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__NOTOC__
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{{Syphilis}}
{{Syphilis}}
==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.<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }} </ref><ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref><ref name="pmid17560432">{{cite journal| author=Wöhrl S, Geusau A| title=Clinical update: syphilis in adults. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1912-4 | pmid=17560432 | doi=10.1016/S0140-6736(07)60895-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560432  }} </ref>


==Physical Examination==
==Physical Examination==
The physical exmaination findings of syphilis are described according to the stage of syphilis.<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }} </ref><ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref><ref name="pmid17560432">{{cite journal| author=Wöhrl S, Geusau A| title=Clinical update: syphilis in adults. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1912-4 | pmid=17560432 | doi=10.1016/S0140-6736(07)60895-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560432  }} </ref>
The physical examination findings of syphilis are described according to the stage of syphilis.<ref name="pmid10194456">{{cite journal| author=Singh AE, Romanowski B| title=Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 2 | pages= 187-209 | pmid=10194456 | doi= | pmc=88914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10194456  }} </ref><ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref><ref name="pmid17560432">{{cite journal| author=Wöhrl S, Geusau A| title=Clinical update: syphilis in adults. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1912-4 | pmid=17560432 | doi=10.1016/S0140-6736(07)60895-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560432  }} </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Primary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Primary syphilis'''
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'''''Chancre'''''
'''Chancre'''
:*Single painless papule which rapidly progresses to an ulcerated, indurated lesion with a surrounding red [[areola]].
:*Single painless [[papule]] which rapidly progresses to an ulcerated, indurated lesion with a surrounding red [[areola]]
:*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]].
:*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]]
'''''Regional [[lymphadenopathy]]'''''
'''Regional [[lymphadenopathy]]'''
:*Unilateral or bilateral
:*Unilateral or bilateral
:*[[Lymph node]]s are firm, painless, non-tender and non-suppurative.
:*[[Lymph node]]s are firm, painless, non-tender and non-suppurative
| style="padding: 5px 5px; background: #F5F5F5;" |<gallery>
| style="padding: 5px 5px; background: #F5F5F5;" |<gallery>


File:800px-Primary stage syphilis sore (chancre) on the surface of a tongue-CDC.jpg| Primary stage syphilis sore (chancre) on the surface of a tongue.
File:800px-Primary stage syphilis sore (chancre) on the surface of a tongue-CDC.jpg| Primary stage syphilis sore (chancre) on the surface of a tongue. - By Centers for Disease Control and Prevention (CDC) - http://www.cdc.gov/std/syphilis/images.htm#, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26062941


File:800px-Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|Chancres on the penile shaft due to a primary syphilitic infection
File:800px-Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|Chancres on the penile shaft due to a primary syphilitic infection - By CDC/M. Rein, VD - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #6803.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743113
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</gallery>
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Secondary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Secondary syphilis'''
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'''''Cardinal signs'''''
'''Cardinal signs'''
:*[[Skin rash]]: initial macular lesions on the trunk and proximal limbs with progressive generalized papular rash and may cause necrotic ulcers.
:*[[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.  
:*[[Lymphadenopathy]]: localized or generalized, firm and non-tender   


'''''Condylomata lata'''''
'''Condylomata lata'''
:*Reddish-brown papular lesions on the intertriginous areas that coalesce and enlarge into large plaques known as 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.
:*Lesions usually progress from painful vesicular pattern to erosive lesions with resultant broad, grey-white highly infectious lesions


'''''Superficial mucosal patches'''''  
'''Superficial mucosal patches'''  
::*Painless
::*Painless
::*May be macular, papular, pustular or mixed.
::*May be macular, papular, pustular or mixed.
::*Located on the [[palate]], [[pharynx]], [[larynx]], [[penis]], [[vulva]], [[anal canal]] or [[rectum]].  
::*Located on the [[palate]], [[pharynx]], [[larynx]], [[penis]], [[vulva]], [[anal canal]] or [[rectum]]   
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Image:Secondary Syphilis on palms CDC 6809 lores rsh.jpg|Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet
Image:Secondary Syphilis on palms CDC 6809 lores rsh.jpg|Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet - By CDC/ Robert Sumpter - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #6809.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134272
Image:Vaginal syphilis (disturbing image).jpg|Secondary syphilis manifested perineal condylomata lata lesions  
Image:Vaginal syphilis (disturbing image).jpg|Secondary syphilis manifested perineal condylomata lata lesions - De Content Providers(s): CDC - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #4098.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−The direct image URL is [1], Dominio público, https://commons.wikimedia.org/w/index.php?curid=21063
Image:Syphilis lesions on back.jpg|Syphilis lesions on a patient's back
Image:Syphilis lesions on back.jpg|Syphilis lesions on a patient's back - By Office of Medical History, US Surgeon General - Adapted from http://history.amedd.army.mil/booksdocs/wwii/internalmedicinevolIII/chapter20figure64.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1202157
Image:Syphilis secondary 15.jpeg|Condymoata lata
Image:Syphilis secondary 15.jpeg|Condymoata lata - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Latent syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Latent syphilis'''
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*ASymptomatic (serologically positive)
*Asymptomatic (serologically positive)
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Tertiary syphilis'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Tertiary syphilis'''
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'''''Neurosyphilis'''''
'''Neurosyphilis'''
*ASymptomatic [[meningitis]]
*Asymptomatic [[meningitis]]
*Symptomatic meningitis: neck stiffness, [[brudzinski's sign]]+, [[kernig's sign]]+, ataxia.
*Symptomatic meningitis: neck stiffness, [[Brudzinski's sign]], [[Kernig's sign]], [[ataxia]].
*Meningovascular syphilis
*Meningovascular syphilis
:*Focal deficits.
:*Focal deficits
:*Intermittent or progress slowly over a few days.
:*Intermittent or progresses slowly over a few days
*Parenchymatous neurosyphilis
*Parenchymatous neurosyphilis
:*Develops 15-20 years after primary infection.
:*Develops 15-20 years after primary infection
:*Clinical presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]].
:*Presents as [[general paresis]] or [[tabes dorsalis]] with resultant [[ataxia]]
:*[[Argyll Robertson pupil]]: small irregular pupil.
:*[[Argyll Robertson pupil]]: small irregular pupil


'''''Cardiovascular syphilis'''''
'''Cardiovascular syphilis'''
*[[Aortic insufficiency physical findings|aortic regurgitation]]:
*[[Aortic insufficiency physical findings|Aortic regurgitation]]:
:*[[Diastolic murmur]]
:*[[Diastolic murmur]]
:*[[De Musset's sign]]<ref>{{cite journal | author=Sapira JD | title="Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations" | journal=South Med J. | date=1981 Apr | volume=74 | issue=4 | pages=459-67 }}</ref>
:*[[De Musset's sign]]<ref>{{cite journal | author=Sapira JD | title="Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations" | journal=South Med J. | date=1981 Apr | volume=74 | issue=4 | pages=459-67 }}</ref>
'''Gummatous lesions'''
'''Gummatous lesions'''
*[[Gumma]]:
*[[Gumma]]:
:*Soft, asymmetric, coalscent [[granuloma|granulomatous]] lesion.
:*Soft, asymmetric, coalscent [[granuloma|granulomatous]] lesion  
:*Solitary lesions less than a centimeter in diameter.
:*Solitary lesions less than a centimeter in diameter
:*Appear almost anywhere in the body.
:*Appear almost anywhere in the body  
:*Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation.
:*Cutaneous gumma: indurated, nodular, papulosquamous to ulcerative lesions with peripheral hyperpigmentation
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<gallery>
<gallery>
File:800px-Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.
File:800px-Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|A gumma of nose due to a long standing tertiary syphilitic ''Treponema pallidum'' infection. - By CDC/ J. Pledger - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #5330.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743277


Image:Syphilis tertiary 01.jpeg| Gummatous lesions in tertiary syphilis
Image:Syphilis tertiary 01.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
Image:Syphilis tertiary 02.jpeg| Gummatous lesions in tertiary syphilis
Image:Syphilis tertiary 02.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>


Image:Syphilis tertiary 03.jpeg| Gummatous lesions in tertiary syphilis
Image:Syphilis tertiary 03.jpeg| Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
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</gallery>  
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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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