INFECTIOUS DISEASE■ Rash
■ Nonpruritic
■ Dull red maculopapular
■ Spreads trunk →extremities (may involve palms and/or soles)
■ Constitutional symptoms
■ Flulike
■ Sore throat, oral lesions
■ Wartlike anogenital growths (condyloma lata)
■ Generalized lymphadenopathy
■ Symptoms resolve spontaneously.
■ Latent
■ Asymptomatic period (serologies positive)
■ Normally lasts 3–4 years
■ Two phases
■ Early latent (<1 year from acquisition)
■ Late latent (>1 year)
■ Tertiary
■ Peripheral neuropathy (tabes dorsalis)
■ Meningitis
■ Dementia
■ Gummatous lesions of mucous membranes
■ Aortitis
■ Aortic-valve insufficiency
■ Thoracic aortic aneurysm
DIAGNOSIS
■ Early stages
■ Dark-field microscopy (sensitivity ~80%)
■ From chancre or oral/genital lesions
■ Later (>2 weeks after 1°chancre)
■ RPR or VDRL
■ Screening test (nonspecific antibodies)
■ False-positive rate ~2%
■ FTA-ABS
■ More specific (treponemal antibodies)
■ Used to confirm diagnosis
TREATMENT
■ 1 °, 2°, or early latent
■ Benzathine penicillin 2.4 million U IM × 1
■ Alternative: Doxycycline ×14 days
■ Late latent or unknown
■ Benzathine penicillin 2.4 million U IM weekly × 3
■ Alternative: Doxycycline ×28 days
■ Partners should be tested and treated empirically if sexual contact within
90 days.
■ Jarisch-Herxheimer reaction
■ A transient inflammatory reaction following treatment of syphilis (1°,
~75%; 2°, ~90%)
■ Symptoms
■ Fever, chills, headache, myalgias, and exacerbation of cutaneous lesions
■ Duration=several hours
■ Also seen with borreliosis, brucellosis, typhoid fever, and trichinellosis
RPR and VDRL false-positives
occur frequently in patients
with HIV, malaria,
pneumonia, and lupus.