Syphilis physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}{{AE}}{{AA}}
{{CMG}}{{AE}}{{AA}}; {{NRM}}
{{Syphilis}}
{{Syphilis}}
==Overview==
The physical examination findings of syphilis are described according to the stage of syphilis which includes non-tender [[chancre]] in primary syphilis followed by [[rash]] and generalized [[lymphadenopathy]] in secondary syphilis. Physical examination findings in tertiary syphilis depend on the organ system involved.<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }} </ref><ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref><ref name="pmid17560432">{{cite journal| author=Wöhrl S, Geusau A| title=Clinical update: syphilis in adults. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1912-4 | pmid=17560432 | doi=10.1016/S0140-6736(07)60895-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560432  }} </ref>


==Physical Examination==
==Physical Examination==
XXXXX<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }} </ref>
The physical examination findings of syphilis are described according to the stage of syphilis.<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456 }} </ref><ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref><ref name="pmid17560432">{{cite journal| author=Wöhrl S, Geusau A| title=Clinical update: syphilis in adults. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1912-4 | pmid=17560432 | doi=10.1016/S0140-6736(07)60895-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560432 }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Primary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Primary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
'''''Chancre'''''
'''Chancre'''
:*Single painless papule which rapidly progresses an ulcerated, indurated lesion with a surrounding red [[areola]]
:*Single painless [[papule]] which rapidly progresses to an ulcerated, indurated lesion with a surrounding red [[areola]]
:*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]]
:*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]]
'''''Regional [[lymphadenopathy]]'''''
'''Regional [[lymphadenopathy]]'''
:*Unilateral or bilateral
:*Unilateral or bilateral
:*[[Lymph node]]s are firm, painless, non-tender and non-suppurative
:*[[Lymph node]]s are firm, painless, non-tender and non-suppurative
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |<gallery>
 
File:800px-Primary stage syphilis sore (chancre) on the surface of a tongue-CDC.jpg| Primary stage syphilis sore (chancre) on the surface of a tongue. - By Centers for Disease Control and Prevention (CDC) - http://www.cdc.gov/std/syphilis/images.htm#, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26062941
 
File:800px-Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|Chancres on the penile shaft due to a primary syphilitic infection - By CDC/M. Rein, VD - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #6803.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743113
</gallery>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Secondary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Secondary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
'''''Cardinal signs'''''
'''Cardinal signs'''
:*[[Skin rash]]: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers.
:*[[Skin rash]]: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers


:*[[Lymphadenopathy]]: localized or generalized, firm and non-tender   
:*[[Lymphadenopathy]]: localized or generalized, firm and non-tender   


'''''Condylomata lata'''''
'''Condylomata lata'''
:*Reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as condylomata lata  
:*Reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as condylomata lata  
:*Lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions
:*Lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions


'''''Superficial mucosal patches'''''  
'''Superficial mucosal patches'''  
::*Painless
::*Painless
::*May be macular, papular, pustular or mixed
::*May be macular, papular, pustular or mixed.
::*Located on the [[palate]], [[pharynx]], [[larynx]], [[penis]], [[vulva]], [[anal canal]] or [[rectum]]   
::*Located on the [[palate]], [[pharynx]], [[larynx]], [[penis]], [[vulva]], [[anal canal]] or [[rectum]]   
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
<gallery perRow="5">
Image:Secondary Syphilis on palms CDC 6809 lores rsh.jpg|Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet - By CDC/ Robert Sumpter - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #6809.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134272
Image:Vaginal syphilis (disturbing image).jpg|Secondary syphilis manifested perineal condylomata lata lesions - De Content Providers(s): CDC - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #4098.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−The direct image URL is [1], Dominio público, https://commons.wikimedia.org/w/index.php?curid=21063
Image:Syphilis lesions on back.jpg|Syphilis lesions on a patient's back - By Office of Medical History, US Surgeon General - Adapted from http://history.amedd.army.mil/booksdocs/wwii/internalmedicinevolIII/chapter20figure64.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1202157
Image:Syphilis secondary 15.jpeg|Condymoata lata - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
</gallery>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Latent syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Latent syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*ASymptomatic (serologically positive)
*Asymptomatic (serologically positive)
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Tertiary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Tertiary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
'''''Neurosyphilis'''''
'''Neurosyphilis'''
*ASymptomatic [[meningitis]]
*Asymptomatic [[meningitis]]
*Symptomatic meningitis: neck stiffness, [[brudzinski's sign]]+, [[kernig's sign]]+, ataxia
*Symptomatic meningitis: neck stiffness, [[Brudzinski's sign]], [[Kernig's sign]], [[ataxia]].
*Meningovascular syphilis
*Meningovascular syphilis
:*Focal deficits
:*Focal deficits
:*Intermittent or progress slowly over a few days
:*Intermittent or progresses slowly over a few days
*Parenchymatous neurosyphilis
*Parenchymatous neurosyphilis
:*Develops 15-20 years after primary infection
:*Develops 15-20 years after primary infection
:*Clinical presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]]
:*Presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]]
:*[[Argyll Robertson pupil]]: small irregular pupil
:*[[Argyll Robertson pupil]]: small irregular pupil


'''''Cardiovascular syphilis'''''
'''Cardiovascular syphilis'''
*[[Aortic insufficiency physical findings|aortic regurgitation]]:
*[[Aortic insufficiency physical findings|Aortic regurgitation]]:
:*[[Diastolic murmur]]
:*[[Diastolic murmur]]
:*[[De Musset's sign]]<ref>{{cite journal | author=Sapira JD | title="Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations" | journal=South Med J. | date=1981 Apr | volume=74 | issue=4 | pages=459-67 }}</ref> a bobbing of the head that de Musset first noted in Parisian prostitutes.
:*[[De Musset's sign]]<ref>{{cite journal | author=Sapira JD | title="Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations" | journal=South Med J. | date=1981 Apr | volume=74 | issue=4 | pages=459-67 }}</ref>
'''Gummatous lesions'''
'''Gummatous lesions'''
*[[Gumma]]:
*[[Gumma]]:
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:*Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation
:*Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
|-
|}
===Primary syphilis: Chancre===
*Afebrile
*Chancre:
:*Single painless papule which rapidly progresses an ulcerated, indurated lesion with a surrounding red [[areola]]
:*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]]
:*Highly infectious lesion
*Regional [[lymphadenopathy]] accompanies primary lesion.
:*Onset within a week
:*Unilateral or bilateral
:*[[Lymph node]]s are firm, painless, non-tender and non-suppurative
*Primary [[chancre]] heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods.
<gallery>
File:800px-Primary stage syphilis sore (chancre) on the surface of a tongue-CDC.jpg| Primary stage syphilis sore (chancre) on the surface of a tongue.
File:800px-Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|Chancres on the penile shaft due to a primary syphilitic infection
File:Chancre-penile-1.jpg|Primary stage syphilis sore (chancre) on glans (head) of the penis.
File:Syphilis primary chancre 01.jpeg| Syphilis primary chancre.
File:Syphilis primary chancre 02.jpeg| Syphilis primary chancre.
</gallery>
<gallery perRow="5">
Image:Secondary Syphilis on palms CDC 6809 lores rsh.jpg|Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet
Image:condyoma lata (syphilis secondary).jpg|Condyoma lata (syphilis secondary)
Image:TreponemaPallidum.jpg|Electron micrograph of Treponema pallidum
Image:Syphilis lesions on back.jpg|Syphilis lesions on a patient's back
Image:Syphilis lesions on chest.jpg|Syphilis lesions on a patient's chest
Image:Penis syphilis.png|Chancres on the penile shaft due to a primary syphilitic infection
Image:Vaginal syphilis (disturbing image).jpg|Secondary syphilis manifested perineal condylomata lata lesions, which presented as gray, raised papules that sometimes appear on the vulva or near the anus, or in any other warm intertriginous region.
Image:Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|Gumma of the nose due to long standing tertiary syphilis
</gallery>
===Secondary syphilis: Condylomata Lata===
*Develops 6-8 weeks after the appearance of primary [[chancre]].
*Cardinal signs include:
:*[[Skin rash]]: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers.
:*[[Lymphadenopathy]]: localized or generalized, firm and non-tender 
:*Condylomata lata:
::*Reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as condylomata lata
:*Lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions
:*Superficial mucosal patches:
::*Painless
::*May be macular, papular, pustular or mixed
::*Located on the [[palate]], [[pharynx]], [[larynx]], [[penis]], [[vulva]], [[anal canal]] or [[rectum]]
<gallery>
Image:Skin syphillis foot.jpg|Erruption on Sole of Foot Associated with Secondary Syphilis.
Image:Skin_syphillis1.jpg|Generalized (Maculo-Papular) Eruption Associated with Secondary Syphilis.
Image:Skin syphillis hand2.jpg|Palmar Erruption Associated with Secondary Syphilis.
Image:Skin syphillis hand1.jpg|Palmar Erruption Associated with Secondary Syphilis.
Image:Manifestations of secondary syphilis Treponema pallidum 6539 lores.jpg| manifestations of secondary syphilis
File:Syphilis lesions on back.jpg|Syphilis lesions on back.
Image:408px-Secondary syphilitic rash Treponema pallidum 6756 lores.jpg|Syphilis lesions on back
File:Palmar-1.jpg|Secondary stage syphilis sores (lesions) on the palms of the hands. Referred to as "palmar lesions.
File:Plantar-2.jpg|Secondary stage syphilis sores (lesions) on the bottoms of the feet. Referred to as "plantar lesions."
Image:Syphilis secondary 01.jpeg|Secondary syphilis
Image:Syphilis secondary 02.jpeg|Secondary syphilis
Image:Syphilis secondary 03.jpeg|Secondary syphilis
Image:Syphilis secondary 04.jpeg|Secondary syphilis
Image:Syphilis secondary 05.jpeg|Secondary syphilis
Image:Syphilis secondary 06.jpeg|Secondary syphilis
Image:Syphilis secondary 07.jpeg|Secondary syphilis
Image:Syphilis secondary 08.jpeg|Secondary syphilis
Image:Syphilis secondary 09.jpeg|Secondary syphilis
Image:Syphilis secondary 10.jpeg|Secondary syphilis
Image:Syphilis secondary 11.jpeg|Secondary syphilis
Image:Syphilis secondary 12.jpeg|Secondary syphilis
Image:Syphilis secondary 13.jpeg|Secondary syphilis
Image:Syphilis secondary 14.jpeg|Secondary syphilis
Image:Syphilis secondary 15.jpeg|Secondary syphilis
Image:Syphilis secondary 16.jpeg|Secondary syphilis
Image:Syphilis secondary 17.jpeg|Secondary syphilis
Image:Syphilis secondary 18.jpeg|Secondary syphilis
Image:Syphilis secondary 19.jpeg|Secondary syphilis
Image:Syphilis secondary 20.jpeg|Secondary syphilis
Image:Syphilis secondary 21.jpeg|Secondary syphilis
Image:Syphilis secondary 22.jpeg|Secondary syphilis
Image:Syphilis secondary 23.jpeg|Secondary syphilis
Image:Syphilis secondary 24.jpeg|Secondary syphilis
Image:Syphilis secondary 25.jpeg|Secondary syphilis
Image:Syphilis secondary 26.jpeg|Secondary syphilis
Image:Syphilis secondary 27.jpeg|Secondary syphilis
Image:Syphilis secondary 28.jpeg|Secondary syphilis
Image:Syphilis secondary 29.jpeg|Secondary syphilis
Image:Syphilis secondary 30.jpeg|Secondary syphilis
Image:Syphilis secondary 31.jpeg|Secondary syphilis
Image:Syphilis secondary 32.jpeg|Secondary syphilis
Image:Syphilis secondary 33.jpeg|Secondary syphilis
Image:Syphilis secondary 34.jpeg|Secondary syphilis
Image:Syphilis secondary 35.jpeg|Secondary syphilis
Image:Syphilis secondary 36.jpeg|Secondary syphilis
Image:Syphilis secondary 37.jpeg|Secondary syphilis
Image:Syphilis secondary 38.jpeg|Secondary syphilis
Image:Syphilis secondary 39.jpeg|Secondary syphilis
Image:Syphilis secondary 40.jpeg|Secondary syphilis
Image:Syphilis secondary 41.jpeg|Secondary syphilis
Image:Syphilis secondary 42.jpeg|Secondary syphilis
Image:Syphilis secondary 44.jpeg|Secondary syphilis
Image:Syphilis secondary 45.jpeg|Secondary syphilis
</gallery>
===Tertiary syphilis: Gumma===
*[[Gumma]]:
:*Soft, asymmetric, coalscent [[granuloma|granulomatous]] lesion
:*Solitary lesions less than a centimeter in diameter
:*Appear almost anywhere in the body including in the skeleton
:*Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation
<gallery>
<gallery>
File:800px-Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.
File:800px-Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|A gumma of nose due to a long standing tertiary syphilitic ''Treponema pallidum'' infection. - By CDC/ J. Pledger - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #5330.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743277


Image:Syphilis tertiary 01.jpeg| Tertiary syphilis
Image:Syphilis tertiary 01.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
Image:Syphilis tertiary 02.jpeg| Tertiary syphilis
Image:Syphilis tertiary 02.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>


Image:Syphilis tertiary 03.jpeg| Tertiary syphilis
Image:Syphilis tertiary 03.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
</gallery>  
</gallery>  
*Cardiovascular manifestation secondary to aortic dilation with resultant [[Aortic insufficiency physical findings|aortic regurgitation]]:
|-
:*[[Diastolic murmur]]
|}
:*[[De Musset's sign]]<ref>{{cite journal | author=Sapira JD | title="Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations" | journal=South Med J. | date=1981 Apr | volume=74 | issue=4 | pages=459-67 }}</ref> a bobbing of the head that de Musset first noted in Parisian prostitutes
 
*Neurological manifestation:
:*Asymptomatic meningitis
::*Asymptomatic neurosyphilis usually has no signs or symptoms and is diagnosed exclusively with the presence of CSF abnormalities notably pleocytosis, elevated protein, decreased glucose or a positive VDRL test.
 
:*Symptomatic meningitis
::*Develops within 6-months to several years of primary infection
::*Typical meningitis symptoms present
::*Cranial nerve abnormalities may be observed
 
:*Meningovascular syphilis
::*Occurs a few months to 10 years (average, 7 years) after the primary infection
::*Associated with [[prodromal]] symptoms lasting weeks to months before focal deficits are identifiable
::*Focal deficits initially are intermittent or progress slowly over a few days
::*Clinical present with CNS vascular insufficiency or [[stroke]] involving the middle cerebral artery
 
:*Parenchymatous neurosyphilis
::*Develops 15-20 years after primary infection
::*Clinical presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]]
::*[[Argyll Robertson pupil]]: small irregular pupil
 
===Ophthalmic Examination===
*Slit-lamp examination and ophthalmic examination may be helpful to differentiate between acquired and congenital syphilis.
 
*Presence of [[interstitial keratitis]] is suggestive of [[congenital syphilis]] with latent infection of unknown duration.
 
===Clinical pearl: Syphilis detecting Handshake===
{{#ev:youtube|SAedwyzTMWA}}


==References==
==References==
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{{WikiDoc Sources}}
{{WikiDoc Sources}}


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Latest revision as of 00:23, 30 July 2020

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Overview

The physical examination findings of syphilis are described according to the stage of syphilis which includes non-tender chancre in primary syphilis followed by rash and generalized lymphadenopathy in secondary syphilis. Physical examination findings in tertiary syphilis depend on the organ system involved.[1][2][3]

Physical Examination

The physical examination findings of syphilis are described according to the stage of syphilis.[1][2][3]

Stage of syphilis Physical Examination Images
Primary syphilis

Chancre

Regional lymphadenopathy

  • Unilateral or bilateral
  • Lymph nodes are firm, painless, non-tender and non-suppurative
Secondary syphilis

Cardinal signs

  • Skin rash: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers

Condylomata lata

  • Reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as condylomata lata
  • Lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions

Superficial mucosal patches

Latent syphilis
  • Asymptomatic (serologically positive)
Tertiary syphilis

Neurosyphilis

  • Focal deficits
  • Intermittent or progresses slowly over a few days
  • Parenchymatous neurosyphilis

Cardiovascular syphilis

Gummatous lesions

  • Soft, asymmetric, coalscent granulomatous lesion
  • Solitary lesions less than a centimeter in diameter
  • Appear almost anywhere in the body
  • Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation

References

  1. ↑ 1.0 1.1 Singh AE, Romanowski B (1999). "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features". Clin Microbiol Rev. 12 (2): 187–209. PMC 88914. PMID 10194456.
  2. ↑ 2.0 2.1 Carlson JA, Dabiri G, Cribier B, Sell S (2011). "The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity". Am J Dermatopathol. 33 (5): 433–60. doi:10.1097/DAD.0b013e3181e8b587. PMC 3690623. PMID 21694502.
  3. ↑ 3.0 3.1 Wöhrl S, Geusau A (2007). "Clinical update: syphilis in adults". Lancet. 369 (9577): 1912–4. doi:10.1016/S0140-6736(07)60895-2. PMID 17560432.
  4. ↑ 4.0 4.1 4.2 4.3 "Dermatology Atlas".
  5. ↑ Sapira JD (1981 Apr). ""Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations"". South Med J. 74 (4): 459–67. Check date values in: |date= (help)


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