Syphilis physical examination

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.

Physical Examination

The physical examination findings of syphilis are described according to the stage of syphilis.

Stage of syphilis	Physical Examination	Images
Primary syphilis	Chancre 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 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. 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 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	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 Syphilis lesions on a patient's back Condymoata lata
Latent syphilis	Asymptomatic (serologically positive)
Tertiary syphilis	Neurosyphilis Asymptomatic meningitis Symptomatic meningitis: neck stiffness, Brudzinski's sign, Kernig's sign, ataxia. Meningovascular syphilis Focal deficits Intermittent or progresses slowly over a few days Parenchymatous neurosyphilis Develops 15-20 years after primary infection Presents as general paresis or tabes dorsalis with resultant ataxia Argyll Robertson pupil: small irregular pupil Cardiovascular syphilis Aortic regurgitation: Diastolic murmur De Musset's sign Gummatous lesions Gumma: 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. Gummatous lesions in tertiary syphilis Gummatous lesions in tertiary syphilis Gummatous lesions in tertiary syphilis

References

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