Syphilis history and symptoms

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. Maha Jaffar Azhar, M.D.

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## Overview[edit | edit source]

The history and symptoms of syphilis depends on stage of disease. The hallmark of syphilis infection is painless chancre. A positive history of painless chancre on genitalia, and presence of risk factors such as unprotected sex, multiple sexual partners, residence in highly prevalent area and previous history of sexually transmitted infections may be suggestive of syphilis infection. The most common symptoms of syphilis infection include painless chancre which progresses to ulcer with regional lymphadenopathy in primary syphilis. Secondary syphilis is characterized by rash and constitutional symptoms. Syphilis infection in tertiary syphilis can involve any organ system, hence named the "Great Imitator".[1][2][3]

## History and symptoms[edit | edit source]

The history and symptoms of syphilis according to the stage of disease are described below:[1][2][3]

Stage of syphilis | History and symptoms

|

Primary syphilis |

* 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

* Regional lymphadenopathy

* Heals spontaneously within 4-6 weeks; 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 |

* Previous history of chancre or rash
* Asymptomatic

Tertiary syphilis | Clinical manifestation of this stage depends on organ system involved:

Neurosyphilis

* Altered mental status
* Dementia
* Focal neurodeficit affecting hearing and vision

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.

## References[edit | edit source]

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.
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.CS1 maint: Multiple names: authors list (link)
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.

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