Syphilis physical examination

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

Sexually transmitted diseases Main Page
Syphilis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Syphilis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy Primary and Secondary Syphilis Latent Syphilis Tertiary Syphilis Neurosyphilis HIV-Infected Patients Pregnancy Management of Sexual Partners
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Syphilis physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Syphilis physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Syphilis physical examination
CDC on Syphilis physical examination
Syphilis physical examination in the news
Blogs on Syphilis physical examination
Directions to Hospitals Treating Syphilis
Risk calculators and risk factors for Syphilis physical examination

Physical Examination

Stage of syphilis	Physical Examination	Images
Primary syphilis	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 Regional lymphadenopathy Unilateral or bilateral Lymph nodes are firm, painless, non-tender and non-suppurative
Secondary syphilis	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
Latent syphilis
Tertiary syphilis	Neurosyphilis Cardiovascular syphilis Gummatous lesions

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 4-6 weeks; however, regional lymphadenopathy may persist for longer periods.

• 

  Primary stage syphilis sore (chancre) on the surface of a tongue.

• 

  Chancres on the penile shaft due to a primary syphilitic infection

• 

  Primary stage syphilis sore (chancre) on glans (head) of the penis.

• 

  Syphilis primary chancre.

• 

  Syphilis primary chancre.

• 

  Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet

• 

  Condyoma lata (syphilis secondary)

• 

  Electron micrograph of Treponema pallidum

• 

  Syphilis lesions on a patient's back

• 

  Syphilis lesions on a patient's chest

• 

  Chancres on the penile shaft due to a primary syphilitic infection

• 

  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.

• 

  Gumma of the nose due to long standing tertiary syphilis

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.

• 

  manifestations of secondary syphilis

• 

  Syphilis lesions on back.

• 

  Syphilis lesions on back

• 

  Secondary stage syphilis sores (lesions) on the palms of the hands. Referred to as "palmar lesions.

• 

  Secondary stage syphilis sores (lesions) on the bottoms of the feet. Referred to as "plantar lesions."

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

• 

  Secondary syphilis

Tertiary syphilis: Gumma

• Gumma:

• Soft, asymmetric, coalscent granulomatous lesion
• Solitary lesions less than a centimeter in diameter
• Appear almost anywhere in the body including in the skeleton
• Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation

• 

  A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.

• 

  Tertiary syphilis

• 

  Tertiary syphilis

• 

  Tertiary syphilis

• Cardiovascular manifestation secondary to aortic dilation with resultant aortic regurgitation:

• Diastolic murmur
• De Musset's sign a bobbing of the head that de Musset first noted in Parisian prostitutes

• Neurological manifestation:

• Asymptomatic meningitis

• Asymptomatic neurosyphilis usually has no signs or symptoms and is diagnosed exclusively with the presence of CSF abnormalities notably pleocytosis, elevated protein, decreased glucose or a positive VDRL test.

• Symptomatic meningitis

• Develops within 6-months to several years of primary infection
• Typical meningitis symptoms present
• Cranial nerve abnormalities may be observed

• Meningovascular syphilis

• Occurs a few months to 10 years (average, 7 years) after the primary infection
• Associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable
• Focal deficits initially are intermittent or progress slowly over a few days
• Clinical present with CNS vascular insufficiency or stroke involving the middle cerebral artery

• Parenchymatous neurosyphilis

• Develops 15-20 years after primary infection
• Clinical presents as general paresis or tabes dorsalis with resultant ataxia
• Argyll Robertson pupil: small irregular pupil

Ophthalmic Examination

• Slit-lamp examination and ophthalmic examination may be helpful to differentiate between acquired and congenital syphilis.

• Presence of interstitial keratitis is suggestive of congenital syphilis with latent infection of unknown duration.

Clinical pearl: Syphilis detecting Handshake

{{#ev:youtube|SAedwyzTMWA}}

References

Template:WikiDoc Sources