Syphilis physical examination: Difference between revisions

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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
Image:Syphilis secondary 08.jpeg|Secondary syphilis
Image:Vaginal syphilis (disturbing image).jpg|Secondary syphilis manifested perineal condylomata lata lesions
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
Image:Syphilis secondary 15.jpeg|Condymoata lata
Image:Syphilis secondary 15.jpeg|Condymoata lata
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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.
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===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
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.
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Image:Syphilis tertiary 03.jpeg| Tertiary syphilis
Image:Syphilis tertiary 03.jpeg| Tertiary syphilis
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</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}}


[[Category:Disease]]
 
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Bacterial diseases]]
[[Category:Sexually transmitted diseases]]
[[Category:Needs overview]]

Revision as of 14:03, 28 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

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Physical Examination

The physical exmaination 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.
  • Primary stage syphilis sore (chancre) on the surface of a tongue.

    Primary stage syphilis sore (chancre) on the surface of a tongue.

  • Chancres on the penile shaft due to a primary syphilitic infection

    Chancres on the penile shaft due to a primary syphilitic infection

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

  • Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet

    Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet

  • Secondary syphilis manifested perineal condylomata lata lesions

    Secondary syphilis manifested perineal condylomata lata lesions

  • Syphilis lesions on a patient's back

    Syphilis lesions on a patient's back

  • Condymoata lata

    Condymoata lata

Latent syphilis
  • ASymptomatic (serologically positive)
Tertiary syphilis

Neurosyphilis

  • Focal deficits.
  • Intermittent or progress 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.
  • A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.

    A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.

  • Tertiary syphilis

    Tertiary syphilis

  • Tertiary syphilis

    Tertiary syphilis

  • Tertiary syphilis

    Tertiary syphilis

References

  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. ↑ 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. ↑ 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. ↑ 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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