Syphilis physical examination

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.

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## Overview

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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

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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

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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.
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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