Syphilis physical examination: Difference between revisions
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==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> | |||
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'''''Chancre''''' | '''''Chancre''''' | ||
:*Single painless papule which rapidly progresses 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. | ||
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:*[[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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'''''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 progress 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]] | :*Clinical 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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*Chancre: | *Chancre: | ||
:*Single painless papule which rapidly progresses an ulcerated, indurated lesion with a surrounding red [[areola]] | :*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]] | :*Usually located on the [[penis]], [[cervix]], [[labia]], anal canal, [[rectum]], or [[oral cavity]]. | ||
:*Highly infectious lesion | :*Highly infectious lesion. | ||
*Regional [[lymphadenopathy]] accompanies primary lesion. | *Regional [[lymphadenopathy]] accompanies primary lesion. | ||
:*Onset within a week | :*Onset within a week. | ||
:*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. | ||
*Primary [[chancre]] heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods. | *Primary [[chancre]] heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods. | ||
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Image:Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|Gumma of the nose due to long standing tertiary syphilis | Image:Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection 5330 lores.jpg|Gumma of the nose due to long standing tertiary syphilis | ||
Image:Syphilis secondary 01.jpeg|Secondary syphilis | Image:Syphilis secondary 01.jpeg|Secondary syphilis | ||
Revision as of 13:01, 28 September 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
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American Roentgen Ray Society Images of Syphilis physical examination | |
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Risk calculators and risk factors for Syphilis physical examination | |
Physical Examination
The physical exmaination 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
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| Secondary syphilis |
Cardinal signs
Condylomata lata
Superficial mucosal patches |
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| Latent syphilis |
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| Tertiary syphilis |
Neurosyphilis
Cardiovascular syphilis Gummatous lesions
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Primary syphilis: Chancre
- Afebrile
- Chancre:
- 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.
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Primary stage syphilis sore (chancre) on the surface of a tongue.
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Chancres on the penile shaft due to a primary syphilitic infection
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Primary stage syphilis sore (chancre) on glans (head) of the penis.
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Syphilis primary chancre.
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Syphilis primary chancre.
_on_the_surface_of_a_tongue-CDC.jpg)
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Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet
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Condyoma lata (syphilis secondary)
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Electron micrograph of Treponema pallidum
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Syphilis lesions on a patient's back
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Syphilis lesions on a patient's chest
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Chancres on the penile shaft due to a primary syphilitic infection
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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.
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Gumma of the nose due to long standing tertiary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Secondary syphilis
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Tertiary syphilis: 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
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A gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection.
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Tertiary syphilis
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Tertiary syphilis
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Tertiary syphilis
- Cardiovascular manifestation secondary to aortic dilation with resultant aortic regurgitation:
- Diastolic murmur
- De Musset's sign[5] 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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) - ↑ 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)