TREPONEMA SPP.
Treponema
• These spirochetes are thin, helical, gram-negative bacteria.
• The order Spirochaetales is subdivided into three families and 13 genera, of which
three (Treponema, Borrelia, and Leptospira) are responsible for human diseases.
Spirochete
Treponema
• The two treponemal species that cause human disease are Treponema pallidum (with
three subspecies) and Treponema carateum.
• All are morphologically identical.
• Produce the same serologic response in humans.
• Susceptible to penicillin.
• The organisms are distinguished by their epidemiologic characteristics and clinical
presentation.
Treponema
• T. pallidum subspecies pallidum is the etiologic agent of the venereal disease syphilis
• T. pallidum subspecies and endemicum causes endemic syphilis (bejel).
• T. pallidum subspecies pertenue causes yaws
• T. carateum cause pinta.
• Bejel, yaws and pinta are nonvenereal diseases
Pinta
yaws
Treponema
• T .Pallidum and related pathogenic treponems are thin, tightly coiled spirochetes with pointed,
straight ends.
• Three flagellae are inserted at each end.
• These spirochetes do not grow in cell-free cultures/synthetic media.
• Are too thin to be seen with light microscopy in specimens stained with Gram or Giemsa stain.
• visualized by dark-field microscopy or by staining with specific antitreponemal antibodies
labeled with flourescent dyes.
Epidemiology
• Syphilis is found worldwide
• The third most common sexually transmitted bacterial disease
• incidence of disease has decreased since the advent of penicillin therapy.
• Periodic increases have been observed that correspond to changes in sexual
practices.
CLINICAL DISEASES
Primary Syphilis
• Syphilitic chancre develops at the site where the spirochete is inoculated. Lesion starts as a
papule but then erodes to become a painless ulcer with raised borders
• A painless regional lymphadenopathy develops 1 to 2 weeks after the appearance of the
chancre.
• This ulcer heals spontaneously within 2 months, gives the patient a false sense of relief.
Secondary syphilis
• Flulike
syndrome with sore throat , headache, fever, myalgias, anorexia,
lymphadenopathy and generalised mucocutaneous rash.
• The rash cover the entire skin surface (including the palms and soles).
• As with the primary chancre, the rash in secondary syphilis is highly infectious.
Tertiary (Late) Syphilis
• Cause a destruction of virtually any organ or tissues(arteritis, dementia, blindness).
• Granulomatous lesions (gummas) in bone, skin and other tissues.
• The nomenclature of late syphilis reflects the organs of primary involvement (Neurosyphilis,
cardiovascular syphilis).
• Tabes dorsalis/ syphilitic myelopathy: demyelination of dorsal columns. Responsible for
proprioception, vibration and discriminative touch.
Congenital Syphilis
• Can lead to latent infections , multiorgan malformations, death of the fetus.
• Teeth (Hutchinson teeth) and bone malformation, blindness, deafness, facial defects
are common in untreated infants.
• Seizures, hepatosplenomegaly, anemia, jaundice
LABORATORY DIAGNOSIS
• Dark-field examination of the exudate from the skin lesion.
• Reliable only when an experienced microscopist immediately examines the clinical
material with actively motile spirochetes.
• Fluorescent-labelled antitreponemal antibodies are used to stain the bacteria.
serology
• Syphilis is diagnosed in most patients on the basis of serologic tests.
• Two general types of tests are biologically nonspecific (non-treponemal) tests and
specific treponemal tests.
Nontreponemal tests
• Antigen used for the nontreponemal tests is cardiolipin
• Developed against lipids released from the damaged cells during the early stages of disease and
present on the cell surface of treponems.
• the Venereal disease Research Laboratory (VDRL) test and the Rapid plasma Reagin (RPR) test.
Nontreponemal tests
• Successful treatment of primary or secondary syphilis leads to reduced titers
measured in VDRL and RPR tests.
• These test can be used to monitor the effectiveness of therapy
Treponemal tests
• Are specific antibody tests used to confirm positive reactions with the VDRL or RPR
tests.
• The test most commonly used are the fluorescent treponemal antibody-absorption
(FTA-ABS) test and Treponema pallidum particle agglutination(TP-PA) test.
Serologic test in infants of the infected mothers
• Represent a passive transfer of antibodies or a specific immunologic response to
infection.
• These two possibilities are distinguished by measuring the antibody titers of the
infant during a 6 month period.
• Antibody titers in non-infected infants decrease to undetectable levels within 3
months of birth but remain elevated in infants who have congenital syphilis
Treatment
• Benzathine penicillin for early stages and Penicillin G for congenital and late syphilis.
• Tetracycline and doxycycline for patients allergic to penicillin
PREVENTION AND CONTROL
• No vaccines
• Safe-sex and treatment of sex partners.
