diagnosis. These lesions are most often seen in HIV/AIDS and other immunosuppressed conditions. Differentiation from syphilis, moniliasis, and glossitis migrans is easily made, but differentiation from other local leukokeratoses is sometimes difficult, and biopsy then becomes a helpful adjunct. The histopathologic picture in lichen planus shows moderate keratosis or parakeratosis, a “sawtooth” arrangement of the rete pegs, and a very typical band of lymphocytes chiefly concentrated beneath a vague basal cell zone. This lymphocytic infiltrate is sharply demarcated from the rest of the stroma. Pemphigus begins in over 50% of cases with manifestations on the oral mucosa, where large, painless vesicles or bullae develop. The thin-walled blebs rupture in a short time, leaving a superficial ulcer rimmed with tattered, grayish shreds of thin membrane. Signs of inflammatory reactions are absent in the early stages but may present themselves later in the form of a slightly red halo. The onset is insidious, chronicity and recurrence being typical even when unaccompanied by skin signs. As the disease progresses, confluent areas become raw and oozing, and salivation, pain, and bleeding increase; mastication and swallowing are impaired. Erythema multiforme major may affect, along with the skin, the mucous membranes of the mouth, eyes, and anogenital regions. Erythema multiforme minor presents similarly but without any mucosal involvement. Both the major and minor forms have the distinctive target skin lesions. The earliest vesicular lesions in the mouth are sometimes indistinguishable from those of pemphigus. A diffuse bullous stomatitis ensues, with a heavy yellowish pseudomembrane, a marked variation in the size of the lesions, and, often, a bluish red areola around the lesions. The lips are usually swollen, ulcerated, and covered with hemorrhagic crusts. The severity of the disease varies. Recurrence is common and tends to be seasonal. Although the development of erythema multiforme has been linked to many factors, including but not limited to, medications, malignancy, autoimmune disease, and herpes simplex virus infection, the virus is the precipitating agent in over 90% of cases. Stevens-Johnson syndrome is a rare acute, life-threatening mucocutaneous disease that is nearly always triggered by a drug. Most often the offending agents are allopurinol, anticonvulsants, antimicrobial agents, and nonsteroidal medications. The cutaneous reaction includes extensive keratinocyte cell death causing separation of areas of skin at the dermal-epidermal junction. The oral mucosa and the vermillion border are almost invariably involved with painful hemorrhagic erosions covered with a grayish white membrane. Stomatitis and mucositis lead to impaired oral intake, with consequent malnutrition and dehydration. The degree of body surface area involved in the skin separation process in Stevens-Johnson syndrome is up to 10%. Toxic epidermal necrosis is a further progression of the cutaneous process, resulting in involvement of more than 30% of the body surface area. If the involvement is between 10% and 30%, the disease is classified as a combination of Stevens- Johnson syndrome and toxic epidermal necrosis. Acquired epidermolysis bullosa is an autoimmune subepithelial blistering disease that primarily affects elderly individuals; it has no predilection for gender or race. The skin eruption is generalized and favors skin folds and flexural areas. The initial presentation is an area of localized erythema or urticarial papules that coalesce into plaques and subsequently turn into dark-red vesicles and bullae in a few weeks. Oral blisters can develop; they are few in number and are less severe and more transient than the cutaneous lesions. Hereditary epidermolysis bullosa is a heterogeneous group of genetic bullous disorders characterized by blister formation in response to mechanical trauma. The dystrophic and junctional types are more serious and include organ involvement, skin breakdown, and scarring. Enamel hypoplasia is present in, and limited to, the junctional form, causing pitting of the deciduous and permanent surfaces of the teeth. Dental caries is prominent in both the junctional and dystrophic forms of the disease. None of the serious cutaneous or oral manifestations have been described in the simplex form of the condition. Langerhans cell histiocytosis (histiocytosis X) is a rare disorder characterized by organ infiltration of Langerhans cells. Papules, vesicles, nodules, and a seborrheic-like pattern on the scalp and diaper area are the primary cutaneous findings of the disease. Dental problems are seen in 30% of patients, and they include a destructive periodontitis resulting from osseous infiltration of the Langerhans cells. Ultimately this can cause destruction of the dentition support system from the maxilla and mandible and loosening of the teeth (floating teeth). Periodontal involvement characterized by gingival recession and pocket formation ultimately leads to alveolar bone loss, culminating in loss of dentition. Congenital erythropoietic porphyria is a rare autosomal recessive disorder that is phenotypically depicted as an abnormality of heme biosynthesis. A pale oral mucosa and teeth that appear a red-maroon color (erythrodontia) are the primary dental abnormalities seen. The pattern of discoloration is distinct and aids in the diagnosis. The incisors are nearly completely stained, whereas the canines are colored at the cusp tips and the molars demonstrate varying degrees of discoloration. The coloring of the teeth is thought to be from an affinity of porphyrins for the calcium phosphate rich teeth. Congenital syphilis is a result of transplacental infection by Treponema pallidum. Cutaneous findings of red macules and papules, a papulosquamous eruption, or a desquamating dermatitis are seen in less than half of the infants infected, but hemorrhagic bullae on the palms and soles are pathognomonic of the infection. Rhinitis, mucous patches on the lips, mouth, tongue, and palate, and condylomata mainly in the anogenital area and angles of the mouth are characteristic. Ectodermal dysplasias constitute a group of hereditary conditions characterized by one or more ectodermal structures, including the skin. The typical areas affected are the hair (hypotrichosis, partial or complete alopecia), nails (dystrophic, hypertrophic, or abnormally keratinized), tooth enamel (defects or absent), and hypoplastic or aplastic sweat glands. Dental defects are characteristic and a core manifestation of the disease, including anodontia, polyodontia, dysplastic teeth, retained primary teeth, deficient enamel development (amelogenesis imperfecta), and underdevelopment of the alveolar ridge. Tuberous sclerosis (Bourneville disease) has an autosomal dominant inheritance. It results in the formation of hamartomatous lesions in several organ systems, including the skin, brain, kidney, ear, lung, bone, and eye. Characteristic oral lesions include gingival fibromas and dental enamel pits caused by a reduced amount of enamel present during dentition development. The pits are large defects in the enamel without a change in color or texture of the enamel surrounding the pit, producing a pockmarked appearance. Nevoid basal cell carcinoma syndrome is an autosomal dominant predisposition for the development of epitheliomas, medulloblastomas, and other developmental abnormalities. The hallmark of the disease, however, is the presence of multiple odontogenic keratocysts. Finding the keratocysts in a young child is diagnostic of the condition.

The VDRL (Venereal Disease Research Laboratory) test is a blood test that is used to screen for syphilis, a sexually transmitted disease caused by the bacterium Treponema pallidum.   It is not specific to a particular gender and can be used as a screening tool for syphilis infection in both males and females. VDRL test in pregnancy is also performed for infection.   VDRL Test Here are the basic details for VDRL Test. Also Known As Venereal Disease Research Laboratory Test Type Blood Test Purpose Diagnose Syphilis a sexually transmitted infection Sample Type Blood serum Preparation No Special Preparation Required Fasting No Gender Unisex Age-Group All Ages Normal Value A positive test indicates the presence of Antibodies Reporting Time 1 - 2 hours Cost (INR) 100 - 300* INR *Price range may vary as per location, lab type, and procedure of lab test.   VDRL Test Full Form The Full Form For VDRL Test is Venereal Disease Research Laboratory Test.   VDRL Test Means VDRL Test is a blood test used to screen for syphilis. VDRL Test detects the presence of antibodies produced in response to the syphilis bacteria. A positive VDRL test indicates the presence of syphilis infection. It is an initial screening test and further confirmatory tests are needed for a definitive diagnosis. VDRL Test in pregnancy is also commonly performed to screen for syphilis infection in expectant mothers, as untreated syphilis can pose serious health risks to both the mother and the baby.   VDRL Test Purpose Here are the purposes of the VDRL Test. The VDRL test is commonly used to diagnose syphilis, a sexually transmitted infection caused by the bacterium Treponema pallidum. The VDRL test is also used as a screening tool to detect syphilis in people who may not have any symptoms but are at risk of infection. It can be used to monitor the effectiveness of treatment for syphilis. A decrease in the titer (level) of antibodies in the blood indicates that treatment is working. If the VDRL test is positive, a confirmatory test such as the Treponemal Pallidum Antibody (TP-PA) test is usually done to confirm the diagnosis of syphilis. The VDRL test may be used to test for other conditions that can cause false positive results on a syphilis test, such as lupus and rheumatoid arthritis.     VDRL Test Preparation Here are some preparations, procedures, and aftercare for the VDRL test:   Before Test No fasting or other special preparations are required before the test. Inform your doctor about any medications or supplements you are taking, as some can affect the test results. Inform your doctor if you have any allergies or blood clotting disorders.   During Test The VDRL test involves drawing a blood sample from a vein in your arm. The test is usually done in a doctor's office or laboratory by a trained healthcare professional. The blood sample is sent to a lab for analysis.   After Test The VDRL test usually takes a few days to process. Your doctor will inform you of the results and what they mean for your health. If the test is positive, your doctor may recommend additional tests to confirm the diagnosis and begin treatment. If you test negative but have symptoms of syphilis, your doctor may recommend further testing or monitoring. Summary The VDRL Test requires a blood sample and may require additional testing for diagnosis or treatment if positive.   VDRL Test Procedure Here is the procedure for the VDRL test: A healthcare professional will clean the area where the blood will be drawn, usually the inner elbow or back of the hand, with an antiseptic solution. A tourniquet will be tied around your upper arm to help locate a vein and make it easier to draw blood. A needle will be inserted into the vein, and a small amount of blood will be drawn into a sterile tube. After the needle is removed, a cotton ball or bandage will be placed over the site to stop any bleeding. The blood sample will be sent to a laboratory for analysis. The results of the VDRL test will be provided to you by your healthcare provider.   VDRL Test Result Here are some key points regarding VDRL test results: A non-reactive or negative VDRL test result means that no syphilis antibodies were detected in your blood. A reactive or positive VDRL test result means that syphilis antibodies were detected in your blood. A reactive VDRL test may indicate a current or past infection with syphilis. However, false positive results are possible, and additional tests are needed to confirm a diagnosis. If your VDRL test is positive, your healthcare provider will recommend additional tests to confirm the diagnosis and begin treatment if necessary. If you have a history of syphilis or have been treated for syphilis, a VDRL test may remain positive even if you are no longer infected.   VDRL Test Report VDRL Test Report PDF   VDRL Test Non Reactive Negative Normal Report VDRL Non Reactive Negative Normal Test Report PDF Format VDRL Test Normal Result Report PDF   VDRL Test Reactive Positive Abnormal Report VDRL Reactive Positive Abnormal Test Report PDF Format VDRL Test Abnormal Result Report PDF   VDRL Test Interpretation The VDRL test does not have a specific normal range. However, here is some information about the interpretation of the test results. VDRL Test Result Interpretation Non-reactive or negative means No syphilis antibodies detected Reactive or positive means Syphilis antibodies detected False positive Positive results due to other medical conditions, such as autoimmune diseases, pregnancy, or recent vaccinations It is important to note that a positive VDRL test does not necessarily mean that you have an active syphilis infection. Additional VDRL Test in pregnancy tests are needed to confirm a diagnosis and false positive results can occur.   VDRL Test Positive Means Here is a possible cause of VDRL Test positive means. Positive Result Means Possible Causes Presence of syphilis antibodies Syphilis infection False-positive result Other infections (e.g., HIV, hepatitis), autoimmune diseases Previous syphilis infection Successfully treated or inactive syphilis infection Summary A Positive VDRL Test indicates the presence of syphilis infection or other possible causes.   VDRL Test is Safe? VDRL test is a safe and routine screening test for syphilis. It involves a simple blood draw and does not pose any significant risks or side effects. However, false-positive results can occur, which may require additional testing to confirm the diagnosis.   When Do You Get VDRL Test Results? The turnaround time for VDRL test results varies depending on the laboratory where the test was performed and the method used. In general, results may be available within 1-2 hours after the sample is collected. Your healthcare provider will be able to provide you with more information about when you can expect to receive your VDRL test results.   VDRL Test Limitation Here are some possible limitations of the VDRL Test. False-negative results in the early stages of syphilis. Limited specificity, leads to false-positive results in certain conditions. Cannot differentiate between active and past syphilis infection. Requires confirmation with additional tests for accurate diagnosis. May not detect syphilis in certain body fluids or tissues.   VDRL Test Risk Factors Here is the potential risk factor of the VDRL Test. High-risk sexual behavior, such as multiple sexual partners. Unprotected sexual intercourse with an infected individual. History of previous sexually transmitted infections (STIs). Intravenous drug use and sharing needles. VDRL test in pregnancy for Vertical transmission from mother to child during pregnancy or childbirth.   Doctor Recommendations After VDRL Test Result Here are Doctor recommendations or consult a specialist after VDRL Test. VDRL Test Result Doctor to Visit Reason to Visit Reactive (Positive) Infectious Disease Possible syphilis infection Normal General Practitioner Routine follow-up or other symptoms Non Reactive (Negative) No specific doctor No immediate concerns   VDRL Test Price Here are the estimated VDRL Test Price in India with different top cities. City Price Range (INR)* Mumbai 100 - 300 New Delhi 150 - 300 Bangalore 150 - 300 Hyderabad 100 - 300 Kolkata 150 - 300 Pune 150 - 300 Lucknow 100 - 300 Noida 100 - 300 Surat 150 - 300 Gurugram 100 - 300 Patna 150 - 300 Chennai 100 - 300 Jaipur 150 - 300 Ahmedabad 100 - 300 *Prices are approximate and vary depending on a specific laboratory or healthcare facility.   Summary Overall, VDRL Test is a blood test used to diagnose syphilis and to monitor the effectiveness of treatment; it measures the antibodies that the body produces in response to the bacterium that causes syphilis. Also check Drlogy Test for detailed information about all medical tests for patients, doctors, scholers and medical students.   Reference Venereal Disease Research Laboratory test - Wikipedia [1]. Syphilis- Wikipedia [2].    

Syphilis, an ancient STI, still haunts society. But you don't have to be another victim! Discover how to protect yourself and keep your health up to date. And get ready to be surprised by some facts you may not have known about this disease!

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