Syphilitic Aneurysms and Aortitis

Introduction to Syphilitic Aortitis

• The American Heart Association notes that syphilitic aortitis causes true aneurysms through a distinct chronic inflammatory mechanism, not the acute infectious process that defines modern mycotic aneurysms 1, 2
• The term "mycotic aneurysm" was originally coined by Osler to describe infected aneurysms, but this historical nomenclature is misleading in the context of syphilis 3, 4

Key Characteristics of Syphilitic Aortitis

• Syphilitic aneurysms are pathophysiologically distinct from what we now call mycotic aneurysms, with a delayed presentation of 10 to 25 years after initial spirochetal infection 1, 2
• The Centers for Disease Control and Prevention recommends that patients with syphilitic aortitis be evaluated for associated cardiovascular manifestations, such as aortic regurgitation and coronary ostial disease 1, 8
• The European Society of Cardiology notes that syphilitic aneurysms predominantly affect the ascending thoracic aorta, and are typically fusiform aneurysms 1, 2, 5

Diagnosis and Evaluation

• The American College of Cardiology recommends serologic confirmation of syphilis using both nontreponemal (RPR/VDRL) and treponemal tests 8
• Imaging characteristics of syphilitic aneurysms may show calcification and develop over years, unlike acute mycotic aneurysms 6, 7

Management and Treatment

• The Centers for Disease Control and Prevention recommends antibiotic therapy with IV penicillin G for confirmed syphilitic aortitis with aneurysm 8
• The American Heart Association notes that surgical intervention is required for ascending aortic aneurysm with aortic valve replacement if indicated, and that timing allows for planned surgical repair after antibiotic initiation 1, 2, 6, 7