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tertiary syphilis

Monday 20 June 2016

Definition: Tertiary syphilis has three main manifestations: cardiovascular syphilis, neurosyphilis and so-called benign tertiary syphilis. These may occur alone or in combination.

The tertiary stage of syphilis is rare where adequate medical is available, but it occurs in approximately one-third of untreated patients, usually after a latent period of 5 years or more.


- facial destruction by syphilitic gummas

- Skull destruction by tertiary syphilis


  • Cardiovascular syphilis, in the form of syphilitic aortitis, accounts for more than 80% of cases of tertiary disease.
  • The aortitis leads to slowly progressive dilation of the aortic root and arch, which causes aortic valve insufficiency and aneurysms of the proximal aorta.
  • Neurosyphilis may be symptomatic or asymptomatic.
  • Symptomatic disease manifests in several ways, including chronic meningovascular disease, tabes dorsalis, and a generalized brain parenchymal disease called general paresis.
  • Asymptomatic neurosyphilis, which accounts for about one third of neurosyphilis, is detected when a patient’s CSF exhibits abnormalities such as pleocytosis, elevated protein levels, or decreased glucose.
  • Antibodies stimulated by the spirochetes, discussed below, can also be detected in CSF, and this is the most specific test for neurosyphilis.
  • Asymptomatic people are tested for neurosyphilis because antibiotics are given for a longer time if the spirochetes have spread to the central nervous system.
  • So-called benign tertiary syphilis is characterized by the formation of gummas in various sites. These are nodular lesions probably related to the development of delayed hypersensitivity to the bacteria.
  • Gummas occur most commonly in bone, skin, and the mucous membranes of the upper airway and mouth, although any organ may be affected.
  • Skeletal involvement characteristically causes local pain, tenderness, swelling, and sometimes pathologic fractures. Involvement of skin and mucous membranes may produce nodular lesions or, rarely, destructive, ulcerative lesions that mimic malignant neoplasms.
  • Gummas, once common, are now very rare because of the use of effective antibiotics.

See also

- syphilis

  • cutaneous syphilis