Template:ID-STDGallery

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• Bacterial vaginosis Return to Top

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  This photomicrograph of a vaginal smear specimen depicts two epithelial cells, a normal cell, and an epithelial cell with its exterior covered by bacteria giving the cell a roughened, stippled appearance known as a “clue cell”. Clue cells are epithelial cells that have had bacteria adhere to their surface, obscuring their borders, and imparting a stippled appearance. The presence of such clue cells is a sign that the patient has bacterial vaginosis. Adapted from CDC

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  This photograph depicted a single Gardnerella vaginalis, formerly Haemophilus vaginalis, or Corynebacterium vaginalis, bacterial colony. The vagina is normally colonized by Lactobacillus spp., which help to regulate the region’s pH, maintaining it in the low range, thereby, inhibiting the growth of potentially-pathogenic organisms. The Gram-positive Gardnerella vaginalis bacterium is one such organism, and is a common cause for bacterial vaginosis (BV). Adapted from CDC

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  This photograph depicted a single Gardnerella vaginalis, formerly Haemophilus vaginalis, or Corynebacterium vaginalis, bacterial colony. The vagina is normally colonized by Lactobacillus spp., which help to regulate the region’s pH, maintaining it in the low range, thereby, inhibiting the growth of potentially-pathogenic organisms. The Gram-positive Gardnerella vaginalis bacterium is one such organism, and is a common cause for bacterial vaginosis (BV). Adapted from CDC

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  This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells”. “Clue cells” are epithelial cells that have had bacteria adhere to their surface, obscuring their borders, and imparting a stippled appearance. The presence of such clue cells is a sign that the patient has bacterial vaginosis. Adapted from CDC

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  This photomicrograph reveals bacteria adhering to vaginal epithelial cells known as “clue cells”. “Clue cells” are epithelial cells that have had bacteria adhere to their surface, obscuring their borders, and imparting a stippled appearance. The presence of such clue cells is a sign that the patient has bacterial vaginosis. Adapted from CDC

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• Chlamydia Return to Top

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  Under a relatively-low magnification of 63X, this Gram-stained photomicrograph of a vaginal specimen revealed the presence of squamous epithelial cells, polymorphonuclear leukocytes (PMNs), or white blood cells (WBCs), and numerous Gram-positive bacilli, or rods. Vaginal specimens are reviewed for many reasons including the Pap test, tests for STDs such as human papilloma virus (HPV) and Chlamydia trachomatis, as well as others. The vagina is normally home to a number of bacterial organisms, referred to as vaginal microbiota, or vaginal microflora, composed primarily of rod-shaped Lactobacillus spp., as well as others. Adapted from CDC

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  Photomicrograph of Chlamydia trachomatis taken from a urethral scrape. Untreated, chlamydia can cause severe, costly reproductive and other health problems including both short- and long-term consequences, i.e. pelvic inflammatory disease (PID), infertility, and potentially fatal tubal pregnancy. Adapted from CDC

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  This McCoy cell monolayer micrograph reveals a number of intracellular C. trachomatis inclusion bodies; Magnified 50X. The intracellular inclusion body represents the replication phase of the Chlamydia spp. organisms, whereupon, the reorganized reticulate body (RB) multiplies through binary fission into 100-500 new RBs, which mature into elementary bodies (EB). Adapted from CDC

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  This image reveals a close view of a patient’s left eye with the upper lid retracted in order to reveal the inflamed conjunctival membrane lining the inside of both the upper and lower lids, due to what was determined to be a case of inclusion conjunctivitis, a type of conjunctival inflammation caused by the bacterium, Chlamydia trachomatis. Inclusion conjunctivitis, also known as chlamydial conjunctivitis, is more common in newborns. Symptoms include redness of the eye(s), swelling of the eyelids, and discharge of pus, usually 5 to 12 days after birth. Adapted from CDC

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  This photomicrograph depicts HeLa cells infected with Type-A Chlamydia trachomatis, Magnified 400X. The cell line of choice is McCoy, however a particular strain of HeLa cells, i.e. HeLa 299-24, can be used to culture C. trachomatis. For identification, either iodine or fluorescent antibody (FA) stains are usually used. Adapted from CDC

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  Under a low magnification of 12.5X, this photomicrograph reveals McCoy cell monolayers with Chlamydia trachomatis inclusion bodies. Chlamydia, caused by Chlamydia trachomatis, is the most common bacterial sexually transmitted infection. Using cell cultures from the McCoy cell line is one methods implemented in diagnosing Chlamydial infections. Adapted from CDC

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  This photomicrograph reveals McCoy cell monolayers with Chlamydia trachomatis inclusion bodies; Magnified 50X. Chlamydia, caused by Chlamydia trachomatis, is the most common bacterial sexually transmitted infection. Using cell cultures from the McCoy cell line is one methods implemented in diagnosing Chlamydial infections.Adapted from CDC

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  This photomicrograph reveals McCoy cell monolayers with Chlamydia trachomatis inclusion bodies; Magnified 200X. Chlamydia, caused by Chlamydia trachomatis, is the most common bacterial sexually transmitted infection. Using cell cultures from the McCoy cell line is one methods implemented in diagnosing Chlamydial infections. Adapted from CDC

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• Genital Herpes Return to Top

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  Viewed from the right posterior-oblique view, the male patient depicted here was in bed, in a clinical setting, and had presented with a pancorporeal maculopapular rash, which was initially thought to be a possible case of smallpox, but which later, was diagnosed as herpes simplex. Here you see the patient’s feet from a left lateral perspective revealing papules on the dorsal surface of the left foot. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. The virus can become disseminated, as was the case here, usually involving patients who are immunocompromised such as in the case of AIDS, or undergoing chemotherapeutic treatment. Adapted from CDC

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  Viewed from the right posterior-oblique view, the male patient depicted here was in bed, in a clinical setting, and had presented with a pancorporeal maculopapular rash, which was initially thought to be a possible case of smallpox, but which later, was diagnosed as herpes simplex. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. The virus can become disseminated, as was the case here, usually involving patients who are immunocompromised such as in the case of AIDS, or undergoing chemotherapeutic treatment.Adapted from CDC

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  This male patient presented with maculopapular lesions on the distal penile shaft that were first thought to be due to syphilis, but through the process of conducting a differential diagnosis, was later determined to be due to a Herpesviridae infection. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2.Adapted from CDC

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  This was a posterior view of the back and buttocks of a male patient, in a clinical setting, who had presented with a pancorporeal maculopapular rash, which was initially thought to be a possible case of smallpox, but which later, was diagnosed as herpes simplex. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. The virus can become disseminated, as was the case here, usually involving patients who are immunocompromised such as in the case of AIDS, or undergoing chemotherapeutic treatment.Adapted from CDC

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  The male patient depicted here was in bed, in a clinical setting, and had presented with a pancorporeal maculopapular rash, which was initially thought to be a possible case of smallpox, but which later, was diagnosed as herpes simplex. See PHIL 15819, for another view of this patient in the same setting. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. The virus can become disseminated, as was the case here, usually involving patients who are immunocompromised such as in the case of AIDS, or undergoing chemotherapeutic treatment.Adapted from CDC

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  This image depicts the right foot of an infant born with a herpes simplex infection, known as neonatal herpes, or herpes simplex neonatorum, which had manifested itself through the development of maculopapular lesions of the foot’s heal and sole. See PHIL 6510, for another view of this condition.Adapted from CDC

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  This image depicts the perineal region of a male patient which displayed a perianal mucocutaneous lesion caused by a herpes simplex infection. Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. Adapted from CDC

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  This neonate displayed a maculopapular outbreak on his feet due to congenitally acquired herpes simplex virus. In this instance, due to the age of the patient, this condition is known as herpes simplex neonatorum. See PHIL 15115, for a closer view of these lesions. Genital HSV can cause potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.Adapted from CDC

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  This 7 year old child with a history of recurrent herpes labialis presented with a periocular herpes simplex vesicular outbreak. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes (herpes labialis), i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. Adapted from CDC

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  This patient presented with what were recurrent characteristic vesiculopapular herpes simplex lesions on his anterior thigh. These early vesiculopapular herpetic lesions on the anterior thigh (Cntr) had yet to rupture. Herpes simplex virus is a member of a group of viruses including those which cause oral herpes (usually HSV-1), and genital herpes (usually HSV-2). Adapted from CDC

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  This male presented with primary vesiculopapular herpes genitalis lesion at the base of his penis due to the HSV-2 serotype. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes (herpes labialis), i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2.

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  This patient presented with what was diagnosed as a herpes genitalis outbreak on the penile shaft due to HSV-2. Genital herpes is a sexually transmitted disease caused by the herpes simplex viruses type 1 (HSV-1), and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Symptoms typically include one or more blisters on or around the genitals or rectum. Adapted from CDC

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  This patient presented with what was diagnosed as a herpes genitalis outbreak on the penile shaft due to HSV-2. Genital herpes is a sexually transmitted disease caused by the herpes simplex viruses type 1 (HSV-1), and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Symptoms typically include one or more blisters on or around the genitals or rectum. Adapted from CDC

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  This patient presented with what was differentially diagnosed as a herpes genitalis outbreak on the penile glans and shaft. Note that what at first appears as erythematous areas are actually coalescence of herpes genitalis “micro-ulcers”. Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Adapted from CDC

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  This male presented with primary vesiculopapular herpes genitalis lesions on his glans penis, and penile shaft. When signs of herpes genitalis do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur.

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  This 7 year old child with history of recurrent herpes labialis presented with a periocular herpes simplex vesicular outbreak. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes (herpes labialis), i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2.Adapted from CDC

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  This male patient presented with a maculopapular herpetic rash on the penile shaft and corona of the glans penis. When signs of genital herpes do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they appear. Adapted from CDC

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  This 7 year old child presented with a generalized herpes simplex vesiculopapular rash over his trunk 5 days after onset. Herpes simplex virus, otherwise known as Herpesvirus hominis is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2.

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  This patient presented with a generalized Herpes hominis vesiculopapular rash over the dorsum of the left foot. Herpesvirus hominis, otherwise known as “herpes simplex virus” is a member of a group of viruses including those which cause oral herpes, i.e., usually HSV-1, and genital herpes, i.e., usually HSV-2. Adapted from CDC

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  This was an outbreak of herpes genitalis manifested as blistering around the vaginal introitus due to the HSV-2 virus. The sexually transmitted herpes simplex virus type-2 (HSV-2) typically causes one or more blisters to form on, or around the genitals or rectum, which break, leaving tender ulcers that may take 2-4 wks to heal after making their initial appearance.Adapted from CDC

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  Herpes simplex ulcerations on the lateral plantar surface of an infant’s foot. Women who acquire genital herpes during pregnancy can transmit the virus to their babies. Untreated Herpes Simplex Virus (HSV) infections in newborns can result in mental retardation and death.Adapted from CDC

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  Blisters on the vulva due to a recurring Herpes II (HSV-2) virus infection. Symptoms from HSV-1 or HSV-2 infection, when signs do occur, typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Adapted from CDC

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  Blisters on the penis due to a recurring Herpes II (HSV-2) virus infection. Symptoms from HSV-1 or HSV-2 infection, when signs do occur, typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur.Adapted from CDC

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• Gonorrhea Return to Top

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  This 1970 photograph revealed the presence of what was determined to be a secondary gonococcal lesion located on the distal finger tip of a patient who presented with a case of gonorrhea. Usually, secondary gonococcal lesions manifest themselves when a primary infection of the urogenital tract becomes disseminated throughout the body by way of the circulatory system.

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  This 1970 photograph revealed the presence of what was determined to be a gonococcal infection involving the cervix of a patient who presented with a case of gonorrhea. Note that there is a purulent discharge emanating from the cervical os, and pooling in the vagina.Adapted from CDC

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  This gonorrhoeae patient presented with gonococcal arthritis of the hand, which caused the hand and wrist to swell due to bacterium Neisseria gonorrhoeae. Adapted from CDC

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  This gonococcal arthritic patient presented with an inflammation of the skin of her right arm due to a disseminated Neisseria gonorrhoeaebacterial infection. Adapted from CDC

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  This patient presented with a cutaneous gonococcal lesion due to a disseminated Neisseria gonorrhea bacterial infection. Though a sexually transmitted disease, if a Gonorrhea infection is allowed to go untreated, the Neisseria gonorrhea bacteria responsible for the infection can become disseminated throughout the body, forming lesions in extra-genital locations. Adapted from CDC

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  This colposcopic view of this patient’s cervix reveled an eroded ostium due to Neisseria gonorrhea infection. A chronic Neisseria gonorrhea infection can lead to complications, which can be apparent such as this cervical inflammation, and some can be quite insipid, giving the impression that the infection has subsided, while treatment is still needed.Adapted from CDC

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  This patient presented with a lesion of the right hand due to a disseminated Neisseria gonorrhoeae bacteremia. Though a sexually transmitted disease, if a Gonorrhea infection is allowed to go untreated, the Neisseria gonorrhea bacteria responsible for the infection can become disseminated throughout the body, forming lesions in extra-genital locations.Adapted from CDC

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  This patient presented with urogenital complications from a case of gonorrhea including penile paraphimosis. Due to the accompanying inflammation brought on by the Neisseria gonorrhoeae infection, the foreskin becomes adherent to the glans penis resulting in a condition known as phimosis, and cannot be retracted in order to expose the entire glans. Adapted from CDC

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  This patient presented with a paraurethral abscess due to the spread of N. gonorrhoeae bacteria. In this case, the spread of the bacterial pathogen from its initial urethral site of origin to the surrounding penile tissues brought on the formation of an abscess, which was one of three that had formed in this manner.Adapted from CDC

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  This patient presented with cutaneous foot lesions that were diagnosed as a disseminated gonococcal infection. Gonorrhea is the most frequently reported communicable disease in the U.S. Disseminated gonococcal infection is most often the cause of acute septic arthritis in sexually active adults, and the reason for most hospitalizations due to infective arthritis.Adapted from CDC

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  This patient presented with a cutaneous lesion that was traced to a systemically disseminated gonoccal infection. Though a sexually transmitted disease, if a Gonorrhea infection is allowed to go untreated, the Neisseria gonorrhea bacteria responsible for the infection can become disseminated throughout the body, forming lesions in extra-genital locations.Adapted from CDC

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  Here, a specimen is about to be collected from this patient who presented with symptoms including a penile discharge. Most Neisseria and related species are normal flora in humans and animals, however, some species such as N. gonorrhoeae are pathogens in normal hosts and those species known to be commensal, may be opportunistic pathogens. Adapted from CDC

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  This patient presented with a cutaneous lesion on the palm of his right hand due to a N. gonorrhoeae infection. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body. Adapted from CDC

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  His patient presented with cutaneous lesions on his left ankle and calf due to a disseminated N. gonorrhoeae infection. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body.Adapted from CDC

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  This patient presented with cutaneous lesions on the right forearm and left hand due to a N. gonorrhoeae infection. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body.Adapted from CDC

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  This patient presented with ophthalmic inflammation that was diagnosed as gonococcal conjunctivitis. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as cutaneous ulcerations or conjunctival inflammation.

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  A highly contagious infection, gonococcal ophthalmia is due the pathogenic bacteria Neisseria gonorrhoeae. This case involved an adult patient with a systemically disseminated gonococcal infection, but neonates are in danger of acquiring this ophthalmic infection at the time of their delivery when the mother is infected with N. gonorrhoeae bacteria.Adapted from CDC

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  This case of gonorrheal conjunctivitis resulted in partial blindness due to the spread of N. gonorrhoeae bacteria. Gonococci cause both localized infections, usually in the genital tract, and disseminated infections with seeding of various organs. Diagnosis of localized infections depends on Gram-staining, and culture of the discharge.Adapted from CDC

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  The early lesion on this patient’s left index finger was due to the systemic dissemination of N. gonorrhoeae bacteria. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body.Adapted from CDC

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  The lesion on this patient’s left hand was due to the systemic dissemination of the Neisseria gonorrhoeae bacteria. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body.Adapted from CDC

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  The lesion on this patient’s heel was due to the systemic dissemination of the N. gonorrhoeae bacteria. Gonorrhea is the most frequently reported communicable disease in the U.S. Disseminated gonococcal infection is most often the cause of acute septic arthritis in sexually active adults, and the reason for most hospitalizations due to infective arthritis.Adapted from CDC

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  Note the cloudiness of this patient's right eye in this case of gonococcal conjunctivitis due to N. gonorrhoeae bacteria. Gonococcal conjunctivitis in caused by a direct inoculation of the conjunctival membrane of the eye with Neisseria gonorrhoeae bacteria, causing this membrane covering the eye to become inflamed, edematous, and produce a purulent exudate.Adapted from CDC

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  This patient presented with a penile meatal discharge which was diagnosed as gonorrhea. When collecting a male specimen, if no discharge is evident, the urethra is stripped towards the orifice to express some pus. A thin sterile swab is then inserted 23 cm into the urethra and rotated before being withdrawn.Adapted from CDC

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  This patient presented with a case of gonorrhea with symptoms including cervicitis and vaginal discharge. Gonorrhea is the most frequently reported communicable disease in the U.S. Disseminated gonococcal infection is most often the cause of acute septic arthritis in sexually active adults, and the reason for most hospitalizations due to infective arthritis.Adapted from CDC

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  This male presented with purulent penile discharge due to gonorrhea with an overlying penile pyodermal lesion. Pyoderma involves the formation of a purulent skin lesion as in this case located on the glans penis, and overlying the sexually transmitted disease gonorrhea. Adapted from CDC

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  This male presented with a purulent penile discharge due to gonorrhea with an overlying penile pyodermal lesion. Pyoderma involves the formation of a purulent skin lesion, in this case located on the glans penis, and overlying the sexually transmitted disease gonorrhea.Adapted from CDC

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  This patient presented with symptoms later diagnosed as due to Gonococcal pharyngitis.Gonococcal pharyngitis is a sexually-transmitted disease acquired through oral sex with an infected partner. The majority of throat infections caused by gonococci have no symptoms, but some can suffer from mild to severe sore throat.Adapted from CDC

• This technician is collecting a specimen from a male suspected of having gonorrhea. When collecting a male specimen, if no discharge is evident, the urethra is “stripped” towards the orifice to express some pus. A thin sterile swab is then inserted 23cm into the urethra and rotated before being withdrawn. Adapted from CDC

  This technician is collecting a specimen from a male suspected of having gonorrhea. When collecting a male specimen, if no discharge is evident, the urethra is “stripped” towards the orifice to express some pus. A thin sterile swab is then inserted 23cm into the urethra and rotated before being withdrawn. Adapted from CDC

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  This patient presented with a gonorrheal ecthyma on the skin due to systemically disseminated N. gonorrhoeae bacteria. An ecthyma is a cutaneous eruption consisting of a large, round pustule on an inflamed base caused by untreated gonococcal bacteria spread systemically throughout the bloodstream.Adapted from CDC

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  This was a skin lesion on a patient with gonorrhea due to the systemic spread of N. gonorrhoeae bacteria. Gonorrhea is caused by Neisseria gonorrhoeae. If left untreated, will enter the blood, thereby, spreading throughout the body. As is shown here, such full body dissemination may manifest itself as skin lesions throughout the body.Adapted from CDC

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  This was a newborn with gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. Unless preventative measures are taken, it is estimated that gonococcal ophthalmia neonatorum will develop in 28% of infants born to women with gonorrhea. It affects the corneal epithelium causing microbial keratitis, ulceration and perforation.Adapted from CDC

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  This patient with diagnosed gonococcal urethritis presented with unilateral gonococcal conjunctivitis. See PHIL 16400, for the appearance of her eye 24 hours following treatment with 4.8 million units of aqueous procaine penicillin G (APPG) and probenicid. If untreated N. gonorrhoeae bacteria may spread to the bloodstream, and thereby, throughout the body. The most common symptoms are then rash and joint pains, but other generalized symptoms may result as well such as conjunctivitis.Adapted from CDC

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  This patient presented with gonorrhea and a disseminated gonococcal skin infection about the ankle. Gonorrhea, caused by Neisseria gonorrhoeae, if left untreated will enter the blood, thereby, spreading throughout the body. As is shown here, such full body dissemination may manifest itself as skin lesions throughout the body.Adapted from CDC

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  This is a photograph of a skin lesion on a patient diagnosed with gonorrhea. Gonorrhea, caused by Neisseria gonorrhoeae, if left untreated will enter the blood, thereby, spreading throughout the body. As is shown here, such full body dissemination may manifest itself as skin lesions throughout the body.Adapted from CDC

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  This is a skin lesion in a patient with systemically disseminated Neisseria gonorrhoeae bacteria. Gonorrhea, caused by Neisseria gonorrhoeae, if left untreated will enter the blood, thereby, spreading throughout the body. As is shown here, such fully systemic dissemination may manifest itself as skin lesions throughout the body.Adapted from CDC

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  Here a technician is about to collect an intraurethral specimen to be tested for gonorrhea, or non-specific urethritis. Doctors or other health care workers usually use three laboratory techniques to diagnose gonorrhea: staining samples directly for the bacterium, detection of bacterial genes or DNA in the urine, and growing the bacteria in laboratory cultures.Adapted from CDC

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  This photograph shows the collection of a specimen from a male suspected of having gonorrhea.When collecting a male specimen, if no discharge is evident, the urethra is stripped towards the orifice to express some pus. A thin sterile swab is then inserted 23 cm into the urethra and rotated before being withdrawn.Adapted from CDC

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  The foot of this patient is swollen due to gonococcal arthritis. Gonorrhea is the most frequently reported communicable disease in the U.S. Disseminated gonococcal infection is most often the cause of acute septic arthritis in sexually active adults, and the reason for most hospitalizations due to infective arthritis.Adapted from CDC

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  Note the gonococcal lesion on the skin of the left arm due to the bacterium Neisseria gonorrhoeae. N. gonorrhoeae, a gram-negative diplococcus, is the causative agent for Gonorrhea. Though these bacteria can infect the genital tract, the mouth, and the rectum, they can become disseminated throughout a person’s bloodstream. Adapted from CDC

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  Close-up of a gonococcal lesion on the skin of a patient’s arm. Gonorrhea, caused by Neisseria gonorrhoeae, if left untreated will enter the blood, thereby, spreading throughout the body. As is shown here, such full body dissemination may manifest itself as skin lesions in the form of gray pustules. Adapted from CDC

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• Pubic lice infestation Return to Top

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  This 2006 image depicted five body lice, Pediculus humanus var. corporis, which from left to right included three nymphal-staged lice, beginning with a stage N1, then N2, and thirdly a N3-staged nymph, followed by an adult male louse, and finally an adult female louse. Lice are parasitic insects that can be found on people's heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Lice found on each area of the body are different from each other. The three types of lice that live on humans are: Pediculus humanus capitis (head louse), Pediculus humanus corporis (body louse, clothes louse) and Phthirus pubis ("crab" louse, pubic louse). Only the body louse is known to spread disease. Lice infestations are spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice. Lice move by crawling; they cannot hop or fly. Both over-the-counter and prescription medications are available for treatment of lice infestations. Adapted from CDC

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  This photomicrograph depicts a dorsal view of an adult female human head louse, Pediculus humanus capitis. Lice are parasitic insects that can be found on people's heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Lice found on each area of the body are different from each other. The three types of lice that live on humans are: Pediculus humanus capitis (head louse), Pediculus humanus corporis (body louse, clothes louse) and Pthirus pubis ("crab" louse, pubic louse). Only the body louse is known to spread disease. Lice infestations (pediculosis and pthiriasis) are spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice. Lice move by crawling; they cannot hop or fly. Both over-the-counter and prescription medications are available for treatment of lice infestations. Adapted from CDC

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  This illustration depicts a dorsal view of a “crab louse”, Phthirus pubis, a member of the suborder Anoplura, or “sucking lice”. The crab louse Phthirus pubis, is not known to carry disease producing organisms. Infestations usually occur in the pubic region of humans, and may occasionally be found on other coarse body hair, such as hair on the legs, armpits, mustache, beard, eyebrows, or eyelashes. Infestations of young children are usually on the eyebrows or eyelashes. Lice found on the head are not pubic lice; they are head lice. Adapted from CDC

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  This illustration depicts some of the morphologic differences seen in two “sucking lice” of the Order Annoplura. The louse on the left is a “body louse”, Pediculus humanus var. corporis, and the louse on the right is a “crab” or “pubic louse”, Phthirus pubis. Note that both of these lice are wingless, and possess three pairs of claw-tipped legs, which allows them to firmly grasp the hair shafts to which they remain attached as human ectoparasitic pests. Adapted from CDC

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  This photograph reveals the presence of crab lice, Phthirus pubis with reddish-brown crab feces. Pubic lice are generally found in the genital area on pubic hair; but may occasionally be found on other coarse body hair, such as hair on the legs, armpit, mustache, beard, eyebrows, and eyelashes. Adapted from CDC

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  This is an illustration comparing the Head Louse, Pediculus humanus, with the Pubic Louse, Phthirus pubis. These insects use their hook-like appendages to grasp unto the hair shafts of their hosts in body regions unique to its species, i.e. the head louse infests the head region of its host, while the pubic louse infests its host’s pubic region. Adapted from CDC

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  This patient presented with an infestation of Phthirus pubis, or crab lice. A Phthirus pubis infestation has caused the erythematous lesions seen in the pubic region of this patient in response to the bites of the crab lice arthropods. Adapted from CDC

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  This image depicts a dorsal view of a female head louse, Pediculus humanus var. capitis. Lice are parasitic insects that can be found on people's heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Lice found on each area of the body are different from each other. The three types of lice that live on humans are: Pediculus humanus var. capitis (head louse), Pediculus humanus var. corporis (body louse, clothes louse) and Pthirus pubis ("crab" louse, pubic louse). Only the body louse is known to spread disease. Lice infestations (pediculosis and pthiriasis) are spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice. Lice move by crawling; they cannot hop or fly. Both over-the-counter and prescription medications are available for treatment of lice infestations. Adapted from CDC

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• Scabies Return to Top

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  Under a moderate modification, this photomicrograph revealed the histopathologic changes in a human skin sample from the site of a number of scabies burrows, due to an infestation of Sarcoptes scabiei var. hominis. Note that the scabies had burrowed into the upper layers of this patient’s skin, into the epidermis, superficial to the stratum basale, also known as the stratum germinativum. The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria. Adapted from CDC

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  This image depicts the anterior aspect of a patient’s lower legs, either of which displaying the pathologic consequences of an infestation of Sarcoptes scabiei var. hominis, otherwise known as scabies. Of note, were the secondary severe excoriations, resulting from the patient having scratched at the primary maculopapular rash caused by the scabies bites. The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria. Adapted from CDC

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  This close view of the genitalia of a male patient reveals the presence of erosive, inflamed lesions, which had been caused by an infestation of scabies, Sarcoptes scabiei var. hominis. The lesions are on the penile glans, and the preputial skin. The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria. Adapted from CDC

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  This photograph depicting the dorsal surface of a human hand focused on the interdigital web space between the index and middle fingers, and revealed the presence of papules due to an infestation of the human itch mite, Sarcoptes scabiei var. hominis, otherwise commonly known as scabies. The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria. Adapted from CDC

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  The right axillary region of this male patient exhibited a papular rash, which had been caused by an infestation of the human itch mite, Sarcoptes scabiei var. hominis, otherwise commonly known as scabies. The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria. Adapted from CDC

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  This photomicrograph reveals a single human itch mite, Sarcoptes scabiei var. hominis, otherwise commonly known as scabies, that had burrowed itself into the epidermal layers of a skin tissue sample extracted from an unknown host. The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Scabies occurs worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. Adapted from CDC

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  This woman presented with a rash composed of pimple-like irritations on the abdomen and thorax due to canine scabies. If an animal is infested with scabies, or mange, and comes in close contact with humans, the mites can get under the skin causing itching and irritation. However, this form of scabies is mild, and the mites die in a couple of days without reproducing. Adapted from CDC

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• Syphilis Return to Top

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  This image depicts the soles of both feet of a syphilis patient revealing the presence of secondary syphilitic lesions consisting of erosive dermal regions of the toes, mainly involving the intertriginous spaces between the toes. Secondary syphilitic lesions consist of skin rashes and/or sores in the mouth, vagina, or anus (also called mucous membrane lesions) mark the secondary stage of symptoms. This stage usually starts with a rash on one or more areas of the body. Rashes associated with secondary syphilis can appear from the time when the primary sore is healing to several weeks after the sore has healed. The rash usually does not cause itching. This rash may appear as rough, red, or reddish brown spots both on the palms of the hands and/or the bottoms of the feet. However, this rash may look different on other parts of the body and can look like rashes caused by other diseases Large, raised, gray or white lesions may develop in warm, moist areas such as the mouth, underarm or groin region. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. Other symptoms of secondary syphilis include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The symptoms of secondary syphilis will go away with or without treatment. Without appropriate treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicted the umbilicus of an infant, which displayed an inflamed lesion that under a darkfield examination revealed the presence of Treponema pallidum spirochetes, and hence, a diagnosis of congenital syphilis. Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. It is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
  Adapted from CDC

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  With a VDRL (Venereal Disease Research Laboratory) titer of 1:128, this syphilis patient displayed symptoms indicative of the onset of the secondary stage of this disease, which included generalized lymphadenopathy, and accompanying lingual (tongue) mucous patches. Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. It is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
  Adapted from CDC

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  This image depicts the dorsal surface of the tongue in the case of an elderly African-American male, due to what was determined to be a secondary syphilitic infection. Note the furrowed appearance, and the papillae-free, i.e., desquamated, smooth lingual surface. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This close-up view demonstrates the interior oral cavity of an elderly African-American male patient, revealing a perforated hard palate due to what was a congenital syphilis infection. At the time of this photograph, the patient was being treated for both active syphilis, and gonorrhea infections. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This close-up view demonstrates the dentition within the oral cavity of a young African-American female patient, revealing the triangular-shaped deformity of her right lateral incisor, and the left central incisor, which is known as Hutchinson incisors, and is caused by a congenital syphilitic infection. In this particular case, at the time of her birth, one of this woman’s parents tested positive for syphilis. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This image depicts a close view of the right corner, i.e., angle, of the mouth of an African-American female, upon which one can see a circular lesion that was diagnosed as a primary syphilitic chancre. The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
  Adapted from CDC

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  This image depicts a close view of the surface of an African-American female’s tongue, upon which one can see a circular lesion that was diagnosed as a primary syphilitic chancre. The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
  Adapted from CDC

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  This photograph depicts the destruction of a patient’s left knee joint, which was determined to be a case of neuropathic arthropathy, also known as Charcot’s joint, brought on by a tertiary syphilitic infection. See PHIL 12606, for a radiographic view (x-ray) of a patient's knee with this arthritic deformity. Late and Latent Stages: The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10-20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
  Adapted from CDC

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  This photograph depicts a patient’s face revealing pathologic cutaneous changes in the region around the nose and mouth, consisting of noduloulcerative lesions, known as syphilids, due to a syphilitic infection. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This photograph depicts the a patient’s opened mouth revealing pathologic changes in the superior mucosal surface of his tongue known as syphilitic glossitis, due to a congenital syphilitic infection. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This photograph depicts the wrinkled skin around a patient’s nose and mouth known as “rhagades”, due to a congenital syphilitic infection. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This image depicts an inferior, intraoral view of a patient’s hard palate revealing the pathologic changes in palatal anatomy, which resulted in a perforation into the nasal cavity, and was due to a congenital syphilitic infection. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This image depicts a close view of the right eye of a patient revealing the pathologic changes in her cornea known as interstitial corneal keratitis, which was due to a congenital syphilitic infection, and is a chronic progressive keratitis of the corneal stroma, i.e., connective tissue matrix, often resulting in blindness and frequently associated with congenital syphilis. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This image depicts the dentition of a congenital syphilis patient, who due to this disease, went on to develop what are known as Hutchinson’s teeth, in which case the teeth are widely spaced, and the bite surfaces of the incisors are notched. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

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  This photograph depicts a lateral view of a patient's right knee, who'd been diagnosed with "Clutton’s joints" due to what was determined to be congenital syphilis. See PHIL 4102, for a view of the patient's knees, from an anterior persoective. ”Clutton's joints”, or symmetrical hydrarthrosis of the knee joints, is a painless condition that often occurs during the late stages of congenital syphilis. It involes synovitis, or swelling of a joint, accompanied by collections of fluid within the joint capsule.
  Adapted from CDC

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  This image depicts the perineal region and upper thighs of an infant born with what was diagnosed as congenital syphilis. In this particular case, one will note the presence of early cutaneous syphilids. How does syphilis affect a pregnant woman and her baby: The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die. Infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum because umbilical cord blood can become contaminated with maternal blood and could yield a false-positive result. Conducting a treponemal test (i.e., TP-PA or FTA-ABS) on a newborn’s serum is not necessary. No commercially available immunoglobulin (IgM) test can be recommended. All infants born to women who have reactive serologic tests for syphilis should be examined thoroughly for evidence of congenital syphilis (e.g., nonimmune hydrops, jaundice, hepatosplenomegaly, rhinitis, skin rash, and/or pseudoparalysis of an extremity). Pathologic examination of the umbilical cord by using specific fluorescent antitreponemal antibody staining is suggested. Darkfield microscopic examination or DFA staining of suspicious lesions or body fluids (e.g., nasal discharge) also should be performed.
  Adapted from CDC

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  This image depicts the perineal region of a male patient, who’d presented with what was described as eroded, moist, papular intertrigo, due to what was diagnosed as a case of secondary syphilis. Intertrigo is an inflamed area of a skin fold where two skin surfaces touch one another, such as here, in the gluteal cleft between the buttocks. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the left axillary region of a female patient, who’d presented with what was described as condylomata lata lesions, due to what was diagnosed as a case of secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the perineal region of a female patient, who’d presented with what was described as perianal condylomata lata lesions, due to what was diagnosed as a case of secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the perineal region of a patient, who’d presented with what was described as moist papular and nodular perianal syphilids, due to what was diagnosed as a case of secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the tongue of a patient, who’d presented with what was described as a number of syphilitic mucous patches, due to what was diagnosed as secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the upper half of a patient’s face, who’d presented with what was described as syphilitic alopecia, which had caused thinning of the eyebrows, due to what was diagnosed as secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the posterior scalp of a patient, who’d presented with what was described as “motheaten” alopecia, due to what was diagnosed as secondary syphilis. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the palms of a patient's hands, who’d presented with an outbreak of palmar syphilids, due to what was diagnosed as a secondary syphilitic infection. Note that some of the rash sparsely included areas of her forearms, as well. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

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  This image depicts the soles of a patient's feet, who’d presented with an outbreak of plantar syphilids, due to what was diagnosed as a secondary syphilitic infection. The secondary stage of syphilis is characterized by the manifestation of a skin rash and mucous membrane lesions. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
  Adapted from CDC

• 

  This photograph shows a penile chancre due to a primary syphilitic infection caused by Treponema pallidumbacteria. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 3-6 weeks, healing on its own.
  Adapted from CDC

• 

  This patient presented with a primary syphilitic chancre on the ventral side of the penile glans and shaft. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 3-6 weeks, healing by itself.
  Adapted from CDC

• 

  This photograph shows a penile chancre due to his primary syphilitic infection caused by Treponema pallidum bacteria. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 3-6 weeks, healing on its own.
  Adapted from CDC

• 

  Though initially thought to be herpes lesions, the differential diagnostic process showed these to be syphilitic in nature. Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
  Adapted from CDC

• 

  This patient presented with a penile lesion, which under darkfield microscopic examination was found to be due to syphilis. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  This patient with a primary staged syphilis infection presented with phimosis of the penile foreskin. Due to the formation of a primary syphilitic chancre, adhesions developed affixing the foreskin to the glans penis resulting in a condition known as phimosis, where the foreskin cannot be retracted in order to expose the entire glans.

• 

  This patient presented with a Moon’s Molar or Mulberry Molar due to a congenital syphilitic infection. Moon's- or Mulberry Molar is a condition where the first lower molar tooth has become dome-shaped due to malformation by congenital syphilis.
  Adapted from CDC

• 

  This patient presented with a primary vulvar syphilitic chancre due to Treponema pallidum bacteria. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  This patient presented with an anal chancre due to Treponema pallidum bacteria. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  This patient presented with a case of syphilis during the secondary stage with the appearance of a papular forearm lesion. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment the rash clears up on its own.
  Adapted from CDC

• 

  This patient presented with a case of alopecia during the secondary stage of syphilis. Second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. The disease can easily be passed to sex partners during the primary or secondary stages.
  Adapted from CDC

• 

  This patient presented with a case of alopecia during the secondary stage of syphilis. Second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. The disease can easily be passed to sex partners during the primary or secondary stages.
  Adapted from CDC

• 

  This patient presented with a case of alopecia due to what was determined to be secondary syphilis. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment the rash clears up on its own.
  Adapted from CDC

• 

  This patient presented with a gumma of nose due to a long standing tertiary syphilitic Treponema palliduminfection. Without treatment, an infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.
  Adapted from CDC

• 

  This 16 year old patient presented with a "saddle nose" deformity due to a congenital syphilitic condition. See PHIL 17626, for a color version of this image. The presence of the Treponema pallidum bacterium detrimentally affects the normal cytoarchitectural development of the soft, boney precursor tissues such as cartilage, giving rise to boney malformations like this “saddle nose” deformity.
  Adapted from CDC

• 

  This image depicts a lingual mucous patch on the tongue of a patient who was subsequently diagnosed with secondary syphilis, due to the Treponema pallidum bacterium. Secondary syphilis is the most contagious of all the stages of this disease, and is characterized by a systemic spread of the Treponema pallidum bacterial spirochetes. Skin rash and mucous membrane lesions characterize the secondary stage. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and late stages of disease.
  Adapted from CDC

• 

  This patient presented demonstrating a rash on both arms due to secondary syphilis. Secondary syphilis is the most contagious of all the stages, and is characterized by the spread of the bacteria Treponema pallidum, which causes symptoms throughout the body.
  Adapted from CDC

• 

  This is an example of interstitial corneal keratitis in a patient with late congenital syphilis. Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
  Adapted from CDC

• 

  This newborn presented with symptoms of congenital syphilis that included lesions on the soles of both feet. If not treated immediately, an infected baby may be born without symptoms, but can develop them within a few weeks. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.
  Adapted from CDC

• 

  This patient presented with an extragenital syphilitic chancre of the left index finger. The chancre is usually firm, round, small, and painless, appearing at the spot where syphilis entered the body, and lasts 3-6 weeks, healing on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.
  Adapted from CDC

• 

  This patient presented with secondary syphilytic lesions on the palms of her hands. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  These are secondary syphilitic lesions, known as syphilids on a patient's palms. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with secondary syphilytic lesions on the palms. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  These are secondary syphilitic lesions, known as syphilids on a patient's palms. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  A photograph depicts an anterior view of a patient's knees, who'd been diagnosed with "Clutton’s joints" due to what was determined to be congenital syphilis. See PHIL 12598, for a view of the patient's right knee, from a lateral perspective. ”Clutton's joints”, or symmetrical hydrarthrosis of the knee joints, is a painless condition that often occurs during the late stages of congenital syphilis. It involves synovitis, or swelling of a joint, accompanied by collections of fluid within the joint capsule.
  Adapted from CDC

• 

  This patient presented with a case of secondary syphilis manifested as perinal wart-like growths.
  Adapted from CDC

• 

  This patient with 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.
  Adapted from CDC

• 

  This patient presented with what was first thought to be syphilis, but turned out to be seborrheic dermatitis. This condition of the skin occurs in area of the body where the sebaceous glands experience an over-production of sebum, and subsequently gives rise to an infection and inflammation. Other causes include fungal involvement by a form of the yeast, Malassezia, having a genetic predisposition to this condition, hormonal changes disrupting the skin’s normal physiology, generalized stress, illness, fatigue, and sleep deprivation.
  Adapted from CDC

• 

  This patient presented with secondary papular syphilids on the soles of his feet. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This was a case of congenital syphilis resulting in the death of this newborn infant. Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth, known as “syphilitic stillbirth”, or of giving birth to a baby who dies shortly after birth.
  Adapted from CDC

• 

  This patient presented with secondary syphilitic lesions on the plantar aspect of the foot. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with a papulosquamous rash of secondary syphilitic lesions on the plantar surface of his feet. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with secondary syphilitic lesions of the face. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  Note the keratotic secondary syphilitic lesions on the sole of this patient's right foot. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with secondary syphilitic lesions of the lips. Note the split papules at the angles of the mouth. Second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners during the primary or secondary stage of the disease.
  Adapted from CDC

• 

  This patient presented with secondary syphilitic lesions on the face. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with a primary syphilitic chancre of the lip. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 3-6 weeks, healing on its own.
  Adapted from CDC

• 

  This patient presented with secondary annular syphilitic lesions of the face. Second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners during the primary or secondary stage of the disease.
  Adapted from CDC

• 

  This patient presented with areas of facial alopecia due to secondary syphilis. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with a primary syphilitic lesion of the right groin region. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 3-6 weeks, healing on its own.
  Adapted from CDC

• 

  These are psoriaform lesions on the legs of a patient with secondary syphilis. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own. Note the secondary palmar syphilytic lesions on this syphilis patient. Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
  Adapted from CDC

• 

  These keratotic lesions on the palms are due to secondary syphilis. Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
  Adapted from CDC

• 

  This patient presented with secondary syphilitic lesions on her face. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish-brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  The ulcerative primary syphilitic lesion on this patient's finger was due to lab acquired disease. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  This female patient presented with a case of granuloma inguinale with coexisting secondary syphilis. See PHIL 3485 and 18895, for additional views of this patient's condition. Granuloma inguinale, like syphilis, is also a sexually transmitted disease. It is a slowly progressive ulcerative condition of the skin and lymphatics of the genital, and perianal area caused by infection with Calymmatobacterium granulomatis.
  Adapted from CDC

• 

  This female patient presented with a case of granuloma inguinale with coexisting secondary syphilis. See PHIL 3486 and 18895, for additional views of this patient's condition. Granuloma inguinale, like syphilis, is also a sexually transmitted disease. It is a slowly progressive ulcerative condition of the skin and lymphatics of the genital, and perianal area caused by infection with Calymmatobacterium granulomatis.
  Adapted from CDC

• 

  This patient presented with a primary syphilitic chancre in the right inguinal region. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  This patient presented with a primary syphilitic chancre in the right inguinal region. The primary stage of syphilis is usually marked by the appearance of a single sore known as a chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless. These serpiginous, nodular ulcerative lesions are due to late syphilitic disease. The signs and symptoms of late stage syphilis include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death.
  Adapted from CDC

• 

  This patient presented with a papulo-squamous rash on the sole of the foot due to secondary syphilis. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with a papular rash on the sole of the foot due to secondary syphilis. The second stage of syphilis starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of hands and on the bottoms of feet. Even without treatment, rashes clear up by itself.
  Adapted from CDC

• 

  This patient presented with phimosis and inguinal lymphadenopathy due to primary syphilis. One of the symptoms of primary syphilis is the presence of lymphadenopathy, i.e. the swelling of the inguinal lymph nodes, either bilaterally or unilaterally, as well as the presence of a primary chancre.
  Adapted from CDC

• 

  This patient presented with a secondary syphilitic maculopapular rash of the right hand and forearm. The second stage starts when one or more areas of the skin break into a rash that appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. Even without treatment, rashes clear up on their own.
  Adapted from CDC

• 

  This patient presented with inguinal lymphadenopathy due to primary syphilis. One of the symptoms of primary syphilis is the presence of lymphadenopathy, i.e. the swelling of the inguinal lymph nodes, either bilaterally or unilaterally, as well as the presence of a primary chancre.
  Adapted from CDC

• 

  These were secondary syphilitic lesions on the palms of a 60 yr old woman. See PHIL 17051, for another image of this patient depicting a cutaneous labial lesion, which was also attributed to this illness. Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
  Adapted from CDC

• 

  Photograph of a patient with secondary syphilis presenting pigmented macules and papules on the skin. This patient has pigmented macules and papules of skin resulting from a cutaneous reaction during secondary syphilis, which is the most contagious of all the stages, and is characterized by the spread of the bacteria throughout the body.
  Adapted from CDC

• 

  Photograph of rhagades resulting from congenital syphilis. This patient with congenital syphilis is exhibiting rhagades, which are cracks or fissures in the skin around the mouth. Such a rare type of facial disfigurement, results from persistent infantile syphilitic rhinitis.
  Adapted from CDC

• 

  This photograph depicts a perforated hard palate on a patient with congenital syphilis. This patient with congenital syphilis has developed a perforation of hard palate due to gummatous destruction. These destructive tumors can also attack the skin, long bones, eyes, mucous membranes, throat, liver, or stomach lining.
  Adapted from CDC

• 

  This image depicts the dentition of a congenital syphilis patient, who due to this disease, went on to develop what are known as mulberry molars. “Moon's“, or mulberry molars, is a condition where the bite surface of the permanent first lower molar teeth develops rounded surfaces to its cusps, resembling the surface of a mulberry. Congenital syphilis, is a condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe cases are clinically apparent at birth. An infant or child (aged less than 2 years) may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).
  Adapted from CDC

• 

  A photograph of Hutchinson’s Teeth resulting from congenital syphilis. Hutchinson’s Teeth is a congenital anomaly in which the permanent incisor teeth are narrow and notched. Note the notched edges and "screwdriver" shape of the central incisors.
  Adapted from CDC

• 

  A photograph of a patient with congenital syphilis exhibiting interstitial corneal keratitis. This patient’s congenital syphilitic disease resulted in the onset of interstitial keratitis, an inflammation of the connective tissue structure of the cornea. Syphilis is the most common cause for this condition.
  Adapted from CDC

• 

  A photograph of a patient with tertiary syphilis resulting in gummas seen here on the nose. This patient presented with tertiary syphilitic gummas of the nose mimicking basal cell carcinoma. The gummatous tumors are benign and if properly treated, will heal and the patient will recover in most cases.
  Adapted from CDC

• 

  A photograph of a young child with congenital syphilis exhibiting intraoral mucous patches and facial skin lesions. An infant demonstrating mucous patches and skin lesions resulting from congenital syphilis. In 1998, 81.3% of reported cases of CS occurred because the mother received no penicillin treatment or inadequate treatment before or during pregnancy.
  Adapted from CDC

• 

  A photograph of a patient with tertiary syphilis resulting in gummatous lesions on the dorsal surface of the left hand. Gummatous lesions due to tertiary syphilis occur many years after initial untreated primary syphilis. The tumors are benign and if properly treated, the gummas will heal and the patient will recover in most cases.
  Adapted from CDC

• 

  A photograph of a patient with tertiary syphilis resulting in gummas seen here on the scalp. Tertiary syphilis occurs many years after initial untreated primary syphilis. Gummas, or internal tissue granulation, form and result in severe damage to the skin, bone, and liver.
  Adapted from CDC

• 

  A photograph of a patient with tertiary syphilis depicting gummatous lesions on the volar surface of the right arm. Tertiary syphilis occurs many years after initial untreated primary syphilis. Gummas, or internal tissue granulation, form and result in severe damage to the skin, bone, liver and other bodily organs, or regions.
  Adapted from CDC

• 

  The onset of this aortic aneurysm occurred during the tertiary stage of syphilis. This patient with late tertiary syphilis has developed an aortic aneurysm, which is eroding supraclavicularly through the ribs and clavicle. Cardiovascular syphilis can begin 5 to 10 years after initial infection.
  Adapted from CDC

• 

  Photograph of neuropathic arthropathy (Charcot joint) resulting from tertiary syphilis. This patient sustained progressive destruction, degeneration, and disorganization of the knee joint resulting from a loss of sensation caused by long standing tabes dorsalis. This condition was brought on during tertiary syphilis.
  Adapted from CDC

• 

  A photograph of mucous patches on the tongue due to secondary syphilis. Mucous patches form during the breakdown of mucous membranes, seen here on the inferior surface of the tongue. During the secondary stage of syphilis, mucous patches can also develop inside the mouth, vulva, and vagina.
  Adapted from CDC

• 

  A photograph of mucous patches on the lower lips due to secondary syphilis. Mucous patches form during the breakdown of mucous membranes, seen here on the inside the lower lip. During the secondary stage of syphilis, mucous patches can also develop inside the mouth, vulva, and vagina.
  Adapted from CDC

• 

  A photograph of syphilitic papules in the intertriginous areas of the toes. A patient with moist papules developing in the intertriginous areas between the toes. This clinical manifestation occurs during the secondary stage of syphilis, and is caused by the bacterium Treponema palladium.
  Adapted from CDC

• 

  A photograph of eyebrow alopecia, or hair loss, caused by secondary syphilis. This patient developed eyebrow alopecia during the secondary stage of syphilis. Other symptoms that may occur during this stage are mild fever, fatigue, headache, sore throat and swollen lymph glands.
  Adapted from CDC

• 

  A photograph of a patient with secondary syphilis showing typical "nickel and dime" lesions on the face. A patient with typical "nickel and dime" lesions on the face, which can develop during secondary syphilis. Other symptoms that may occur during this stage are mild fever, fatigue, headache, sore throat, patchy hair loss, and swollen lymph glands.
  Adapted from CDC

• 

  A patient with papulosquamous syphilids, or cutaneous eruptions of the disease, seen here on the wrist and palms. This patient presented with papulosquamous syphilids on the wrist and palms during the secondary stage of syphilis. The rash often appears as rough, red or reddish brown spots and can appear on both the palms of the hands and on the bottoms of the feet.
  Adapted from CDC

• 

  A photograph of secondary syphilitic lesions on the back and right shoulder. These papulosquamous lesions on the back and shoulder developed during secondary syphilis. The rash often appears as rough, red or reddish brown spots that can appear on palms of hands, soles of feet, the chest and back, or other parts of the body.
  Adapted from CDC

• 

  A photograph of secondary syphilitic lesions on a patient’s face. This patient with secondary syphilis has extensive lesions on the face. Secondary syphilis is the most contagious of all the stages, and is characterized by the spread of the bacteria Treponema pallidum, which causes symptoms throughout the body.
  Adapted from CDC

• 

  Photograph of secondary syphilitic papulosquamous lesions on penis, scrotum, and thighs. This patient with secondary syphilis has papulosquamous lesions of penis, scrotum, and thighs. Secondary syphilis is the most contagious of all the stages and is characterized by the spread of the bacteria which causes syphilis throughout the body.

• 

  Photograph of secondary syphilitic papular rash on a patient’s left arm. A patient with a papular rash on the left arm that developed during secondary syphilis. The rash often appears as rough, red or reddish brown spots that can appear on palms of hands, soles of feet, the chest and back, or other parts of the body.
  Adapted from CDC

• 

  A photograph of a secondary syphilitic papulosquamous rash seen on the torso and upper body. This patient had an extensive papulosquamous rash that developed during secondary syphilis. The rash often appears as rough, red or reddish brown spots that can appear on palms of hands, soles of feet, the chest and back, or other parts of the body
  Adapted from CDC

• 

  A photograph of a primary syphilitic chancre of the lower lip due to Treponema pallidum bacteria. A patient with a typical syphilitic chancre located on lower lip. A chancre is a small, painless red ulcer that develops during primary syphilis. Primary syphilis is characterized by one or more chancres after inoculation with T. pallidum bacteria.
  Adapted from CDC

• 

  Photograph of a primary syphilitic penile meatal chancre caused by the bacterium Treponema pallidum. This patient has a primary syphilitic chancre located in the urethral meatus. A chancre is a primary skin lesion of syphilis which begins at the site of infection after an interval of 10-30 days as a papule or red ulcerated skin lesion.

• 

  Patient with secondary syphilitic macular rash on the medial right foot. The rash often appears as rough, red or reddish brown spots, and can appear on both the palms of the hands as well as on the plantar surface (bottom) of the feet.
  Adapted from CDC

• 

  Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum bacteria. The primary stage of syphilis is usually marked by the appearance of a single sore called a chancre. The chancre is usually firm, round, small, and painless.
  Adapted from CDC

• 

  A chancre of the posterior vaginal fourchette during the primary stage of syphilis. This chancre is located on the posterior vaginal fourchette (where labia minora meet). The primary stage of syphilis is often marked by the appearance of a single sore – called a chancre, which is usually firm, round, small, and painless.
  Adapted from CDC

• 

  A chancre on the penis due to primary syphilis. The primary stage of syphilis is usually marked by the appearance of a single sore called a chancre. The chancre is usually firm, round, small, and painless. This image shows a chancre located at the coronal sulcus of the penis.
  Adapted from CDC

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• Trichomoniasis Return to Top

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  This photomicrograph of a wet-mounted vaginal discharge specimen, reveals numbers of Trichomonas vaginalis protozoan parasites, leading to a diagnosis of trichomoniasis, or “trich”, which is a very common sexually transmitted disease (STD) that is caused by infection with T. vaginalis. Although symptoms of the disease vary, most women and men who have the parasite cannot tell they are infected. The parasite is passed from an infected person to an uninfected person during sex. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, or urethra), and in men, the most commonly infected body part is the inside of the penis (urethra). During sex, the parasite is usually transmitted from a penis to a vagina, or from a vagina to a penis, but it can also be passed from a vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus. It is unclear why some people with the infection get symptoms while others do not, but it probably depends on factors like the person’s age and overall health. Infected people without symptoms can still pass the infection on to others. Adapted from CDC

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  This patient presented with a "strawberry cervix” due to a Trichomonas vaginalis infection, or trichomoniasis. The term “strawberry cervix” is used to describe the appearance of the cervix due to the presence of T. vaginalis protozoa. The cervical mucosa reveals punctate hemorrhages along with accompanying vesicles or papules.