STD

Tertiary Syphilis

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Tertiary Syphilis, Syphylitic Gumma, Gumma

  • See Also
  1. Syphilis
  2. Sexually Transmitted Disease
  3. Primary Syphilis
  4. Secondary Syphilis
  5. Latent Syphilis
  6. Tertiary Syphilis
  7. Syphilitic Gumma
  8. Cardiovascular Syphilis
  9. Neurosyphilis
  10. Syphilis Testing
  11. Genital Ulcer
  • 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 (appear as CNS Mass)
    4. Meningitis
    5. Dementia
  • Labs
  1. See Syphilis Testing
  • Management
  1. See Syphilis
  2. See Neurosyphilis
  • Complications
  1. Thoracic Aortic Aneurysm (from ascending aortitis)
  2. Neurosyphilis complications
  • References
  1. Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9
  2. Mattel (2012) Am Fam Physician 86(5): 433-40 [PubMed]
  3. Ricco (2020) Am Fam Physician 102(2): 91-8 [PubMed]