Treponema pallidum subsp. pallidum

congenital syphilis : syphilis acquired in utero, and manifested variously by any of several characteristic malformations of the teeth or bones known as stigmata and by active mucocutaneous syphilis

transuterine contagion

first 3 months => abortion
last 6 months => malformations : periostitis , osteochondritis , iritis , chorioretinitis , optic neuritis

transplacental contagion after month 4 => severity depends on fetal age at contagion :

bones : long bones osteochondritis (Wegner's disease ), including nasal osteochondritis => saddle-shaped nose, oxycephaly , periarticular tumefaction, Verneuil's disease , Parrot's pseudoparalysis / syphilitic pseudoparalysis . At age 2 gums may destroy nasal septum and perforate both soft and hard palate => syphilitic coryza

Wegner's sign : a broadened, discolored appearance of the epiphyseal line in infants who have died from congenital syphilis.
Parrot's sign or nodes / hot cross bun skull / natiform skull : bony nodes on the outer table of the skull of infants with congenital syphilis, so that it has a hot cross bun or buttock shape
Higouménaki's clavicular sign : a tumefaction on the inner third of the right clavicle
Dubois' sign : shortness of the little finger
Wimberger's sign : symmetrical erosions of the proximal tibia seen radiographically in infants

Clutton arthropathy

papular rash (syphilitic pemphigus) on hand palms and foot soles at the birth

Silex's sign : furrows radiating from the mouth
Krisovski's or Krisowski's sign : cicatricial lines radiating from the mouth in congenital syphilis.

Leredde's syndrome
pneumonia alba
blindness
mental retardation
Sisto's sign : constant crying as a sign of congenital syphilis in infancy
tabes infantum

Hutchinson's triad

Hutchinson's teeth and Moon-Fournier teeth
bilateral hypoacusia or deafness due to labyrinthitis
interstitial keratitis and a dull-red discoloration of the cornea (Hutchinson's sign)

acquired syphilis through sexual route (rarely transmitted through direct contact with infected tissues and blood or contaminated fomites, scar wound or scratches). Only 30% of infected people undergo disease (remaining 30% undergo latency and in 35% is self-limiting). Untreated syphilis usually progresses through 3 clinical stages (primary, secondary, and tertiary s.), with a latent period (latent syphilis) intervening between the first 2 and the last. The time of duration of each stage varies, and they are often noticeably shortened in immunocompromised patients

early syphilis : the stage comprising :

primary syphilis : after 10-90 days incubation, a usually painless syphiloma / hard chancre or sore / hunterian or true chancre / syphylitic chancroid occurring at the site of inoculation (penis or cervix, rarely on anus, lip, neck, breast or fingers), typically presenting as a small red papule or crusted erosion that breaks down without scarring to become round or oval, indurated, and slightly elevated with an eroded surface that exudes a serous fluid, and gives rise to a nontender, nonfluctuant, firm regional lymphadenitis (bullet or syphilitic bubo) : usually it is self-limiting and undergoes scaring within 2÷6 weeks.

mixed chancre / mixed sore : a skin lesion due to simultaneous infection with Treponema pallidum subsp. pallidum (primary syphilis) and Haemophilus ducreyi (chancroid)

septicemia

secondary syphilis : headache , bone and muscle pain, self-limiting morbilliform maculopapular exanthema (syphilid ) appears usually on the palms or soles of feet, on trunk, limbs, hands (stigmata), neck and forehead ("Venus necklace and crown"), flat condyloma on anus or vulva, symmetric knee and ankle arthralgias, pericholangitis , acute glomerulonephritis due to type III hypersensitivity. In the secondary stage of syphilis 10% of patients may develop inflammatory signs and symptoms involving virtually any structure of the eye (e.g., conjunctivitis, iritis, vitritis, episcleritis, scleritis, neuroretinitis, chorioretinitis, and retinal detachment). During secondary syphilis, T. pallidum simultaneously elicits local and systemic innate and adaptive immune responses that may set the stage for the bidirectional transmission of HIV^ref. These symptoms usually last 3-6 months, but may not last and then re-appear at any time, in a period that varies from 2 up to 5 years, after which ...
latent syphilis : a stage after secondary syphilis when an infected patient is free of overt symptoms but has a positive serologic test for syphilis; it may last a short time or many years and may be subdivided into early latent and late latent syphilis, distinguished by the time since initial infection, degree of infectiousness of the disease, and certain other characteristics.

early latent syphilis : the first period of latent syphilis, when relapses of secondary syphilis are most likely to occur and the patient is considered to be more infectious than at later stages; this usually lasts until 1-2 years after the initial infection.
late latent syphilis : the later period of latent syphilis, beginning 1-2 years after the initial infection; relapses of secondary syphilis are rare and patients are resistant to infection. The disease is now usually not infectious, although fetuses in utero may contract congenital syphilis from mothers at this stage.

Therapy : 2 g single-dose oral azithromycin

is effective in treating syphilis and may be particularly useful in developing countries in which the use of 2.4 MU dose of penicillin G benzathine

injections is problematic. However, recent reports of azithromycin-resistant Treponema pallidum in the USA indicate the importance of continued monitoring for resistance^ref

late or tertiary syphilis : the third and last stage of syphilis, which may develop soon or many years after the lesions of secondary syphilis have resolved (from as few as 1 to over 40 years from onset of infection), but only in 15-20% of untreated patientsm, and they are no longer infectious; it is marked by destructive lesions involving many tissues and organs and occurs in 3 principal forms:

cardiovascular syphilis : a form of tertiary syphilis in which aortic insufficiency and aortic aneurysm, usually of the ascending aorta, occur as a result of obliterative endoarteritis of vasa vasorum => luetic mesoaortitis / Döhle disease (10%; => aortic arc aneurysm and Babinski-Vaquez syndrome : the association of cardiac and arterial disorders with chronic syphilitic meningitis, tabes dorsalis, paralytic dementia, and other late syphilitic manifestations), causing damage to the intima and media of the great vessels, and may result in congestive heart failure
late benign syphilis / gumma / gummatous syphilis : a form of tertiary syphilis that responds very rapidly to treatment and is therefore relatively benign, in which the typical lesion is the gumma / syphiloma (type IV hypersensitivity). Tertiary syphilis may cause granulomatous disease of any structure of the eye as well as abnormal pupillary findings, oculomotor palsies, and glaucoma. Blindness may result.
neurosyphilis / parenchymatous syphilis : the CNS manifestations of syphilis, which may be divided into 2 groups:

asymptomatic neurosyphilis : neurosyphilis diagnosed when there is a positive VDRL test in the CSF in the absence of the signs and symptoms of neurologic disease.
symptomatic neurosyphilis

meningovascular neurosyphilis or syphilis / lues cerebri (after 5-7 years) : extensive meningeal involvement, secondarily investing and then occluding vessels in their course through the subarachnoid space, resulting in focal or widespread cerebrovascular disease.

spinal syphilis / myelosyphilis : syphilis primarily affecting the spinal cord

cerebrospinal syphilis / Erb's spastic paraplegia
parenchymatous neurosyphilis or syphilis : widespread parenchymal damage
tabes dorsalis or spinalis / tabetic neurosyphilis / Duchenne's disease / locomotor ataxia / posterior spinal sclerosis

general paresis / paretic neurosyphilis / Bayle's disease / dementia paralytica / paralytic dementia / syphilitic meningoencephalitis

gummatous meningitis

osteomyelitis
orchitis
luetic hepatitis
Biederman's sign : a dark red color (instead of the normal pink) of the anterior pillars of the throat, seen in some patients with syphilis.
Demarquay's sign : fixation or lowering of the larynx during phonation and deglutition; a sign of syphilis of the trachea.
Elliot's sign : induration of the edge of a syphilitic skin lesion

Immunity to re-infection is incomplete.
Laboratory examinations

Therapy