The stages of syphilis, based on clinical findings and time, and not always clinically apparent, are early (2 to 6 weeks after infection, with ulcers and chancres), secondary (1 to 2 months after primary, with skin and mucocutaneous lesions that are contagious) latent (early and late) and tertiary, 2 to 50 years after infection, which consists of cardiovascular (e.g., aortic dissection), ocular syphilis, otic syphilis, gummatous disease and late neurosyphilis (general paresis and tabes dorsalis and meningovascular disease and meningomyelitis). Average inoculation of 500 to 1000 organisms is required for disease occurrence. The incubation period of syphilis is inversely proportional to the number of inoculated organisms. Many exposures resolve in people with an intact immune system. Bacteria may invade the CNS in early syphilis with asymptomatic CNS involvement demonstrable in up to 40% of patients with early syphilis. Treponema pallidum pallidum invades the body through abrasions in the skin and intact mucous membranes and then travels via the lymphatics and blood within a few hours. In asymptomatic neurosyphilis, which is inflammation without symptoms, a lumbar puncture for CSF evaluation is controversial. However, many feel it is important, especially in PLWH, to establish the diagnosis when present since treatment with penicillin at higher and longer doses than used for primary and secondary syphilis can retard or prevent the development of clinically evident and debilitating neurosyphilis, which, when it develops as late neurosyphilis is not as amenable to symptom reversal. Neurosyphilis can be both symptomatic and asymptomatic. Thus, the clinical suspicion of neurosyphilis in PLWH must always remain strong with neurological, visual, or otologic signs or symptoms. HIV coinfection commonly occurs with neurosyphilis in the U.S. Men who have sex with men and patients with human immunodeficiency virus (HIV) infection, or PLWH (patients living with HIV), are at a higher risk of neurosyphilis, especially the early types. The cellular infiltration in the spinal cord displays T-helper cells, macrophages that produce cytokines that intensify the inflammatory process. Some studies support the invasion of the large myelinated nerve fibers by Treponema pallidum and subsequent neuronal degeneration. The pathogenesis of tabes dorsalis follows the pattern of syphilis elsewhere: a perivascular inflammatory response against the treponeme along with gummas (caseous necrosis in granulomata). Although cerebrospinal fluid (CSF) invasion often occurs early in syphilis, the clinical syndrome of tabes dorsalis, one of two manifestations of late neurosyphilis, usually occurs years, often two to three decades later. It may be accompanied by meningitis or meningomyelitis. It generally occurs in the late tertiary stage of syphilis, but early involvement is reported. Tabes dorsalis is a slowly progressive parenchymatous degenerative disease of the dorsal column and dorsal root of the spinal cord as a result of syphilis caused by infection with Treponema pallidum pallidum, one of three subspecies of Treponema pallidum that can cause sexually transmitted disease in humans. This activity can help professionals' understanding of tabes dorsalis and can augment the interprofessional effort in caring for these individuals who often require institutionalization with support by several specialties like neurology, urology, and, eventually, sometimes palliative care. The disease has a delayed and insidious onset resulting in ataxia, dementia, painful crises, and skin, joint, and bladder abnormalities. Although CSF invasion often occurs early in infection with Treponema pallidum, the clinical syndrome of tabes dorsalis usually occurs many years, even decades, later. Tabes generally occurs in the late tertiary stage of syphilis, but early involvement is reported. Tabes dorsalis, one of two manifestations of late neurosyphilis, is a slowly progressive parenchymatous degenerative disease of the dorsal column and dorsal root of the spinal cord as a result of infection with Treponema pallidum subspecies pallidum, one of three subspecies of Treponema pallidum that can cause sexually transmitted diseases in humans.
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