Find information on medical topics, symptoms, drugs, procedures, news and more, written for the health care professional. Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential clinical, symptomatic stages separated by periods of asymptomatic latent infection. Common manifestations include genital ulcers, skin lesions, meningitis, aortic disease, and neurologic syndromes.
Diagnosis is by serologic tests and adjunctive tests selected based the disease stage. Penicillin is the drug of choice.
Syphilis is caused by T. Syphilis occurs in 3 stages see Table: There are long latent periods between the "Trophically transmitted sexual disease." Infected people are contagious during the first 2 stages.
Rashes which may be confused Trophically transmitted sexual disease those due to several other disorderssores on mucous membranes, hair loss, fever, many other symptoms.
Early latent syphilis infection 1 yr durationsometimes with recurrence of infectious lesions. Clinically classified as benign tertiary syphilis, cardiovascular syphilis, or neurosyphilis eg, asymptomatic, meningovascular, or parenchymatous neurosyphilis; tabes dorsalis. Infection is usually transmitted by sexual contact including genital, orogenital, and anogenital but may be transmitted nonsexually by skin contact or transplacentally, causing congenital syphilis.
Infection does not lead to immunity against reinfection. Syphilis may manifest at any stage and may affect multiple or single organs, mimicking many other disorders. Syphilis may be accelerated by coexisting HIV infection; in these cases, eye involvement, meningitis, and other neurologic complications are more common and more severe. After an incubation period of 3 to 4 wk range 1 to 13 wka primary lesion chancre develops at the site of inoculation.
The initial red papule quickly forms a chancre, usually a painless ulcer with a firm base; when rubbed, it produces clear fluid containing numerous spirochetes. Nearby lymph nodes may be enlarged, firm, and nontender. About half of infected women and one third of infected men are unaware of the chancre because it causes few symptoms.
Chancres in the rectum or mouth, usually occurring in men, are often unnoticed. The spirochete spreads in the bloodstream, producing widespread mucocutaneous lesions, lymph node swelling, and, less commonly, symptoms in other organs.
Fever, loss of appetite, nausea, and fatigue are common. Headache due to meningitishearing loss due to otitisbalance problems due to labyrinthitisvisual disturbances due to retinitis or uveitisand bone pain due to periostitis can also occur.
Without treatment, lesions may disappear in a few days to weeks, persist for months, or return after healing, but all eventually heal,
Trophically transmitted sexual disease without scarring.
Syphilitic dermatitis is usually symmetric and more marked on the palms and soles. The individual lesions are round, often scale, and may coalesce to produce larger lesions, but they generally do not itch or hurt. After lesions resolve, the affected areas may be lighter or darker than normal. If the scalp is involved, alopecia areata often occurs. Condyloma lata are hypertrophic, flattened, dull pink or gray papules at mucocutaneous junctions and in moist areas of the skin eg, in the perianal area, under the breasts ; lesions are extremely infectious.
Lesions of the mouth, throat, larynx, penis, vulva, or rectum are usually circular, raised, and often gray to white with a red border. About half of patients have lymphadenopathy, usually generalized, with nontender, firm, discrete nodes, and often hepatosplenomegaly.
Symptoms and signs are absent, but antibodies, detected by serologic tests for syphilis STSpersist. Because symptoms of primary and secondary syphilis are often minimal or ignored, patients frequently are first diagnosed during the latent stage when routine blood tests for Trophically transmitted sexual disease are done.
Syphilis may remain latent permanently, but relapses with contagious skin or mucosal lesions may occur during the early latent period. Patients are often given antibiotics for other disorders, which may cure latent syphilis and may account for the rarity of late-stage disease in developed countries. About one third of untreated people develop late syphilis, although not until years to decades after the initial infection. Lesions may be clinically classified as. Benign tertiary gummatous syphilis usually develops within 3 to 10 yr of infection and may involve the skin, bones, and internal organs.
Gummas are soft, destructive, inflammatory masses that are typically localized but may diffusely infiltrate an organ or tissue; they grow and heal slowly and leave scars. Benign tertiary syphilis of bone results in either inflammation or destructive lesions that cause a deep, boring pain, characteristically worse at night.
Cardiovascular syphilis usually manifests 10 to 25 yr after the initial infection as any of the following:. Pulsations of the dilated aorta may Trophically transmitted sexual disease symptoms by compressing or eroding adjacent structures in the chest.
Trophically transmitted sexual disease include brassy cough and obstruction of breathing due to pressure on the trachea, hoarseness due to vocal cord paralysis resulting from compression of the left laryngeal nerve, and painful erosion of the sternum and ribs or spine.
If CSF examination does not detect evidence of meningitis 2 yr after the initial infection, neurosyphilis is unlikely to develop. Meningovascular neurosyphilis results from inflammation of large- to medium-sized arteries of the brain or spinal cord; symptoms typically occur 5 to 10 yr after infection and range from none to strokes.
Initial symptoms may include headache, neck stiffness, dizziness, behavioral abnormalities, poor concentration, memory loss, lassitude, insomnia, and blurred vision. Spinal Trophically transmitted sexual disease involvement may cause weakness and wasting of shoulder-girdle and arm muscles, slowly progressive leg weakness with urinary or fecal incontinence or both, and, rarely, sudden paralysis of the legs due to thrombosis of spinal arteries.
Parenchymatous neurosyphilis general paresis, or dementia paralytica results when chronic meningoencephalitis causes destruction of cortical parenchyma. It usually develops 15 to Trophically transmitted sexual disease yr after initial infection and typically does not affect patients before their 40s or 50s.
Behavior progressively deteriorates, sometimes mimicking a mental disorder or dementia. Irritability, difficulty concentrating, deterioration of memory, defective judgment, headaches, insomnia, fatigue, and lethargy are common; seizures, aphasia, and transient hemiparesis are possible.
Hygiene and grooming deteriorate.
Patients may become emotionally unstable and depressed and have delusions of grandeur with lack of insight; wasting may occur. Tremors of the mouth, tongue, outstretched hands, and whole body may occur; other signs include pupillary abnormalities, dysarthria, hyperreflexia, and, in some patients, extensor plantar responses.
Handwriting is usually shaky and illegible.
Tabes dorsalis locomotor ataxia involves slow, progressive degeneration of the posterior columns and nerve roots. It typically develops 20 to 30 yr after initial infection; mechanism is unknown. Usually, the earliest, most characteristic symptom is an intense, stabbing lightning pain in the back and legs that recurs irregularly. Gait ataxia, hyperesthesia, and paresthesia may produce a sensation of walking on foam rubber. Loss of bladder sensation leads to urine retention, incontinence, and recurrent "Trophically transmitted sexual disease." Erectile dysfunction is common.
Most patients with tabes dorsalis are thin and have characteristic sad facies and Argyll Robertson pupils pupils that accommodate for near vision but do not respond to light. Optic atrophy may occur.
Examination of the legs detects hypotonia, hyporeflexia, impaired vibratory and joint position sense, ataxia in the heel-shin test, absence of deep pain sensation, and Romberg sign. Tabes dorsalis tends to be intractable even with treatment. Visceral crises episodic pain are a variant of tabes dorsalis; paroxysms of pain occur "Trophically transmitted sexual disease" various organs, most commonly in the stomach causing vomiting but also in the rectum, bladder, and larynx.
Ocular syndromes can affect virtually any part of the eye; they include interstitial keratitis, uveitis anterior, intermediate, and posteriorchorioretinitis, retinitis, retinal vasculitis, and cranial nerve and optic neuropathies. Cases of ocular syphilis have occurred among HIV-infected men who have sex with men.
Several cases resulted in significant morbidity, including blindness. Patients with ocular syphilis are at risk of neurosyphilis. Otosyphilis may affect the cochlea causing hearing loss and tinnitus or vestibular system causing vertigo and nystagmus. Trophic lesionssecondary to hypoesthesia of the skin or periarticular tissues, may develop in the later stages. Trophic ulcers may develop on the soles of the feet and penetrate as deeply as the underlying bone.
Neurogenic Trophically transmitted sexual disease Charcot jointsa painless joint degeneration with bony swelling and abnormal range of movement, is a classic manifestation of neuropathy.
Serologic treponemal tests eg, fluorescent treponemal antibody absorption or microhemagglutination assay for antibodies to T. Syphilis should Trophically transmitted sexual disease suspected in patients with typical mucocutaneous lesions or unexplained neurologic disorders, particularly in areas where the infection is prevalent.
In such areas, it should also be considered in patients with a broad range of unexplained findings. Because clinical manifestations are so diverse and advanced stages are now relatively rare in most developed countries, syphilis may escape recognition.
Patients with HIV and syphilis may have atypical or accelerated disease. Diagnostic test selection depends on which stage of syphilis is suspected. Neurologic infection is best detected by and followed with quantitative reaginic tests of CSF. Cases must be reported to public health agencies.
Traditionally, reaginic tests have been done first, and positive results are confirmed by a treponemal test. Some laboratories now reverse this sequence; they do newer, inexpensive treponemal tests first and confirm positive results using a nontreponemal test.
Nontreponemal reaginic tests use lipid antigens cardiolipin from bovine hearts to detect reagin human antibodies Trophically transmitted sexual disease bind to lipids. The Venereal Disease Research Laboratory VDRL and rapid plasma reagin RPR tests are sensitive, simple, and inexpensive reaginic tests that are used screening but are not completely specific for syphilis.
Results may be presented qualitatively eg, reactive, weakly reactive, borderline, or nonreactive and quantitatively as titers eg, positive at 1: Many disorders other than treponemal infections eg, SLE, antiphospholipid antibody syndromes can produce a positive biologically false-positive reagin test result.
CSF reaginic tests are reasonably sensitive for early disease but less so for late neurosyphilis. CSF reagin tests can be used to diagnose neurosyphilis or to monitor response to treatment by measuring antibody titers. Treponemal tests detect antitreponemal antibodies qualitatively and are very specific for syphilis. They include the following:. If they do not confirm treponemal infection after a positive reaginic test, the reaginic result is deemed biologically false-positive.
Neither reaginic nor treponemal tests become positive until 3 to 6 wk after the initial infection. Thus, a negative result is common in early primary syphilis and does not exclude syphilis until after 6 wk.