STD

Tertiary Syphilis

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Tertiary Syphilis, Syphylitic Gumma, Gumma

  • Epidemiology
  1. Untreated Latent Syphilis progresses to Tertiary Syphilis in one third of patients
  2. Occurs years to decades afer initial untreated Syphilis infection
  • Pathophysiology
  1. Low-level Syphilis infection with strong immune response
  • Types
  1. Late benign Syphilis (50% of Tertiary Syphilis cases)
    1. Presents with gumma, Granulomas and Psoriasis-like Plaques
    2. May form 1 to 10 years after initial infection
    3. Destructive Granulomatous lesions (fungating masses) affect any area
    4. Responds rapidly to treatment
  2. Cardiovascular Syphilis
    1. Typically involves Great Vessels (especially ascending aortitis)
    2. Thoracic Aortic Aneurysm (including ascending aortic aneurysm)
      1. Proximal involvement may result in aortic valve insufficiency or Coronary Artery Disease
  3. Neurosyphilis (Occurs in 10% of untreated Syphilis)
    1. Treponemal penetration of the blood brain barrier
    2. Tabes Dorsalis (Peripheral Neuropathy)
    3. Intracranial gummata
    4. Meningitis
    5. Dementia
  • Labs
  • Management
  • Complications
  1. Thoracic Aortic Aneurysm (from ascending aortitis)
  2. Neurosyphilis complications