Treponema pallidum (Syphilis)

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Treponema pallidum (Syphilis)

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USMLE® Step 1 style questions USMLE

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A 28-month-old boy is brought to the pediatrician for a routine evaluation. The patient was born via vaginal delivery at 38-weeks of gestational age. The patient’s mother received minimal antenatal care. During the third trimester of pregnancy, the mother had developed a disseminated maculopapular rash involving the palms and soles and arthralgias. The patient’s weight is at the 25th percentile, and head circumference is at the 50th percentile. Vitals are within normal limits. Abdominal examination reveals hepatosplenomegaly. A depressed nasal bridge, malformed teeth, and bowing of the tibia are also observed. Cardiovascular examination is unremarkable. Which of the following is the most likely cause of this patient’s condition?  

External References

First Aid

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Alopecia

syphilis p. 145

Aorta

in syphilitic heart disease p. 319

Aortic aneurysm p. 305

syphilitic heart disease p. 319

Aortic insufficiency

syphilitic heart disease p. 319

Aortitis

syphilis p. 145, 180

Argyll Robertson pupils

syphilis p. 145, 180

Ataxia

syphilis p. 145

Charcot joints

syphilis p. 145

Condylomata lata

syphilis p. 145, 180

Deafness

syphilis p. 181

Gummas

syphilis p. 145, 180

Hydrops fetalis

syphilis p. 181

Lymphadenopathy

syphilis p. 145, 180

Maculopapular rash

syphilis p. 145

Pregnancy p. 651

syphilis in p. 145

Rashes

syphilis p. 145, 180

Saber shins

syphilis p. 181

Saddle nose

syphilis p. 181

Spontaneous abortion

syphilis p. 181

Stroke p. 525

syphilis p. 145

Syphilis p. 145

as granulomatous disease p. NaN

presentation p. 722

prophylaxis for p. 194

STI p. 180

tabes dorsalis p. 544

testing for p. 145

thoracic aortic aneurysms and p. 305

ToRCHeS infection p. 181

Syphilitic heart disease p. 319

Tertiary syphilis

aortic aneurysms p. 731

as granulomatous disease p. NaN

presentation p. 722

Treponema pallidum

syphilis p. 145

Vasa vasorum

syphilis p. 145

Transcript

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Treponema pallidum can be considered a gram-negative bacterium even though its cell envelope differs from other gram-negative bacteria.

You might know T. pallidum because it causes syphilis, a sexually transmitted disease that affects the skin and mucous membranes of the external genitalia, and also sometimes the mouth.

Treponema pallidum is an obligate parasite bacteria, meaning it can't survive outside a living body. To be more specific, outside of a human being's body. They belong to a group of bacteria called spirochetes, which are long and thin, and contain endoflagella, which are a band of protein filaments that coil within the spirochetes, and give them a spiral shape - kind of like a curly fry, but a little less appetizing. The endoflagella also help the spirochetes to move around by spinning or twisting, a bit like a drill that’s slowly boring into a piece of wood.

People that have syphilis can transmit the disease to others, in one of two ways. The first way is called acquired syphilis and that’s when Treponema pallidum enters the body through bodily fluids. That can happen when there are tiny cuts, or breaks in the skin or mucous membranes of the external genitalia or mouth and when there’s sexual contact - including oral, anal, and vaginal sex.

It can also happen when people share contaminated needles, or when they have direct contact with a skin lesion on an infected person, because the lesion is covered in this fluid which is rich in spirochetes. The second way is called congenital syphilis and that’s when a pregnant person has syphilis and Treponema pallidum infects a baby either in the uterus or while the baby exits through the vagina at birth.

In acquired syphilis, there are three stages to the infection. The first stage is called primary syphilis or the early localized stage, and it usually starts 1 to 3 weeks after the T. pallidum lands on the skin or mucous membrane.

During this stage, the spirochetes destroy the soft tissue and skin wherever they enter the body, and that results in the formation of ulcers called syphilitic chancres. A syphilitic chancre is painless - and you can remember that by dropping in a “u” to make it chan”cure” like you’re “cured” of the pain. These chancres have a hard base, raised borders, and are usually covered by a fluid rich in spirochetes, and this can spread to other parts of the body as well as to other individuals.

Summary

Treponema pallidum is a type of bacterium that causes syphilis, which is a sexually transmitted infection. It can spread through direct contact with a syphilis sore during vaginal, anal, or oral sex. It can cause disease in three stages. The first is localized primary syphilis, and this produces hard chancres. The second is disseminated secondary syphilis, which produces widespread maculopapular rash, and the third is systemic tertiary syphilis, which affects various organs.

Syphilis can be diagnosed by using serological tests and treated with antibiotics like penicillin. If left untreated, it can lead to severe health complications, including organ damage and even death. Syphilis is primarily treated with intramuscular penicillin G benzathine. The main goals of nursing care include the resolution of their infection, and avoiding the spread of the infection among their sexual contacts. Client teaching is aimed at promoting adherence to treatment and follow-up, as well as disease prevention.

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