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]; Nate Michalak, B.A.

Overview[edit | edit source]

The physical examination findings of syphilis are described according to the stage of syphilis which includes non-tender chancre in primary syphilis followed by rash and generalized lymphadenopathy in secondary syphilis. Physical examination findings in tertiary syphilis depend on the organ system involved.^[1]^[2]^[3]

Physical Examination[edit | edit source]

The physical examination findings of syphilis are described according to the stage of syphilis.^[1]^[2]^[3]


Stage of syphilis	Physical Examination	Images
Primary syphilis	Chancre 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 Regional lymphadenopathy Unilateral or bilateral Lymph nodes are firm, painless, non-tender and non-suppurative	Primary stage syphilis sore (chancre) on the surface of a tongue. - By Centers for Disease Control and Prevention (CDC) - http://www.cdc.gov/std/syphilis/images.htm#, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26062941 +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743113
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 Lymphadenopathy: localized or generalized, firm and non-tender 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 Painless May be macular, papular, pustular or mixed. Located on the palate, pharynx, larynx, penis, vulva, anal canal or rectum	+/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134272 +/−The direct image URL is [1], Dominio público, https://commons.wikimedia.org/w/index.php?curid=21063 Syphilis lesions on a patient's back - By Office of Medical History, US Surgeon General - Adapted from http://history.amedd.army.mil/booksdocs/wwii/internalmedicinevolIII/chapter20figure64.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1202157 Condymoata lata - Adapted from Dermatology Atlas.^[4]
Latent syphilis	Asymptomatic (serologically positive)
Tertiary syphilis	Neurosyphilis Asymptomatic meningitis Symptomatic meningitis: neck stiffness, Brudzinski's sign, Kernig's sign, ataxia. Meningovascular syphilis Focal deficits Intermittent or progresses slowly over a few days Parenchymatous neurosyphilis Develops 15-20 years after primary infection Presents as general paresis or tabes dorsalis with resultant ataxia Argyll Robertson pupil: small irregular pupil Cardiovascular syphilis Aortic regurgitation: Diastolic murmur De Musset's sign^[5] Gummatous lesions Gumma: 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	+/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=743277 Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.^[4] Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.^[4] Gummatous lesions in tertiary syphilis - Adapted from Dermatology Atlas.^[4]

References[edit | edit source]

↑ ^1.0 ^1.1 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.
↑ ^2.0 ^2.1 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.
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 ^4.2 ^4.3 "Dermatology Atlas".
↑ 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)

Template:WikiDoc Sources

[pmid10194456-1] 1.0 ^1.1 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.

[pmid21694502-2] 2.0 ^2.1 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.

[pmid17560432-3] 3.0 ^3.1 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.

[Dermatology_Atlas-4] 4.0 ^4.1 ^4.2 ^4.3 "Dermatology Atlas".

[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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Sexually transmitted diseases Main Page

Syphilis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Syphilis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy Primary and Secondary Syphilis Latent Syphilis Tertiary Syphilis Neurosyphilis HIV-Infected Patients Pregnancy Management of Sexual Partners

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Syphilis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Syphilis physical examination All Images X-rays Echo & Ultrasound CT Images MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Syphilis physical examination

CDC on Syphilis physical examination

Syphilis physical examination in the news

Blogs on Syphilis physical examination

Directions to Hospitals Treating Syphilis

Risk calculators and risk factors for Syphilis physical examination