II. Epidemiology
- Untreated Latent Syphilis progresses to Tertiary Syphilis in one third of patients
- Occurs years to decades afer initial untreated Syphilis infection
III. Pathophysiology
- Low-level Syphilis infection with strong immune response
- Immune-mediated inflammatory changes result in injury to organs, small vessels and nerves
IV. Types
- Late benign Syphilis (or Gummatous Syphilis, 50% of Tertiary Syphilis cases)
- Presents with gumma and Granulomas
- May form 1 to 10 years after initial infection (up to 40 years later)
- Responds rapidly to treatment
-
Cardiovascular Syphilis (10% of untreated patients)
- Onset >10 years after Primary Syphilis
- Starts with chronic inflammation of the vasa vosorum (small arteriole tributaries to the aorta)
- Inflammation ultimately spreads to the aorta, with destruction, weakening of its media
- Results in irreversible large vessel complications
- Typically involves Great Vessels (especially ascending aortitis)
- Thoracic Aortic Aneurysm (including ascending aortic aneurysm)
- Results in Aortic Dissection
- Proximal involvement may result in aortic valve insufficiency or Coronary Artery Disease
-
Neurosyphilis (Occurs in 8-10% of untreated Syphilis)
- Treponemal penetration of the blood brain barrier
- Asymptomatic Neurosyphilis may occur without clinical findings (but CSF Syphilis positive)
- Manifestations
- See Neurosyphilis
- Tabes Dorsalis (Peripheral Neuropathy, including Argyll-Robertson Pupil)
- Intracranial gummata (appear as CNS Mass)
- Syphilitic Paresis
- Subacute Meningitis
- Meningovascular Syphilis
- Dementia Paralytica
V. Labs
- See Syphilis Testing
VI. Management
- See Syphilis
- See Neurosyphilis
VII. Complications
- Thoracic Aortic Aneurysm (from ascending aortitis)
- Neurosyphilis complications
VIII. References
- Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9
- Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
- Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| MSH | C536774 |
| ICD9 | 097.0 |
| ICD10 | A52 , A52.9, A52.3 |
| SnomedCT | 186905004, 187358009, 276200006, 72083004 |
| English | Late syphilis unspecified, Late syphilis, unspecified, [X]Late syphilis, unspecified, late syphilis (diagnosis), late syphilis, Tertiary Treponema pallidum infection, Late syphilis NOS, Syphilis (late), Syphilis, tertiary, late tertiary syphilis, tertiary syphilis, syphilis tertiary, Late syphilis unspecified (disorder), [X]Late syphilis, unspecified (disorder), Late syphilis, Late tertiary syphilis, Tertiary syphilis, Late syphilis (disorder), late; syphilitic, syphilis; late, syphilis; tertiary, tertiary; syphilitic, Late syphilis, NOS |
| Italian | Sifilide terziaria, Sifilide tardiva non specificata, Infezione terziaria da Treponema pallidum |
| Dutch | gevorderde syfilis, niet-gespecificeerd, tertiaire Treponema pallidum-infectie, laat; syfilis, syfilis; laat, syfilis; tertiair, tertiair; syfilis, Late syfilis, niet gespecificeerd, derde stadium van syfilis, Late syfilis |
| French | Infection tertiaire à Treponema pallidum, Syphilis tardive, non précisée, Syphilis tertiaire |
| German | Spaetsyphilis, unspezifisch, tertiaere Treponema pallidum-Infektion, Spaetsyphilis, nicht naeher bezeichnet, Spaetsyphilis, tertiaere Syphilis |
| Portuguese | Sífilis tardia NE, Infecção terciária por Treponema pallidum, Sífilis terciária |
| Spanish | Sífilis tardía no especificada, Infección terciaria por Treponema pallidum, sífilis tardía no especificada (trastorno), [X]sífilis tardía, no especificada (trastorno), [X]sífilis tardía, no especificada, sífilis tardía no especificada, sífilis tardía (trastorno), sífilis tardía, Sífilis terciaria |
| Japanese | 晩期梅毒、詳細不明, 第３期梅毒, 第３期梅毒トレポネーマ感染症, ﾊﾞﾝｷﾊﾞｲﾄﾞｸｼｮｳｻｲﾌﾒｲ, ﾀﾞｲ3ｷﾊﾞｲﾄﾞｸﾄﾚﾎﾟﾈｰﾏｶﾝｾﾝｼｮｳ, ﾀﾞｲ3ｷﾊﾞｲﾄﾞｸ |
| Czech | Terciální infekce Treponema pallidum, Pozdní syfilis, blíže neurčená, Terciální syfilis |
| Korean | 만기 매독, 상세불명의 만기 매독 |
| Hungarian | tertier syphilis, késői syphilis, nem meghatározott, Treponema pallidum tertier fertőzés |
Ontology: Syphilitic gumma (C0221385)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | A52.3 |
| SnomedCT | 154385000, 64102008 |
| English | Syphilitic gumma, Syphiloma, Gumma (syphilitic), syphilitic gumma, syphilitic gumma (diagnosis), syphilis gummatous, Syphilitic gumma (disorder), gumma; syphilitic, syphilis; gumma, syphiloma, Syphilitic gumma, NOS |
| Dutch | syfilitisch gumma, gumma; syfilis, syfilis; gumma |
| French | Gomme syphilitique |
| German | syphilitische Gumma |
| Italian | Gomma sifilitica |
| Portuguese | Goma sifilítica |
| Spanish | Goma sifilítica, goma sifilítico (trastorno), goma sifilítico, sifiloma, sifílide gomatosa nodular |
| Japanese | 梅毒性ゴム腫, ﾊﾞｲﾄﾞｸｾｲｺﾞﾑｼｭ |
| Czech | Syfilitické guma |
| Hungarian | Syphilises gumma |
