Syphilis/History and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[4]Nate Michalak, B.A. Maha Jaffar Azhar, M.D. Muhammad Saad, M.B.B.S.[5]

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Overview

The history and symptoms of syphilis depends on stage of disease. The hallmark of syphilis infection is painless chancre. A positive history of painless chancre on genitalia, and presence of risk factors such as unprotected sex, multiple sexual partners, residence in highly prevalent area and previous history of sexually transmitted infections may be suggestive of syphilis infection. The most common symptoms of syphilis infection include painless chancre which progresses to ulcer with regional lymphadenopathy in primary syphilis. Secondary syphilis is characterized by rash and constitutional symptoms. Syphilis infection in tertiary syphilis can involve any organ system, hence named the "Great Imitator".

History and symptoms

The history and symptoms of syphilis according to the stage of disease are described below:

Stage of syphilis	History and symptoms
Primary syphilis	History of risk factors (MSM, unprotected sex, multiple sex partners) Onset within 3 weeks of contact Chancre: Single painless firm raised papule Rapidly progresses to an ulcerated lesion Usually located on the glans penis, cervix, labia, anal canal, rectum or oral cavity Nontender regional lymphadenopathy Heals spontaneously within 4-6 weeks; however, regional lymphadenopathy may persist for longer periods
Secondary syphilis	Develops 6-8 weeks after the appearance of primary chancre Generalized systemic symptoms such as malaise, fatigue, headache and fever may be present Nephrotic syndrome and syphilitic hepatitis Skin eruptions may be subtle and asymptomatic Classic: Non-pruritic bilateral symmetrical mucocutaneous rash Non-tender regional lymphadenopathy Condylomata lata Patchy alopecia
Early latent syphilis	No symptoms or findings on examination with a reactive serologic test for syphilis plus (1)a documented non reactive serologic test or sustained 4-fold or greater increase in titer of a nontreponemal test during the prior year, (2)unequivocal symptoms of primary or secondary syphilis, or (3)a sex partner documented to have primary, secondary, or early latent syphilis during the prior year
Late latent syphilis	Asymptomatic
Tertiary (late) syphilis	Clinical manifestation of this stage depends on organ system involved: Symptomatic late neurosyphilis Cardiovascular syphilis Aortic Regurgitation Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea Palpitations (due to compensatory tachycardia) Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion) Congestive heart failure Dyspnea on ordinary exertion Fainting Fatigue Hemoptysis or frothy sputum Nocturia or urination during the night Nocturnal cough Orthopnea or sleeping on pillows Palpitations or extra heart beats Paroxysmal nocturnal dyspnea Shortness of breath Gummatous lesions Presents with any organ system involved. Nodular papular lesions in case of cutaneous gumma.
Symptomatic early neurosyphilis	Meningitis: headache, blurred vision, nausea/vomiting Cranial nerve dysfunction: III, VII, VIIII
Symptomatic late neurosyphillis	General paresis: personality or mood changes, dementia, cognitive decline, and behavioral defects Tabes dorsalis: sharp stabbing pain in limbs or abdomen; bladder disturbances, rectal incontinence; loss of deep tendon reflexes, proprioception, touch, pain, and vibratory sensation; positive Romberg sign; and gait disturbances
Ocular and otic syphilis	Ocular syphilis can present as conjunctivitis, scleritis, episcleritis, uveitis, chorioretinitis, retinitis vasculitis Otosyphilis can present as sensorineural hearing loss, tinnitus, vertigo and may include osteitis of temporal bone; patient may report haring loss, ringing in ears, and dizziness/vertigo

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