Page 202 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 6-27 Integumentary System

SYPHILIS OF GENITALIA

Condylomata lata
2 syphillis
Chancre with inguinal adenopathy
1 syphillis

SYPHILIS Chancre of Chancre
coronal sulcus; of glans:
nontender ulcer firm rubbery,
nontender
Syphilis has been well described in the literature since ulcer
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 zoolo-
gist, 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 Multiple chancres
coiled linear body. There are three subspecies of T. (shaft and meatus)
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 recog-
nized to progress through three stages: primary, sec-
ondary, and tertiary. Not all cases progress through all
of the stages, and only about one third of untreated Spirochetes
under
cases eventually progress to tertiary syphilis. The sec- darkfield
ondary and tertiary phases are interrupted by a latent examination
phase of variable length.
Clinical Findings: Both historically and today, most
cases of syphilis have been transmitted via sexually
intercourse. The disease is often seen in conjunction Penoscrotal chancre
with other sexually transmitted diseases (STDs), espe- with inguinal adenopathy
cially human immunodeficiency virus (HIV) infection.
The two infections may actually facilitate each other’s
infectious potential. There is no race or sex predilec-
tion; the organism is able to infect any host with whom chancre, is firm to palpation. The ulcer can be found This occurs because the ulcer is firm and does not
it comes in contact. The initial infection in most cases anywhere on the genitalia, including the labia, vaginal bow under pressure. If left untreated, these ulcers
results in clinical findings in the genital region. introitus, and mons in females and the glans, foreskin, self-resolve within 1 to 3 weeks. After this occurs, the
Primary syphilis is marked by a nonpainful ulceration and penile shaft in males. Lesions on the foreskin of bacteria hematogenously disseminate to other organ
that begins as a red papule and ulcerates over a period males often show the Dory flop sign. This occurs when systems.
of a few days to weeks. The average time to onset one grasps the area of the prepuce containing the ulcer The timing of secondary syphilis is variable: It can
of the ulcer is 3 to 4 weeks after exposure, but it can and slowly retracts the proximal edge; after a critical occur immediately after primary syphilis or up to 6
occur 3 to 4 months later. This primary ulcer, called a angle has been achieved, the entire ulcer flops over. months after the chancre of primary syphilis has healed.

188 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS