Syphilis history and symptoms

Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The route of transmission of syphilis is almost always by sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult.

History

 * Hx number of sexual partners, condom use,
 * Hx of sexually transmitted disease, intravenous drug use, exposure to blood products

Primary syphilis

 * Onset within 3 weeks of contact


 * Chancre:
 * single painless firm raised papule
 * usually located on the glans penis,cervix, labia, anal canal, rectum or oral cavity
 * rapidly progresses an ulcerated, indurated lesion


 * Regional lymphadenopathy accompanies primary lesion.


 * Primary chancre heals spontaneously within 4-6weeks; however, regional lymphadenopathy may persist for longer periods.

Secondary syphilis

 * Develops 6-8 weeks after the appearance of primary chancre.
 * Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present.
 * Skin eruptions may be subtle and asymptomatic
 * Classic:
 * non-pruritic bilateral symmetrical mucocutaneous rash
 * non-tender regional lymphadenopathy
 * condylomata lata
 * patchy alopecia

Latent syphilis

 * Latency period may last for years before the onset of tertiary lesions


 * 2 phases of latency:
 * early latent period: first year following the resolution of primary or secondary syphilis
 * late latent period: non-infectious phase; however, vertical transmission of the disease is possible


 * Asymptomatic during latency and disease is detected only by serology

Tertiary syphilis

 * Slowly progressive phase
 * Develop within 3-10 years of primary infection


 * Gumma:
 * soft, tumor-like balls of inflammation known as granulomas.
 * chronic and represent an inability of the immune system to completely clear the organism.
 * appear almost anywhere in the body including in the skeleton.
 * gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy.


 * Other characteristics of untreated tertiary syphilis is the neurological manifestations that include:
 * altered mental status
 * focal neurodeficit affecting hearing and vision
 * dementia


 * Cardiovascular manifestations:
 * Insidious in onset
 * The infection of the coronary arteries may cause narrowing of the vessels
 * syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur.
 * syphilitic aortitis can cause de Musset's sign, a bobbing of the head that de Musset first noted in Parisian prostitutes.