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{{CMG}}; {{AE}} {{AA}}{{NRM}} {{Maha}}
{{Syphilis}}
{{Syphilis}}


==History==
==Overview==
Syphilis is a curable [[sexually transmitted disease]] caused by the ''[[Treponema pallidum]]'' [[spirochete]]. The route of transmission of syphilis is almost always by [[sexual]] contact, although there are examples of [[congenital syphilis]] via transmission from mother to child [[in utero]]. The signs and [[symptoms]] of syphilis are numerous; before the advent of [[serological testing]], precise [[diagnosis]] was very difficult.
The history and symptoms of syphilis depends on stage of disease. The hallmark of syphilis infection is painless [[chancre]]. A positive history of painless chancre on genitalia, and presence of risk factors such as unprotected sex, multiple sexual partners, residence in highly prevalent area and previous history of sexually transmitted infections may be suggestive of syphilis infection. The most common symptoms of syphilis infection include painless [[chancre]] which progresses to [[ulcer]] with regional [[lymphadenopathy]] in primary syphilis. Secondary syphilis is characterized by [[rash]] and constitutional symptoms. Syphilis infection in tertiary syphilis can involve any organ system, hence named the "Great Imitator".<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>


*Hx number of sexual partners, condom use,  
== History and symptoms==
*Hx of sexually transmitted disease, intravenous drug use, exposure to blood products
The history and symptoms of syphilis according to the stage of disease are described below:<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
==Symptoms==
|+
===Primary syphilis===
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Stage of syphilis}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|History and symptoms}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Primary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*History of risk factors (MSM, unprotected sex, multiple sex partners)
*Onset within 3 weeks of contact
*Onset within 3 weeks of contact


*[[Chancre]]:
*[[Chancre]]:
:*Rapidly progresses an ulcerated, indurated lesion
:*Single painless firm raised [[papule]]
:*Single painless firm raised papule
:*Rapidly progresses to an ulcerated lesion
:*Usually located on the [[glans penis]], [[cervix]], [[labia]], anal canal, [[rectum]] or [[oral cavity]]
:*Usually located on the [[glans penis]], [[cervix]], [[labia]], anal canal, [[rectum]] or [[oral cavity]]


*Regional [[lymphadenopathy]] accompanies primary lesion.
*Regional [[lymphadenopathy]]


*Primary chancre heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods.
*Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods
 
|-
===Secondary syphilis===
| style="padding: 5px 5px; background: #DCDCDC;" |'''Secondary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Develops 6-8 weeks after the appearance of primary [[chancre]]
*Develops 6-8 weeks after the appearance of primary [[chancre]]
*Generalized systemic symptoms such as [[malaise]], [[fatigue]], [[headache]] and [[fever]] may be present.
*Generalized systemic symptoms such as [[malaise]], [[fatigue]], [[headache]] and [[fever]] may be present
*Skin eruptions may be subtle and asymptomatic
*Skin eruptions may be subtle and asymptomatic
*Classic:  
*Classic:  
:*Non-pruritic bilateral symmetrical mucocutaneous rash  
:*Non-pruritic bilateral symmetrical mucocutaneous rash  
:*Non-tender regional [[lymphadenopathy]]  
:*Non-tender regional [[lymphadenopathy]]
:*Condylomata lata
:*Condylomata lata
:*Patchy [[alopecia]]
:*Patchy [[alopecia]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Latent syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Previous history of chancre or rash
*Asymptomatic
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Tertiary syphilis'''
| style="padding: 5px 5px; background: #F5F5F5;" |Clinical manifestation of this stage depends on organ system involved:


===Latent syphilis===
'''Neurosyphilis'''
*Latency period may last for years before the onset of tertiary lesions
*[[Altered mental status]]
 
*[[Dementia]]
*2 phases of latency:
*Focal neurodeficit affecting hearing and vision
:#Early latent period: first year following the resolution of primary or secondary syphilis
'''Cardiovascular syphilis'''
:#Late latent period: non-infectious phase; however, vertical transmission of the disease is possible
*[[Aortic Regurgitation]]
 
:*[[Dyspnea on exertion]]
*Asymptomatic during latency and disease is detected only by [[serology]]
:*[[Orthopnea]]
 
:*[[Paroxysmal nocturnal dyspnea]]
===Tertiary syphilis===
:*[[Palpitations]] (due to compensatory [[tachycardia]])
*Slowly progressive phase
:*[[Chest pain]] (if [[left ventricular end diastolic pressure]] compromises coronary perfusion)
*Develop within 3-10 years of primary infection
*[[Congestive heart failure]]
 
:*[[Dyspnea|Dyspnea on ordinary exertion]]
*[[Gumma]]:
:*[[Fainting]]
:*Appear almost anywhere in the body including in the [[skeleton]].
:*[[Fatigue]]
:*Chronic and represent an inability of the immune system to completely clear the organism.
:*[[Hemoptysis]] or frothy sputum
:*Gummas produce a [[chronic inflammatory]] state in the body with mass-effects upon the local anatomy.
:*[[Nocturia]] or [[urination during the night]]
:*Soft, tumor-like balls of inflammation known as [[granuloma]]s.
:*[[cough|Nocturnal cough]]
 
:*[[Orthopnea]] or [[sleeping on pillows]]
*Other characteristics of untreated tertiary syphilis is the neurological manifestations that include:
:*[[Palpitation]]s or [[extra heart beats]]
:*[[Altered mental status]]
:*[[Paroxysmal nocturnal dyspnea]]  
:*[[Dementia]]
:*[[Shortness of breath]]
:*Focal neurodeficit affecting hearing and vision
'''Gummatous lesions'''
 
*Presents with any organ system involved.  
*Cardiovascular manifestations:
*Nodular papular lesions in case of cutaneous [[gumma]]. 
:*Insidious in onset
|-
:*Syphilis infects the ascending [[aorta]] causing [[dilation]] and [[aortic regurgitation]]. This can be heard with a stethoscope as a [[heart murmur]].
|}
:*[[Syphilitic aortitis]] can cause [[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.
:*The infection of the [[coronary artery|coronary arteries]] may cause narrowing of the vessels


==References==
==References==
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Latest revision as of 00:29, 21 September 2021

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. Maha Jaffar Azhar, M.D.

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Overview

The history and symptoms of syphilis depends on stage of disease. The hallmark of syphilis infection is painless chancre. A positive history of painless chancre on genitalia, and presence of risk factors such as unprotected sex, multiple sexual partners, residence in highly prevalent area and previous history of sexually transmitted infections may be suggestive of syphilis infection. The most common symptoms of syphilis infection include painless chancre which progresses to ulcer with regional lymphadenopathy in primary syphilis. Secondary syphilis is characterized by rash and constitutional symptoms. Syphilis infection in tertiary syphilis can involve any organ system, hence named the "Great Imitator".[1][2][3]

History and symptoms

The history and symptoms of syphilis according to the stage of disease are described below:[1][2][3]

Stage of syphilis History and symptoms
Primary syphilis
  • History of risk factors (MSM, unprotected sex, multiple sex partners)
  • Onset within 3 weeks of contact
  • Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods
Secondary syphilis
  • Develops 6-8 weeks after the appearance of primary chancre
  • Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present
  • Skin eruptions may be subtle and asymptomatic
  • Classic:
  • Non-pruritic bilateral symmetrical mucocutaneous rash
  • Non-tender regional lymphadenopathy
  • Condylomata lata
  • Patchy alopecia
Latent syphilis
  • Previous history of chancre or rash
  • Asymptomatic
Tertiary syphilis Clinical manifestation of this stage depends on organ system involved:

Neurosyphilis

Cardiovascular syphilis

Gummatous lesions

  • Presents with any organ system involved.
  • Nodular papular lesions in case of cutaneous gumma.

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.


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