why aren't gummas infectious?

MrsMommaRN · Jul 23, 2007

thought this might help its from e-medicine:

the primary lesion (chancre) occurs on the member or scrotum of 70% of men with syphilis and on the vulva, cervix, or perineum of more than 50% of women with syphilis.
the primary lesion usually is a single ulcerated lesion with a
surrounding red areola. the edge and base of the ulcer have a cartilaginous (buttonlike) consistency on palpation.
the lesion is highly infectious; when abraded, it exudes a clear serum containing numerous t pallidum organisms.
extragenital chancres occur most commonly above the neck, typically affecting the lips or oral cavity.
the regional lymph nodes usually enlarge painlessly and are firm, discrete, and nontender.

secondary syphilis
- the protean manifestations of the secondary stage usually include localized or diffuse symmetric mucocutaneous lesions and generalized nontender lymphadenopathy (see [color=#333399]images 3-4).
- the healing primary chancre may remain present in 15-25% of patients.

initial lesions are bilaterally symmetric, pale red to pink (in light-skinned persons) or pigmented (in dark-skinned persons), discrete, round macules that measure 5-10 mm in diameter and are distributed on the trunk and proximal extremities.
after several days or weeks, red papular lesions 3-10 mm in diameter appear. these lesions often become necrotic and are distributed widely with frequent involvement of the palms and soles.

tiny papular follicular syphilids involving hair follicles may result in patchy alopecia. in addition to the classic moth-eaten alopecia, a diffuse alopecia also has been reported.

in 10% of patients, highly infectious papules develop at the mucocutaneous junctions and, in moist intertriginous skin, become hypertrophic and dull pink or gray (condyloma lata; see [color=#333399]image 2).

from 10-15% of patients with secondary syphilis develop superficial mucosal erosions on the palate, pharynx, larynx, glans member, vulva, or in the anal canal and rectum. these mucous patches are circular silver-gray erosions with a red areola.

ocular abnormalities, such as iritis, are a rare clinical finding, although anterior uveitis has been reported in 5-10% of patients with secondary syphilis.

less common findings include periostitis, arthralgias, meningitis, nephritis, hepatitis, and ulcerative colitis.

tertiary syphilis
- gummas may be identified on the skin, in the mouth, and in the upper respiratory tract. they appear most commonly on the leg just below the knee.
- gummas may be multiple or diffuse but usually are solitary lesions that range from less than 1 cm to several centimeters in diameter.
- cutaneous gummas are indurated, nodular, papulosquamous or ulcerative lesions that form characteristic circles or arcs with peripheral hyperpigmentation.

the most common clinical finding on cardiovascular examination is a diastolic murmur with a tambour quality, secondary to aortic dilation with valvular insufficiency.

symptomatic neurosyphilis produces various clinical syndromes that develop in approximately 5% of patients with syphilis who remain untreated. the most common presentation of meningovascular syphilis (diffuse inflammation of the pia and arachnoid along with widespread arterial involvement) is an indolent stroke syndrome involving the middle cerebral artery.
cranial nerve palsies and pupillary abnormalities occur with basilar meningitis.
argyll robertson pupil, which occurs almost exclusively in neurosyphilis, is a small irregular pupil that reacts normally to accommodation but not to light.
tabes dorsalis presents with signs of demyelination of the posterior columns, dorsal roots, and dorsal root ganglia (eg, ataxic wide-based gait and foot slap, areflexia and loss of position, deep pain and temperature sensations). deep ulcers of the feet can result from loss of pain sensation.

rare findings include iritis, with possible adhesion of the iris to the anterior lens, producing a fixed pupil (not to be confused with argyll robertson pupil).

congenital syphilis: the manifestations of untreated congenital syphilis can be divided into those that are expressed prior to age 2 years (early) or after age 2 years (late).

early manifestations
- early signs and symptoms include development of a diffuse rash, characterized by extensive sloughing of the epithelium, particularly on the palms, soles, and skin around the mouth and orifice.
- a compilation of early clinical presentations of congenital syphilis in 9 studies involving a total of 212 infants included abnormal bone radiographs (61%), hepatomegaly (51%), splenomegaly (49%), petechiae (41%), other skin rashes (35%), anemia (34%), lymphadenopathy (32%), jaundice (30%), pseudoparalysis (28%), and snuffles (23%).
- a classic mucocutaneous sign is depressed linear scars radiating from the orifice of the mouth and termed rhagades (parrot lines).

GingerSue · Jul 23, 2007

thanks

"Tertiary syphilis

Gummas may be identified on the skin, in the mouth, and in the upper respiratory tract. They appear most commonly on the leg just below the knee.
Gummas may be multiple or diffuse but usually are solitary lesions that range from less than 1 cm to several centimeters in diameter.
Cutaneous gummas are indurated, nodular, papulosquamous or ulcerative lesions that form characteristic circles or arcs with peripheral hyperpigmentation"

but why aren't the gummas infectious?

maybe it's because the cause of gummas is severe hypersensitivity reaction?

Multicollinearity, BSN, RN · Jul 23, 2007

Well you learn something new every day. I clicked on this thread thinking of 'gummas' from the Sopranos!