Syphilis differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="9;" | Primary | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="9;" | Primary | ||
| style="padding: 5px 5px; background: #F5F5F5;" | [[Herpes simplex 1 | | style="padding: 5px 5px; background: #F5F5F5;" | [[Herpes simplex]](1 and 2) | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Presents as multiple, round, superficial oral and genital [[ulcers]] which are painful.<ref name="pmid17939933">{{cite journal |author=Fatahzadeh M, Schwartz RA |title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 |pages=737–63; quiz 764–6 |year=2007 |pmid=17939933 |doi=10.1016/j.jaad.2007.06.027}}</ref> Adults with non-typical presentation are more difficult to diagnose. However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV from other conditions with similar symptoms like [[allergy|allergic]] [[stomatitis]]. Genital herpes can be more difficult to diagnose than oral herpes since most genital herpes/HSV-2-infected persons have no classical signs and symptoms.<ref name="pmid17939933"/> | | style="padding: 5px 5px; background: #F5F5F5;" | Presents as multiple, round, superficial oral and genital [[ulcers]] which are painful.<ref name="pmid17939933">{{cite journal |author=Fatahzadeh M, Schwartz RA |title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 |pages=737–63; quiz 764–6 |year=2007 |pmid=17939933 |doi=10.1016/j.jaad.2007.06.027}}</ref> Adults with non-typical presentation are more difficult to diagnose. However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV from other conditions with similar symptoms like [[allergy|allergic]] [[stomatitis]]. Genital herpes can be more difficult to diagnose than oral herpes since most genital herpes/HSV-2-infected persons have no classical signs and symptoms.<ref name="pmid17939933"/> | ||
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Revision as of 13:48, 27 September 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Aysha Anwar, M.B.B.S[3]
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Overview
Syphilis must be differentiated from other common diseases that cause rash such as measles, rubella, Kawasaki disease , and mononucleosis. Syphilis must also be differentiated from other genital infections such as chancroid, Condyloma acuminata, genital warts, Herpes simplex, and Herpes zoster.
Differentiating Syphilis from other Diseases
Syphilis is named as "great imitator" because symptomatology and physical exam findings of syphilis in different stages mimicks large variety of other diseases.[1]
| Stage of Syphilis | Differential diagnosis | Findings |
|---|---|---|
| Primary | Herpes simplex(1 and 2) | Presents as multiple, round, superficial oral and genital ulcers which are painful.[2] Adults with non-typical presentation are more difficult to diagnose. However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV from other conditions with similar symptoms like allergic stomatitis. Genital herpes can be more difficult to diagnose than oral herpes since most genital herpes/HSV-2-infected persons have no classical signs and symptoms.[2] |
| Granuloma inguinale | Commonly characterized as painless, progressive ulcerative lesions without regional lymphadenopathy. The lesions are highly vascular and bleed easily on contact.[3] | |
| Chancroid | Characterized by painful sores on the genitalia.[4] | |
| Lymphogranuloma venereum | Self-limited genital ulcer or papule with tender inguinal or femoral lymphadenopathy.[5][6] | |
| Condyloma acuminatum | Presents as warty lesions in the form of clusters and can be very tiny or can spread into large masses in the genital or penile area.[7] | |
| Urethritis | Discharge (milky or pus-like) from the penis, stinging or burning during urination, itching, tingling, burning or irritation inside the penis. | |
| Cystitis | Presents as abnormal urine color (cloudy), blood in the urine, frequent urination or urgent need to urinate, painful or burning urination, pressure in the lower pelvis or back, flank pain, back pain, nausea, vomiting, and chills | |
| Candidiasis | Presents as redness, itching and discomfort of affected area.[8][9] | |
| Other STIs | Such as chlamydia, gonnorhea, and trichomonas vaginalis | |
| Secondary | HIV | Acute illness present with fever, lymphadenopathy, rash, fatigue, and myalgia. AIDS classically presents with weight loss, night sweats, fatigue, diarrhea, mucosal sores, cough, and cognitive and neurological deficits. |
| Pityriasis rosea | Pink and flaky oval-shaped rash followed by clusters of smaller, more numerous patches of rash. May be accompanied by headache, fever, nausea and fatigue. | |
| Viral exanthem | such as measles, mumps, chicken pox, cytomegalovirus, coxsackie virus, rubella. Presenting findings may include fever, rash, and constitutional symptoms.[10] | |
| Scarlet fever | Presenting symptoms include fever, punctate red macules on the hard and soft palate and uvula (Forchheimer's spots), bright red tongue with a "strawberry" appearance, sore throat and headache and lymphadenopathy. | |
| Insect bite | Immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles. | |
| Mononucleosis | Common symptoms include low-grade fever without chills, sore throat, white patches on tonsils and back of the throat, muscle weakness and sometime extreme fatigue, tender lymphadenopathy, petechial hemorrhage and skin rash. | |
| Rocky mountain spotted fever | Symptoms may include maculopapular rash, petechial rash, abdominal pain and joint pain. | |
| Rickettsialpox | Overlapping symptoms with secondary syphilis may include flu-like illness including fever, chills, weakness and muscle pain but the most distinctive symptom is the rash that breaks out, spanning the person's entire body. | |
| Kawasaki disease | Commonly presents with high and persistent fever, red mucous membranes in mouth, "strawberry tongue", swollen lymph nodes and skin rash in early disease, with peeling off of the skin of the hands, feet and genital area | |
| Yaws | Tropical infection of the skin, bones and joints caused by the spirochete bacterium Treponema pertenue | |
| Stevens-Johnson syndrome | Symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. | |
| Tertiary | Brain tumour | Findings which may overlap with neurosyphilis include headache,seizures, visual changes and personality changes. |
| Vasculitides | Cardiovasular syphilis may present as aortitis and aortic aneurysm. Overlapping symptoms with other vasculitis may include back pain, fever, abdominal pain, chest pain, shortness of breath, fatigue, arm and leg weakness, lightheadedness, dizziness, fainting, and headaches.[11][12][13] | |
| Other causes of congestive heart failure | Presenting symptoms include dizziness, dyspnea on ordinary exertion or greater shortness of breath with usual activities, fainting, fatigue, hemoptysis or frothy sputum, nocturia or urination during the night, nocturnal cough, orthopnea or sleeping on pillows, palpitations or extra heart beats, paroxysmal nocturnal dyspnea or awakening at night with shortness of breath, Shortness of breath, Syncope or passing out and weakness. | |
| Other causes of seizures | Neurosyphilitic disease can present with seizures. | |
| Other causes of stroke[14] | Presents as weakness, sensory loss, gait abnormality and cranial nerve damage. | |
| Other causes of meningitis][15] | Such as bacterial, fungal and viral meningitis. It commonly presents with headache, nuchal rigidity, fever, petechiae and altered mental status. | |
| Meningococcemia | Rash, petechiae, headache, confusion, and stiff neck, high fever, mental status changes, nausea and vomiting. | |
| Psychosis | Presents as hallucinations, delusions, auditory hallucinations, and flat or blunted affect and emotion, poverty of speech (alogia), anhedonia, and lack of motivation.[16] | |
| Multiple sclerosis | May presents as changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or emotional symptomatology (mainly depression).[17] | |
| Other causes of glomerulonephritis | May presents as blood in the urine (dark, rust-colored, or brown urine),foamy urine (due to excess protein in the urine), swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen. | |
| Other causes of arthritis | Gummatous lesions of syphilis in joints may present as joint pains and stiffnes. | |
| Other causes of lymphadenitis | May present as fever, myalgias, weight loss, and lymph node enlargement.[18] | |
| Other causes of hepatitis | Common presenting symptoms may include dark urine, fatigue, weight loss, fever usually low-grade, itching, jaundice (yellowing of the skin or eyes), loss of appetite, nausea and vomiting.[19] | |
| Other causes of nephrotic syndrome | Presents as proteinuria, edema, weight gain, fatigue and dyspnea. | |
| Other causes of uveitis | Symptoms of uveitis include eye pain, eye redness, and photophobia. Intermediate, posterior, and panuveitis commonly present with floaters, blurry vision, and impaired vision.[18][20] |
References
- ↑ 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.
- ↑ 2.0 2.1 Fatahzadeh M, Schwartz RA (2007). "Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management". J. Am. Acad. Dermatol. 57 (5): 737–63, quiz 764–6. doi:10.1016/j.jaad.2007.06.027. PMID 17939933.
- ↑ O'Farrell N (2002). "Donovanosis". Sexually Transmitted Infections. 78 (6): 452–7. PMC 1758360. PMID 12473810.
- ↑ Coovadia YM, Kharsany A, Hoosen A (1985). "The microbial aetiology of genital ulcers in black men in Durban, South Africa". Genitourin Med. 61 (4): 266–9. PMC 1011828. PMID 2991120.
- ↑ Mabey D, Peeling RW (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–2. PMC 1744436. PMID 12081191.
- ↑ Workowski, KA.; Berman, S.; Workowski, KA.; Bauer, H.; Bachman, L.; Burstein, G.; Eckert, L.; Geisler, WM.; Ghanem, K. (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459. Unknown parameter
|month=ignored (help) - ↑ F. G. Bruins, F. J. A. van Deudekom & H. J. C. de Vries (2015). "Syphilitic condylomata lata mimicking anogenital warts". BMJ (Clinical research ed.). 350: h1259. PMID 25784708.
- ↑ Baron, Samuel (1996). Medical microbiology. Galveston, Tex: University of Texas Medical Branch at Galveston. ISBN 0-9631172-1-1.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Kang, Jin Han. "Febrile Illness with Skin Rashes." Infection & chemotherapy 47.3 (2015): 155-166.
- ↑ K. Doi, T. Kasaba & Y. Kosaka (1989). "[A comparative study of the depressive effects of halothane and isoflurane on medullary respiratory neurons in cats]". Masui. The Japanese journal of anesthesiology. 38 (11): 1427–1437. PMID 2585712. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ Pugh PJ, Grech ED (2002). "Images in clinical medicine. Syphilitic aortitis". N Engl J Med. 346 (9): 676. doi:10.1056/NEJMicm010343. PMID 11870245.
- ↑ Hotson JR (1981). "Modern neurosyphilis: a partially treated chronic meningitis". West J Med. 135 (3): 191–200. PMC 1273113. PMID 7340118.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M (2009). "Manifest psychosis in neurosyphilis". General Hospital Psychiatry. 31 (4): 379–81. doi:10.1016/j.genhosppsych.2008.09.010. PMID 19555800.
- ↑ Scolding N (2001). "The differential diagnosis of multiple sclerosis". Journal of Neurology, Neurosurgery, and Psychiatry. 71 Suppl 2: ii9–15. PMC 1765571. PMID 11701778.
- ↑ 18.0 18.1 J. Deschenes, C. D. Seamone & M. G. Baines (1992). "Acquired ocular syphilis: diagnosis and treatment". Annals of ophthalmology. 24 (4): 134–138. PMID 1590633. Unknown parameter
|month=ignored (help) - ↑ Young MF, Sanowski RA, Manne RA (1992). "Syphilitic hepatitis". Journal of Clinical Gastroenterology. 15 (2): 174–6. PMID 1401840.
- ↑ T. F. Jr Schlaegel & S. F. Kao (1982). "A review (1970-1980) of 28 presumptive cases of syphilitic uveitis". American journal of ophthalmology. 93 (4): 412–414. PMID 7072806. Unknown parameter
|month=ignored (help)