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Related to anisocoria: Horner's syndrome, physiologic anisocoria


(sĭf`əlĭs), contagious sexually transmitted diseasesexually transmitted disease
(STD) or venereal disease,
term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, lymphogranuloma venereum, and
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 caused by the spirochete Treponema pallidum (described by Fritz SchaudinnSchaudinn, Fritz
, 1871–1906, German zoologist. He confirmed the work of Sir Ronald Ross and G. B. Grassi on malaria, investigated amoebic dysentery, and in his research on protozoa discovered (1905) with Erich Hoffmann the Treponema pallidum (or
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 and Erich Hoffmann in 1905). Syphilis was not widely recognized until an epidemic in Europe at the end of the 15th cent. Some medical historians have proposed that syphilis first appeared in Spain among sailors who had returned from the New World in 1493, while others have concluded from archaeological evidence that it probably originated in the Old World but may have been confused with leprosy. A study (pub. 2008) that examined the evolutionary relationships among Treponema bacteria supported the idea that the spirochete originated in the New World, with some researchers suggesting it may have mutated into a sexually transmitted disease in Europe.


The most prevalent mode of transmission is by sexual contact; infection by other means is possible, but its occurrence depends upon an open wound or lesion to permit invasion of the organisms. A person with syphilitic sores has an increased chance of contracting AIDSAIDS
or acquired immunodeficiency syndrome,
fatal disease caused by a rapidly mutating retrovirus that attacks the immune system and leaves the victim vulnerable to infections, malignancies, and neurological disorders. It was first recognized as a disease in 1981.
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 from an infected partner. An infected mother can transmit the disease to her fetus; 25% of such pregnancies end in stillbirth or death of the infant, and another 40% to 70% will result in a baby with congenital syphilis, which, if untreated, can progress to late-stage syphilis and cause serious damage to the brain and other organs.


The development of syphilis occurs in four stages. The primary stage is the appearance of a painless chancre at the site of infection (often internal) about 10 days to 3 months after contact. There are no other symptoms, and the chancre disappears with or without treatment.

The secondary stage usually begins 3 to 6 weeks after the chancre with a rash over all or part of the body. Active bacteria are present in the sores of the rash. Headache, fever, fatigue, sore throat, patchy hair loss, and enlarged lymph nodes may be present. The signs of the secondary stage will disappear with or without treatment, but may reappear over the next 1 to 2 years.

Untreated syphilis then goes into a noncontagious latent period. Some people will have no more symptoms, but about one third will progress to tertiary syphilis, with widespread damage to the heart, brain, eyes, nervous system, bones, and joints. Late syphilis can result in mental illness, blindness, severe damage to the heart and aorta, and death.

Neurosyphilis, infection of the nervous system, frequently occurs in the early stages in untreated patients. There may be no symptoms, mild headache, or severe consequences such as seizures and stroke. Its treatment and course are complicated by concomitant HIVHIV,
human immunodeficiency virus, either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States.
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Diagnosis and Treatment

Diagnosis is made by symptoms, blood tests (required by many states before issuing marriage licenses), and microscopic identification of the bacterium. Until the advent of penicillin in the 1940s, treatment for syphilis was with mercury, arsenic, and bismuth. Penicillin is the antibiotic of choice for all stages of syphilis treatment, but penicillin-resistant organisms have complicated treatment of the disease. Even late-stage syphilis can be cured, but damage that has already occurred cannot be reversed. Despite available treatment, the incidence of syphilis in the United States was on the rise until 1990, when it began declining significantly; since 2000, it has risen again.

See also Ehrlich, PaulEhrlich, Paul
, 1854–1915, German bacteriologist. He directed (1896) an institute for serum research at Steglitz, near Berlin, that was transferred (1899) to Frankfurt-am-Main as the Institute for Experimental Therapy.
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A sexually transmitted infection of humans caused by Treponema pallidum ssp. pallidum, a corkscrew-shaped motile bacterium (spirochete). Due to its narrow width, T. pallidum cannot be seen by light microscopy but can be observed with staining procedures (silver stain or immunofluorescence) and with dark-field, phase-contrast, or electron microscopy. The organism is very sensitive to environmental conditions and to physical and chemical agents. The complete genome sequence of the T. pallidum Nichols strain has been determined. The nucleotide sequence of the small, circular treponemal chromosome indicates that T. pallidum lacks the genetic information for many of the metabolic activities found in other bacteria. Thus, this spirochete is dependent upon the host for most of its nutritional requirements. See Bacterial genetics, Immunofluorescence

Syphilis is usually transmitted through direct sexual contact with active lesions and can also be transmitted by contact with infected blood and tissues. If untreated, syphilis progresses through various stages (primary, secondary, latent, and tertiary). Infection begins as an ulcer (chancre) and may eventually involve the cardiovascular and central nervous systems, bones, and joints. Congenital syphilis results from maternal transmission of T. pallidum across the placenta to the fetus. See Sexually transmitted diseases

Treponema pallidum is an obligate parasite of humans and does not have a reservoir in animals or the environment. Syphilis has a worldwide distribution. Its incidence varies widely according to geographical location, socioeconomic status, and age group. Although syphilis is controlled in most developed countries, it remains a public health problem in many developing countries. Studies have shown that syphilis is a risk factor for infection with the human immunodeficiency virus (HIV) since syphilitic lesions may act as portals of entry for the virus. There is little natural immunity to syphilis infection or reinfection.

Parenteral penicillin G is the preferred antibiotic for treatment of all stages of syphilis. Alternative antibiotics for syphilis treatment include erythromycin and tetracycline. There is currently no vaccine to prevent syphilis. However, it is anticipated that information obtained from the T. pallidum genome sequence will lead to further improvements in diagnostic tests for syphilis and to the eventual development of a vaccine that would prevent infection. See Antibiotic



(also lues), a chronic infectious disease affecting humans caused by the spirochete Treponema pallidum. The term “syphilis” derives from the poem Syphilis sive Morbus Gallicus (Syphilis, or the French Disease), a poem by the Italian physician G. Fracastoro, published in Verona in 1530 and containing a description of a disease afflicting a shepherd named Syphilus.

Under a microscope, the causative agent is a delicate spirallike filament, measuring 4–14 micrometers long and 0.2–0.35 micrometers wide. Outside the body it dies quickly upon desiccating. Contact with disinfectants, for example, phenol, mercury bichloride, alcohol, and soapy water, produces death in a few seconds. When heated to 48°C, the causative agent dies in 30 minutes, and when heated to 100°C, it dies instantly. It can tolerate low temperatures well.

In syphilitics, T. pallidum is found in the serous discharges of ulcers and weeping rashes and in specimens obtained by puncturing regional lymph nodes. Infection is directly transmitted to a healthy person primarily through sexual intercourse (genital syphilis). Nonvenereal syphilis, which is less common, may be transmitted by kissing or by the exposure of medical personnel to the causative agent. It may also be indirectly transmitted through the common use of such objects as spoons, glasses, toothbrushes, and lipsticks, on which still-wet discharges containing the causative agent are found. (For a discussion of the significance of syphilis and preventive measures seeVENEREAL DISEASES; for a history of the study of syphilis seeVENEREOLOGY.

The clinical course of untreated syphilis is characterized by several developmental stages. The incubation period begins at the moment of infection and continues, on the average, for approximately one month; sometimes it is as little as nine to 11 days or as much as 92 days. Primary syphilis commences with the appearance of a solitary chancre or multiple chancres anywhere on the skin or mucous membranes reached by T. pallidum. A chancre is a round or oval painless erosion or ulcer, with gently sloping edges and a smooth bottom the color of red meat. It is characterized by a slight serous discharge, and a solid infiltrate can usually be felt at its base. The symptoms depend on the location of the chancre, the effect of external factors, and the presence of secondary infection. The lymph nodes nearest the chancre enlarge after approximately one week. The inflamed lymph nodes, which are called buboes, are firm, painless, and motile, and the overlying skin is unaltered.

Primary syphilis lasts an average of six to eight weeks. During the first two or three weeks after the appearance of the chancre, serologic reactions in the blood, including the Wassermann and sedimentation reactions, are negative. This stage, called primary seronegative syphilis, is followed by primary seropositive syphilis. By the end of the primary stage, all lymph nodes become enlarged, and a syphilitic often experiences malaise, weakness, headache, and a subfebrile temperature—indications that secondary syphilis has begun.

Secondary syphilis is characterized by the appearance of eruptions, for example, spots, nodules, blisters, and pustules, on the skin and mucous membranes. The eruptions may disappear spontaneously without treatment and then reappear (relapses) without producing a high temperature or subjective sensations. In the early phase of secondary syphilis the eruptions are profuse, fine, and symmetrical and last from one to two months. The extent of eruptions decreases with a secondary relapse, and the eruptions become larger and frequently asymmetrical, assuming odd shapes, such as wreaths or rings. Hyperpigmenta-tion with depigmented spots (syphilitic leukoderma) may appear on the back and side of the neck at the end of the first six months of the disease. Minimal or severe hair loss may occur, a condition known as syphilitic alopecia. The viscera, periosteum, bones, and nervous system are frequently affected. Serologic reactions are usually positive during this phase.

In the absence of treatment, tertiary syphilis usually sets in three to four years after the onset of the disease. A latent period lasting from several months to many years may precede this stage. Any organs or tissues may be affected; generally, the skin, mucous membranes, bones, and vascular and nervous systems become involved.

Tuberous and gummatous forms of the disease are distinguished according to the size and depth of the eruptions. The tuberous form is characterized by solid bluish red nodules, varying from the size of a hemp grain to that of a pea. Initially clustered together in the skin, the nodules leave scars after they disappear. There are no subjective sensations. The gumma passes through several stages of development. The formation of a solid painless nodule that grows and becomes ulcerated is accompanied by the destruction of tissue and the functional impairment of organs. Syphilitic lesions of the spinal cord and brain may result in tabes dorsalis and Bayle’s disease.

In pregnant women, intrauterine infection with syphilis at the time the placenta is being formed often ends in the premature birth of a stillborn infant. Some children with congenital syphilis survive, although they are usually physically and mentally underdeveloped. Early congenital syphilis is characterized by syphilids (also occurring with secondary syphilis), diffuse papular infiltrations, syphilitic rhinitis, and pemphigus. Sometimes the nervous system, bones, and viscera are also affected. Late congenital syphilis appears between the ages of five and 16, sometimes later; the afflicted exhibit the symptoms of tertiary syphilis, as well as anomalies of tooth development, eye lesions (interstitial keratitis), loss of hearing, and bone deformities, for example, saddle nose and saber shin. Serologic reactions are usually positive with congenital syphilis. All pregnant women should receive a serologic examination as a preventive measure.

Syphilis is treated in phases or continuously, depending on the stage of the disease. Those with contagious syphilis are first treated in hospitals. Antibiotics, iodine alkalies, salts of heavy metals, and organic arsenic compounds are used in combination with fever therapy, blood transfusions, injections of aloe and vitamins, and other nonspecific methods to strengthen the defensive mechanisms of the body. Affected skin should be kept clean. After the completion of treatment, periodic examinations should be scheduled for the next two to five years, depending on the stage of the disease during which treatment was initiated. During this period, serologic examinations should be administered every three to six months. If there are no signs of clinical or serologic relapse, the former syphilitic is declared fully recovered after being examined by a doctor of internal medicine, a roentgenologist, a neuropathologist, and an ophthalmologist.


Astvatsaturov, K. R. Sifilis, ego diagnostika i lechenie, 3rd ed. Moscow, 1971.



An infectious disease caused by the spirochete Treponema pallidum, transmitted principally by sexual intercourse.


Fracastoro’s epic concerning Syphilis, mythical first victim. [Ital. Lit.: RHD, 1443; Plumb, 342]
See: Disease


a venereal disease caused by infection with the microorganism Treponema pallidum: characterized by an ulcerating chancre, usually on the genitals and progressing through the lymphatic system to nearly all tissues of the body, producing serious clinical manifestations
References in periodicals archive ?
Anisocoria may occur due to structural and nonstructural causes.
The extent of anisocoria depends on the surrounding illumination or near effort.
Two false-negative results were recorded, while in 3 patients reversal of anisocoria only occurred under high illumination.
In a study of 21 patients with acute traumatic epidural hematomas and GCS scores lower than 8, anisocoria (pupillary size difference of > 2 mm) was present in 67% of patients.
It is important to measure pupil diameter in dim and bright light, especially in the presence of anisocoria, as the difference between the eyes can change; this is an important factor when determining whether anisocoria is pathological or physiological.
Pharmacological confirmation of Horner's syndrome is often needed because of the frequent co-existence of physiological anisocoria and mechanical ptosis, especially in the elderly.
6] They discouraged the use of blind hyperventilation except for cases of rapidly progressing intracranial catastrophes such as enlarging pupils, anisocoria, or bilateral mydriasis.
With pupil theory, pre-regs should know both nerve pathways and possible pathologies, including any anisocoria, Adies, Homers and Argyll-Robertson pupils.
On examination, she exhibited 3 mm of ptosis in addition to anisocoria (figure, A).
It is important to remember that 2S% of the population will have physiological anisocoria, where the pupils react to light normally.
After lunch, we moved on to meet a furry array of smaller patients, including a Cavalier King Charles Spaniel with corneal dystrophy, a yellow Labrador with the canine equivalent of retinitis pigmentosa and a cat called Frodo with a mysterious unilateral anisocoria who gave us an opportunity to practise our diagnostic skills.