Syphilis physical examination

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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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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

  • 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 progress 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.

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.
  • 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.

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
  • 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

Ophthalmic Examination

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

Clinical pearl: Syphilis detecting Handshake

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References

  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. 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. 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. 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)
  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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