Syphilis is a sexually transmitted disease caused by the spirochaete treponema pallidum.
Stages of syphilis can be divided into:
Primary syphilis
- Incubation 2-3 weeks
- Painless ulcer known as a chancre
- Often local, non-tender lymphadenopathy
Secondary syphilis
- Incubation 6 -12 weeks
- Systemic infection – malaise, rash, generalized lymphadenopathy
- Possibly wart-like lesions called condylomata lata
Latent syphilis
Subdivided into asymptomatic syphilis of less
than 2 years duration (= early latent) or asymptomatic syphilis of more
than 2 years duration (=late latent)
Tertiary syphilis
- Neurosyphilis
- Tabes dorsalis
- Ataxia
- Lightning pains
- Argyll-Robertson pupils
- Absent limb reflexes
- Dorsal column signs (loss of vibration and proprioception)
- Romberg’s sign
- General paralysis of the insane
- Personality changes
- Confusion
- Seizures
- Cardiovascular syphilis
- Aortic aneursym
- Aortic regurgitation
Diagnosis
- Dark ground microscopy for T pallidum in specialist centres
- T pallidum assays – tend to be positive lifelong, even after treatment
- Venereal Disease Reference Laboratory (VDRL)
- Not syphilis specific
- False positives in viral infections (chicken pox, hepatitis, infectious mononucleosis, malaria, HIV), SLE, RA, psoriasis
Treatment
IM penicillin or PO doxycycline
Small print gem: Jarisch-Herxheimer reaction – fever, myalgia and arthralgia hours after starting treatment for syphilis due to the rapid death of treponemes.
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