Syphilis

Syphilis is a sexually transmitted disease caused by the spirochaete treponema pallidum. 

Stages of syphilis can be divided into: 

Primary syphilis

• Incubation 2-3 weeks 
• Painless ulcer known as a chancre 
• Often local, non-tender lymphadenopathy 

Secondary syphilis

• Incubation 6 -12 weeks 
• Systemic infection – malaise, rash, generalized lymphadenopathy 
• Possibly wart-like lesions called condylomata lata 

 

Latent syphilis 

Subdivided into asymptomatic syphilis of less than 2 years duration (= early latent) or asymptomatic syphilis of more than 2 years duration (=late latent)

Tertiary syphilis

• Neurosyphilis 
• Tabes dorsalis 
• Ataxia 
• Lightning pains 
• Argyll-Robertson pupils 
• Absent limb reflexes 
• Dorsal column signs (loss of vibration and proprioception) 
• Romberg’s sign 
• General paralysis of the insane 
• Personality changes
• Confusion
• Seizures 
• Cardiovascular syphilis 
• Aortic aneursym 
• Aortic regurgitation 

Diagnosis 

• Dark ground microscopy for T pallidum in specialist centres 
• T pallidum assays – tend to be positive lifelong, even after treatment 
• Venereal Disease Reference Laboratory (VDRL) 
• Not syphilis specific 
• False positives in viral infections (chicken pox, hepatitis, infectious mononucleosis, malaria, HIV), SLE, RA, psoriasis 

Treatment

IM penicillin or PO doxycycline 

Small print gem: Jarisch-Herxheimer reaction – fever, myalgia and arthralgia hours after starting treatment for syphilis due to the rapid death of treponemes. 

References:

Beal, R, and Merry, D. The VDRL test in a blood transfusion service. J Clin Pathol. 1975; 28(11): 854-859.

French, P. Syphilis. BMJ. 2007; 334(7585): 143-147. 

Goh, B. Syphilis in adults. Sex Transm Infect. 2005; 81(6): 448-452.