Chapter 56 Sexually Transmitted Infections: Syphilis
INTRODUCTION
Description: Since antiquity, syphilis has been the prototypic venereal disease. This disease presents with an easily overlooked first stage and, if left untreated, can slowly progress to a disabling disease noted for central nervous system, cardiac, and musculoskeletal involvement.
ETIOLOGY AND PATHOGENESIS
Causes: Treponema pallidum is one of a very small group of spirochetes that are virulent for humans. This motile anaerobic spirochete can rapidly invade even intact moist mucosa (epithelium).
CLINICAL CHARACTERISTICS
Signs and Symptoms (Based on Stage)
• Painless chancres (shallow, firm, punched out, with a smooth base and rolled edges; on the vulva, anus, rectum, pharynx, tongue, lips, fingers, or the skin of almost any part of the body) 10 to 60 days (average, 21 days) after inoculation
• Low-grade fever; headache; malaise; sore throat; anorexia; generalized lymphadenopathy; a diffuse, symmetrical, asymptomatic maculopapular rash over the palm and soles (“money palms”); mucous patches; condyloma lata (second stage)
DIAGNOSTIC APPROACH
Workup and Evaluation
Laboratory: The Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests are nonspecific and good screening tests because they are rapid and inexpensive. The fluorescent treponemal antibody absorption or microhemagglutination T. pallidum tests are specific treponemal antibody tests that are confirmatory or diagnostic; they are not used for routine screening but are useful to rule out a false-positive screening test result. If neurosyphilis is suspected, a lumbar puncture with a Venereal Disease Research Laboratory performed on the spinal fluid is required. (Unless clinical signs or symptoms of neurologic or ophthalmic involvement are present, cerebrospinal fluid analysis is not recommended for routine evaluation of patients who have primary or secondary syphilis.) Screening for human immunodeficiency virus (HIV) infection should also be strongly considered. False-positive screening results may occur in patients with lupus, hepatitis, sarcoidosis, recent immunization, or drug abuse or during pregnancy. These test results may be falsely negative in the second stage of the disease as a result of high levels of anticardiolipin antibody that interfere with the test (prozone phenomenon). Up to 30% of patients with a primary lesion have negative test results. (Approximately 15% to 25% of patients treated during the primary stage revert to being serologically nonreactive after 2 to 3 years.)
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
