Difference between revisions of "Syphilis"

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==Clinical Features==
 
==Clinical Features==
[[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]
 
 
===Primary Syphilis===
 
===Primary Syphilis===
 
*Primary lesion appears after an incubation of 2-6 weeks
 
*Primary lesion appears after an incubation of 2-6 weeks
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**Heals in 4-6 weeks  
 
**Heals in 4-6 weeks  
 
*Regional lymphadenopathy that is painless and firm
 
*Regional lymphadenopathy that is painless and firm
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===Secondary Syphilis===
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*Characterized by generalized mucocutaneous lesions and generalized lymphadenopathy but can also be found in many tissues such as the CNS and aqueous humor
 +
*Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.
 +
*They progress to more wide spread papular lesions that frequently involve the palms and soles.
 +
**Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks
 +
**Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients.
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**In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata
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*CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic.
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*Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus
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*Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

Revision as of 15:18, 22 December 2014

Background

  • Syphilis is caused by the spirochete Treponema pallidum.
  • Usually sexually transmitted
  • Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency
  • Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection

Pathogenesis

  • Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions.
  • Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation
  • Blood from a patient with incubating or early syphilis is infectious.
  • Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary

Clinical Features

Primary Syphilis

  • Primary lesion appears after an incubation of 2-6 weeks
    • Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation
    • Minority of patients can have multiple lesions or atypical appearance
    • Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia
    • Heals in 4-6 weeks
  • Regional lymphadenopathy that is painless and firm

Secondary Syphilis

  • Characterized by generalized mucocutaneous lesions and generalized lymphadenopathy but can also be found in many tissues such as the CNS and aqueous humor
  • Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.
  • They progress to more wide spread papular lesions that frequently involve the palms and soles.
    • Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks
    • Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients.
    • In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata
  • CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic.
  • Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus
  • Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities

Differential Diagnosis

Workup

Management

  • Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection)

Disposition

See Also

Source

  • Emedicine