Primary and Secondary Syphilis: A Histopathological Study

Abstract

We present a study of biopsies taken from skin lesions of 44 patients presenting with primary or secondary syphilis. In most primary lesions erosion or, more often, ulceration was present, with a dense inflammatory infiltrate. In secondary syphilis a wide variety of histological changes was present. Blood vessels were frequently involved, with marked endothelial swelling and often proliferation. Treponemes were demonstrated with the Steiner staining method in all investigated cases of primary syphilis and in 71% of secondary syphilis cases. Treponemes were present throughout the dermis, particularly perivascularly, and in the dermal-epidermal junction zone. In two specimens of secondary syphilis treponemes were located predominantly in the epidermis, but there were always some microorganisms demonstrable in the dermis. The inflammatory infiltrate was often located in a perivascular coat-sleeve-like arrangement. In this study plasma cells and lymphocytes were present in all specimens of primary and secondary syphilis. Syphilitic lesions differed from yaws lesions mostly in the location of treponemes and the affection of blood vessels. In this histopathological study of early syphilis, treponemes did not show the epidermiotropic character of yaws, and blood vessel changes were more pronounced than in yaws. Unfortunately, due to the protean histopathological manifestations described in venereal syphilis and in yaws, these two treponemal diseases cannot always be differentiated on histological grounds alone.

Nodular secondary syphilis in a woman

“…Therefore, we tended to the diagnosis of a secondary syphilis in our patient. Plasma cells can be found in both syphilis stages 20 21. Serological findings did not aid in the decision for secondary or tertiary syphilis in this case.…”

Defining the Interaction of theTreponema pallidumAdhesin Tp0751 with Laminin

“…Further, T. pallidum specifically attaches to vascular endothelium (37) and isolated basement membranes (22), and the organisms traverse endothelial cell monolayers by moving through the junctions between cells (20, 21, 31, 62, 68, 69). Additionally, two areas in which T. pallidum localizes include laminin-containing cutaneous nerves (65) and the dermal-epidermal junction within the perivascular area of the skin (5,15). Two interrelated hypotheses that can be drawn from these observations are that T. pallidum specifically localizes within infected tissues to areas rich in laminin and that the proximity of T. pallidum to perivascular locales during infection would arise from and facilitate treponemal dissemination via the bloodstream.…”

The Cutaneous Response in Humans toTreponema pallidumLipoprotein Analogues Involves Cellular Elements of Both Innate and Adaptive Immunity

“…On the one hand, they cause the tissue damage that ultimately gives rise to clinical manifestations, while on the other, they also are responsible for the clearance of treponemes, a prerequisite for lesion resolution (2,3). Cellular infiltrates composed of T lymphocytes, macrophages, and plasma cells are the sine qua non of syphilitic lesions (1)(2)(3)(4)(5)(6)(7). Immunocytochemical and RT-PCR analyses of early syphilitic skin lesions have revealed that these infiltrating cells, as well as keratinocytes and proximal vascular endothelium, are activated and that the T cells are elaborating cytokines consistent with a Th1 response (4,8).…”