Syphilis history and symptoms

• History of risk factors (MSM, unprotected sex, multiple sex partners)
• Onset within 3 weeks of contact

• Chancre:

• Single painless firm raised papule
• Rapidly progresses to an ulcerated lesion
• Usually located on the glans penis, cervix, labia, anal canal, rectum or oral cavity

• Nontender regional lymphadenopathy

• Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods

• Develops 6-8 weeks after the appearance of primary chancre
• Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present
• Nephrotic syndrome and syphilitic hepatitis
• Skin eruptions may be subtle and asymptomatic
• Classic:

• Non-pruritic bilateral symmetrical mucocutaneous rash
• Non-tender regional lymphadenopathy
• Condylomata lata
• Patchy alopecia

• (1)a documented non reactive serologic test or sustained 4-fold or greater increase in titer of a nontreponemal test during the prior year,

• (2)unequivocal symptoms of primary or secondary syphilis, or

• (3)a sex partner documented to have primary, secondary, or early latent syphilis during the prior year

• Asymptomatic

Symptomatic late neurosyphilis Cardiovascular syphilis

• Aortic Regurgitation

• Dyspnea on exertion
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Palpitations (due to compensatory tachycardia)
• Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion)

• Congestive heart failure

• Dyspnea on ordinary exertion
• Fainting
• Fatigue
• Hemoptysis or frothy sputum
• Nocturia or urination during the night
• Nocturnal cough
• Orthopnea or sleeping on pillows
• Palpitations or extra heart beats
• Paroxysmal nocturnal dyspnea
• Shortness of breath

Gummatous lesions

• Presents with any organ system involved.
• Nodular papular lesions in case of cutaneous gumma.

• headache,
• blurred vision,
• nausea/vomiting Cranial nerve dysfunction: III, VII, VIIII

• personality or mood changes,
• dementia,
• cognitive decline,
• and behavioral defects

Tabes dorsalis:

• sharp stabbing pain in limbs or abdomen;
• bladder disturbances, rectal incontinence;
• loss of deep tendon reflexes, proprioception, touch, pain, and vibratory sensation;
• positive Romberg sign;
• and gait disturbances

• conjunctivitis,
• scleritis,
• episcleritis,
• uveitis,
• chorioretinitis,
• retinitis
• vasculitis

Otosyphilis can present as

• sensorineural hearing loss,
• tinnitus,
• vertigo and
• may include osteitis of temporal bone; patient may report haring loss, ringing in ears, and dizziness/vertigo