Treponema pallidum

Morphology and identification

a. Typical organism

 0.2 micrometre in width and 5 to 15 micrometres in length

 Actively motile
 Rotate around their endoflagella
 Spirals are thin that only immunofluorescent stain or dark-filled illumination could be seen
 Do not stain with aniline dyes
 Can be seen in tissues when stained by a silver impregnation method

b. Culture

 In proper suspending fluids and in the presence of reducing substance, it will remain motile for 3 to 6 days at
25C
 In whole blood or plasma stored at 4C, organisms remain viable for at least 24 hours that is potential
importance of blood transfusions

c. Reactions to Physical and Chemical Agents

 Drying kills spirochetes rapidly

 Elevation of temperature to 42C can kill spirochetes
 Immobilize rapidly by trivalent arsenical, mercury and bismuth
 Penicillin is treponemicidal in minute concentrations but the rate of killing is slow

d. Genome

 Circular chromosome
 Do not have transposable element, genome is highly conserved and explains its continued susceptibility to
penicillin

Antigenic Structure

 Cannot culture in vitro

 Outer membrane surrounds the periplasmic space and the peptidoglycan-cytoplasmic membrane complex
 Membrane proteins covalently bound lipids at their amino terminals
 Endoflagella are in the periplasmic space
 Has hyaluronidase that breaks down the hyaluronic acid in the ground substance of the tissue and enhances the
invasiveness of the organism
 Humans with syphilis develop antibodies capable of staining T pallidum by indirect immunofluorescence,
immobilizing and killing live motile T pallidum and fixing complement in the presence of a suspension of T
pallidum or spirochetes
 Spirochetes cause the development of a distinct antibody-like substance, regain which gives complement
fixation (CF) and flocculation test results with aqueous suspension of cardiolipin extracted from normal
mammalian tissue

Pathogenesis, Pathology and Clinical Findings

a. Acquired Syphilis

 Natural infection, sexual contact, infectious lesion on the skin or mucous membranes of genitalia, break in the
epidermis
 Spirochetes multiply locally at the site of entry, some spread nearby the lymph node and then reach the blood
 2-10 weeks of infection, a papule develops at the site of infection and then breaks down to form an ulcer with a
clean, hard base.
  Inflammation characterised by the predominance of lymphocytes and plasma cells
 Primary lesion heals spontaneously but secondary lesion appears
 Secondary lesions consist of red maculopapular rash anywhere on the body, including hands, feet and moist
pale papule (condylomas) in the anogenital region, axillae and mouth
 Patient may have syphilitic meningitis, chorioretinitis, hepatitis, nephritis (immune complex type) or periostitis
 Secondary lesions subside spontaneously
 Both lesions are rich in spirochetes and highly infectious
 Contagious lesions occur 3 to 5 years after infections
 Syphilitic infection remains subclinical and the patient may pass through first or second lesion with signs and
symptoms yet develop tertiary lesions
 Early syphilitic infection progresses spontaneously to complete cure without treatment
 Untreated infections remain latent (evident by positive serologic test result
 Tertiary stage characterised by the development of granulomatous lesions in the skin, bones and liver,
degenerative changes in the CNS (meningovascular syphilis, paresis, tabes), cardiovascular lesions (aortitis,
aortic aneurysm, aortic valve insufficiency)
 Treponemes are rare in tertiary lesions

b. Congenital Syphilis

 Pregnant woman can transmit the organism to foetus through placenta beginning of 10 to 15 weeks of
gestation
 Some infected foetus dies and miscarriage result
 Some are stillborn
 Other are born live but develop signs of congenital syphilis (interstitial keratitis, Hutchinson’s teeth, saddlenose,
periostitis, CNS anomalies)
 Adequate treatment of pregnant mother can prevent congenital syphilis
 In congenital infection, the child makes IgM antitreponemal antibody.

Diagnostic Laboratory Test

Specimens

 Tissue fluid (dark field microscopy, immunofluorescence, nucleic acid amplification)

 Blood (serologic test)
 CSF - Venereal Disease Research Laboratory (VDRL)

Immunity

 Person with active or latent syphilis appears to be resistant to superinfection with T pallidum
 If early syphilis is treated adequately and the infection is eradicated, the individual again fully becomes fully
susceptible

Treatment

 Penicillin