Syphilis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The route of transmission of syphilis is almost always by sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult.

• Hx number of sexual partners, condom use,
• Hx of sexually transmitted disease, intravenous drug use, exposure to blood products

History and symptoms

The history and symptoms of syphilis according to the stage of disease are described below:

Stage of syphilis	History and symptoms
Primary syphilis	Onset within 3 weeks of contact Chancre: Rapidly progresses an ulcerated, indurated lesion Single painless firm raised papule Usually located on the glans penis, cervix, labia, anal canal, rectum or oral cavity Regional lymphadenopathy Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods.
Secondary syphilis	Develops 6-8 weeks after the appearance of primary chancre Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present. Skin eruptions may be subtle and asymptomatic Classic: Non-pruritic bilateral symmetrical mucocutaneous rash Non-tender regional lymphadenopathy Condylomata lata Patchy alopecia
Latent syphilis	Previous history of chancre or rash Asymptomatic
Tertiary syphilis	Clinical manifestation of this stage depends on organ system involved: Neurosyphilis Altered mental status Dementia Focal neurodeficit affecting hearing and vision Cardiovascular syphilis Aortic Regurtiation Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea Palpitations (due to compensatory tachycardia) Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion) Congestive heart failure Dyspnea on ordinary exertion Fainting Fatigue Hemoptysis or frothy sputum Nocturia or urination during the night Nocturnal cough Orthopnea or sleeping on pillows Palpitations or extra heart beats Paroxysmal nocturnal dyspnea Shortness of breath Gummatous lesions

Primary syphilis

• Onset within 3 weeks of contact

• Chancre:

• Rapidly progresses an ulcerated, indurated lesion
• Single painless firm raised papule
• Usually located on the glans penis, cervix, labia, anal canal, rectum or oral cavity

• Regional lymphadenopathy accompanies primary lesion.

• Primary chancre heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods.

Secondary syphilis

• Develops 6-8 weeks after the appearance of primary chancre
• Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present.
• Skin eruptions may be subtle and asymptomatic
• Classic:

• Non-pruritic bilateral symmetrical mucocutaneous rash
• Non-tender regional lymphadenopathy
• Condylomata lata
• Patchy alopecia

Latent syphilis

• Asymptomatic during latency and disease is detected only by serology

Tertiary syphilis

• Slowly progressive phase
• Develop within 3-10 years of primary infection

• Gumma:

• Appear almost anywhere in the body including in the skeleton.
• Chronic and represent an inability of the immune system to completely clear the organism.
• Gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy.
• Soft, tumor-like balls of inflammation known as granulomas.

• Other characteristics of untreated tertiary syphilis is the neurological manifestations that include:

• Altered mental status
• Dementia
• Focal neurodeficit affecting hearing and vision

• Cardiovascular manifestations:

• Insidious in onset
• Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur.
• Syphilitic aortitis can cause de Musset's sign, a bobbing of the head that de Musset first noted in Parisian prostitutes.
• The infection of the coronary arteries may cause narrowing of the vessels

References

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