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]