Syphilis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}{{AE}}{{AA}} | {{CMG}}{{AE}}{{AA}}; {{NRM}} | ||
{{Syphilis}} | {{Syphilis}} | ||
==Overview== | ==Overview== | ||
The physical | 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== | ||
The physical | 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> | ||
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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''' | |||
:*Single painless papule which rapidly progresses to 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]]''' | |||
:*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;" |<gallery> | | 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. | 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 | 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> | </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''' | |||
:*[[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''' | |||
:*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''' | |||
::*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"> | <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: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 | 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 | 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 | 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> | </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) | ||
| 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''' | |||
* | *Asymptomatic [[meningitis]] | ||
*Symptomatic meningitis: neck stiffness, [[ | *Symptomatic meningitis: neck stiffness, [[Brudzinski's sign]], [[Kernig's sign]], [[ataxia]]. | ||
*Meningovascular syphilis | *Meningovascular syphilis | ||
:*Focal deficits | :*Focal deficits | ||
:*Intermittent or | :*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 | ||
:* | :*Presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]] | ||
:*[[Argyll Robertson pupil]]: small irregular pupil | :*[[Argyll Robertson pupil]]: small irregular pupil | ||
'''Cardiovascular syphilis''' | |||
*[[Aortic insufficiency physical findings| | *[[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> | :*[[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]]: | ||
:*Soft, asymmetric, coalscent [[granuloma|granulomatous]] lesion | :*Soft, asymmetric, coalscent [[granuloma|granulomatous]] lesion | ||
:*Solitary lesions less than a centimeter in diameter | :*Solitary lesions less than a centimeter in diameter | ||
:*Appear almost anywhere in the body | :*Appear almost anywhere in the body | ||
:*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;" | | ||
<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| Gummatous lesions in 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| Gummatous lesions in 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| Gummatous lesions in 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> | ||
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Latest revision as of 00:23, 30 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]; Nate Michalak, B.A.
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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
|
|
| Secondary syphilis |
Cardinal signs
Condylomata lata
Superficial mucosal patches |
|
| Latent syphilis |
|
|
| Tertiary syphilis |
Neurosyphilis
Cardiovascular syphilis Gummatous lesions
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_on_the_surface_of_a_tongue-CDC.jpg)
![+/−The direct image URL is [1], Dominio público, https://commons.wikimedia.org/w/index.php?curid=21063](/index.php/File:Vaginal_syphilis_(disturbing_image).jpg)
![Condymoata lata - Adapted from Dermatology Atlas.[4]](/index.php/File:Syphilis_secondary_15.jpeg)
![Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.[4]](/index.php/File:Syphilis_tertiary_01.jpeg)
![Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.[4]](/index.php/File:Syphilis_tertiary_02.jpeg)
![Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.[4]](/index.php/File:Syphilis_tertiary_03.jpeg)
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 4.0 4.1 4.2 4.3 "Dermatology Atlas".
- ↑ 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)