Syphilis physical examination: Difference between revisions
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*Chancre: | *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. | *Regional lymphadenopathy accompanies primary lesion. | ||
:* | :*Onset within a week | ||
:* | :*Unilateral or bilateral | ||
:* | :*Lymph nodes are firm, painless, non-tender and non-suppurative | ||
*Primary chancre heals spontaneously within 4-6weeks; however, regional lymphadenopathy may persist for longer periods. | *Primary chancre heals spontaneously within 4-6weeks; however, regional lymphadenopathy may persist for longer periods. | ||
| Line 28: | Line 28: | ||
:*Condylomata lata: | :*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: | :*Superficial mucosal patches: | ||
::* | ::*Painless | ||
::* | ::*May be macular, papular, pustular or mixed | ||
::* | ::*Located on the palate, pharynx, larynx, penis, vulva, anal canal or rectum | ||
<gallery> | <gallery> | ||
| Line 45: | Line 45: | ||
===Tertiary syphilis: Gumma=== | ===Tertiary syphilis: Gumma=== | ||
*[[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 | ||
*Cardiovascular manifestation secondary to aortic dilation with resultant [[Aortic insufficiency physical findings|aortic regurgitation]]: | *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: | *Neurological manifestation: | ||
| Line 59: | Line 59: | ||
:*Symptomatic meningitis | :*Symptomatic meningitis | ||
::* | ::*Develops within 6-months to several years of primary infection | ||
::* | ::*Typical meningitis symptoms present | ||
::* | ::*Cranial nerve abnormalities may be observed | ||
:*Meningovascular syphilis | :*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 | :*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=== | ===Ophthalmic Examination=== | ||
Revision as of 21:38, 17 December 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Physical examination
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 nodes are firm, painless, non-tender and non-suppurative
- Primary chancre heals spontaneously within 4-6weeks; however, regional lymphadenopathy may persist for longer periods.
Secondary syphilis: Condylomata Lata
- Develops 6-8 weeks after the appearance of primary chancre.
- Cardinal signs include:
- 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
-
Erruption on Sole of Foot Associated with Secondary Syphilis.
-
Generalized (Maculo-Papular) Eruption Associated with Secondary Syphilis.
-
Palmar Erruption Associated with Secondary Syphilis.
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Palmar Erruption Associated with Secondary Syphilis.
Tertiary syphilis: Gumma
- Soft, asymmetric, coalscent 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
- Cardiovascular manifestation secondary to aortic dilation with resultant aortic regurgitation:
- Diastolic murmur
- De Musset's sign[1] 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
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