The Specific Treatment of Syphilitic Aortitis

Abstract

Penicillin has made the specific treatment of cardiovascular syphilis easy to give and easy to take and has all but abolished dangerous treatment reactions. Just as the curative therapy of acute syphilis with penicillin is simple and feasible, so is the prophylactic treatment of cardiovascular syphilis in individuals with latent syphilis and uncomplicated syphilitic aortitis simple and feasible. In spite of the fact that the effectiveness of such treatment has not been conclusively established, the prospects seem bright that the incidence of cardiovascular syphilis will decrease sharply in the immediate future. Cardiovascular syphilis may be treated, with or without preliminary bismuth and iodide "preparation," by the administration of 4.8 to 6 million units of penicillin in a period of 8 to 10 days. Larger doses and longer periods of treatment have been employed. Experience thus far does not indicate that penicillin therapy of established complications of syphilitic aortitis will be any more successful than was therapy of the pre-penicillin era.

Aortic aneurysm in a patient with syphilis-related spinal pain and paraplegia

“…During the first half of the 20 th century, thoracic aortic aneurysms were much more common than their abdominal counterparts, due to the prevalence of syphilitic thoracic aortic aneurysms [3, 11]. In 1952 the thoracic/abdominal aneurysms ratio was 2 : 1, until 1964 when this ratio equalised, making the syphilitic cardiovascular involvement very rare in current days [8].…”

“…Cardiovascular syphilis is characterised by obliterating endarteritis, which may affect small-calibre vases irrespective of location, but it is much more devastating whenever it affects the aorta’s vasa vasorum , jeopardising the blood supply of the aortic wall, leading to destruction of the elastic tissue and weakening of the medial aortic tunic, particularly in the ascendant and transverse segments of the thoracic aortic arc [3, 8–10, 12]. The macroscopic aspect is classically described as “tree bark” due to inner layer alterations and parietal calcification [7, 10, 11].…”

“…Among the cardiovascular lesions, 85% of patients present with aortic insufficiency, coronary ostium stenosis in 25 to 30%, and the presence of aneurysms in 5 to 10%, 75% of these being of saccular morphology [3]. …”

“…Classically, syphilitic aneurysms occur in 90% of cases on the thoracic aorta, and in 10% in the abdominal aorta [3, 7–9]. Infection of aortic wall develops during the secondary or bacteraemic phase of syphilis, having a latent period from infection until the clinical presentation ranging from 5 to 50 years [5, 8].…”

A rare case of tertiary syphilis complicated with aortic aneurysm in this era of early use of highly effective antibiotics

“…Aneurysm formation is probably the least common among the complications of aortitis and is symptomatic in only 5-10% patients. [8] Majority of aneurysms are single aneurysms while saccular aneurysms are more common than the fusiform. Involvement of ascending aorta is approximately seen in 50% of patients.…”