Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Syphilis 1395

■Risk factors: young age, race/ethnicity (highest reported rates in

African-Americans and Hispanics); lower socioeconomic status,

urban residence, illicit drug use, prostitution

■30–40% risk of transmission following sexual contact with infected

case

Signs & Symptoms

■Primary syphilis

➣Incubation period averages 21 days, range 10–90 d

➣Chancre: painless, indurated, usually single, multiple in 25%

cases

➣Lymphadenopathy: nontender, rubbery

➣Lesions heal spontaneously without treatment in 3–6 weeks

■Secondary syphilis

➣Incubation period 3–6 weeks after development of chancre

➣Constitutional symptoms (70%): fever, malaise, arthralgias

➣Skin rash (90%): diffuse, typically involving palms and soles

➣Condyloma lata: painless, moist mucosal lesions; highly infec-

tious

➣Lymphadenopathy: generalized, painless

➣CNS: asymptomatic involvement in 8–40%, symptomatic 1–2%

➣Other: patchy alopecia (40%), mucous patches (35%), glomeru-

lonephritis, hepatitis, arthritis, osteitis

➣Symptoms resolve spontaneously; recurrent episodes in 25%

untreated patients usually within first year of infection

■Latent syphilis

➣Positive treponemal serologic tests with no clinical manifesta-

tions

➣Early=disease of <1 year duration

➣Late≥1 year duration or disease of unknown duration

■Tertiary syphilis

➣Late complications occur in 30% of untreated patients

➣Gummas: rare, granulomatous lesions of skin, bone, brain,

heart

➣Cardivascular: ascending aortic aneurysm, aortic insufficiency

➣Neurosyphilis – can occur at any stage of disease

Asymptomatic: CSF abnormalities only

Meningeal: acute meningitis

Meningovascular: stroke syndrome, seizures

Parenchymal: general paresis, tabes dorsalis