The typical lesion of treponema pallidum infection is arteritis obliterans which results initially in painless lesions of the genitalia, followed by necrosis of the media of the vasculature at various sites in the body. This obliterative arteritis is especially profound when the vasa vasorum of the aorta are involved, resulting in&127; ischemic necrosis of the media of the aorta. Note the leukocytic infiltrate around one of the vasa vasorum of the aorta. Necrosis of these vasa vasorum is the primary cause of proximal aortic aneurysm and has profound clinical consequences.
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