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 

  • 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 

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. 

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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)