Syphilis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]; Nate Michalak, B.A.

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Overview

The physical examination findings of syphilis are described according to the stage of syphilis which includes non-tender chancre in primary syphilis followed by rash and generalized lymphadenopathy in secondary syphilis. Physical examination findings in tertiary syphilis depend on the organ system involved.[1][2][3]

Physical Examination

The physical examination findings of syphilis are described according to the stage of syphilis.[1][2][3]

Stage of syphilis Physical Examination Images
Primary syphilis

Chancre

Regional lymphadenopathy

  • Unilateral or bilateral
  • Lymph nodes are firm, painless, non-tender and non-suppurative
Secondary syphilis

Cardinal signs

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

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

Latent syphilis
  • Asymptomatic (serologically positive)
Tertiary syphilis

Neurosyphilis

  • Focal deficits
  • Intermittent or progresses slowly over a few days
  • Parenchymatous neurosyphilis

Cardiovascular syphilis

Gummatous lesions

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

References

  1. 1.0 1.1 Singh AE, Romanowski B (1999). "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features". Clin Microbiol Rev. 12 (2): 187–209. PMC 88914. PMID 10194456.
  2. 2.0 2.1 Carlson JA, Dabiri G, Cribier B, Sell S (2011). "The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity". Am J Dermatopathol. 33 (5): 433–60. doi:10.1097/DAD.0b013e3181e8b587. PMC 3690623. PMID 21694502.
  3. 3.0 3.1 Wöhrl S, Geusau A (2007). "Clinical update: syphilis in adults". Lancet. 369 (9577): 1912–4. doi:10.1016/S0140-6736(07)60895-2. PMID 17560432.
  4. 4.0 4.1 4.2 4.3 "Dermatology Atlas".
  5. Sapira JD (1981 Apr). ""Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations"". South Med J. 74 (4): 459–67. Check date values in: |date= (help)

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