Syphilis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

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.

Physical examination

Primary syphilis: Chancre

• Afebrile

• Chancre:

• single painless papule which rapidly progresses an ulcerated, indurated lesion with a surrounding red areola
• usually located on the penis,cervix, labia, anal canal, rectum or oral cavity
• highly infectious lesion

• Regional lymphadenopathy accompanies primary lesion.

• onset within a week
• unilateral or bilateral
• lymph nodes are firm, painless, non-tender and non-suppurative

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

Secondary syphilis: Condylomata Lata

• Develops 6-8 weeks after the appearance of primary chancre.

• Cardinal signs include:

• Skin rash: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers.

• Lymphadenopathy: localized or generalized, firm and non-tender

• Condylomata lata:

• reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as condylomata lata

• lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions

• Superficial mucosal patches:

• painless
• may be macular, papular, pustular or mixed
• located on the palate, pharynx, larynx, penis, vulva, anal canal or rectum

• 
  Erruption on Sole of Foot Associated with Secondary Syphilis.
• 
  Generalized (Maculo-Papular) Eruption Associated with Secondary Syphilis.
• 
  Palmar Erruption Associated with Secondary Syphilis.
• 
  Palmar Erruption Associated with Secondary Syphilis.

Clinical pearl: Syphilis detecting Handshake

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References

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