Syphilis is a sexually transmitted, systemic disease caused by the spirochete Treponema pallidum
-It occurs in multiple overlapping stages: Primary, Secondary, Tertiary, and Latent syphilis.
-Neurosyphilis can occur at any stage.
-It is contracted through direct sexual contact with primary or secondary lesions
-Congenital syphilis can be contracted across the placenta.
Symptoms & Signs
Syphilis passes through 4 distinct clinical phases:
- Primary stage: one or more, usually painless chancres
- Secondary stage: rash, condylomata lata, with or without lymphadenopathy, and organ disease
- Latent syphilis: absence of signs or symptoms of disease, with only reactive serologic tests as evidence of infection
- Tertiary stage: cutaneous, neurologic, or cardiovascular manifestations.
-Infectious lesions of syphilis can be present anywhere on the body but are typically located in or around the genital, anal, or oral area
-Chancre: Dusky red macule which evolves into a papule, then an ulcer
A diagnosis of syphilis of any stage should be confirmed through the use of two-stage serologic tests
Serologic tests are either nontreponemal, which measure anticardiolipin antibodies, or treponemal , which measure antibodies to T. pallidum
- VDRL—Venereal Disease Research Laboratory.
- RPR—Rapid plasma reagin.
- EIA—Enzyme immunoassay.
- TP-PA—T. pallidum particle agglutination.
- FTA-ABS—Fluorescent treponemal antibody absorption.
- MHA-TP—Microhemagglutination assay for T. pallidum.
– Lyme disease may cause a false-positive treponemal test but rarely causes a false-positive nontreponemal test.
-Test all patients with syphilis for HIV.
-Traditionally, a diagnosis of syphilis of any stage should be confirmed through the use of two-stage serologic tests.
-Dark-field microscopy is useful in evaluating moist cutaneous lesions
-Treatment of choice for all stages of syphilis: Benzathine penicillin
-The dose and duration depend on the stage
-Penicillin allergy: Doxycycline, Ceftriaxone, Azithromycin
-Counsel patients to abstain from sexual activity for 7–10 days after treatment-The Jarisch–Herxheimer reaction: Fever and aggravation of the existing clinical picture in the hours following treatment. The reaction resolves spontaneously within 24 hours