Syphilis natural history, complications and prognosis

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

Overview

Natural history

Initial presentation of syphilis is appearance of painless chancre after 3-4 weeks of exposure. If left untreated, chancre self resolves and may progress to develop constitutional sypmtoms and generalised symmetric rash in four to eight weeks. In less than 10% of individuals, complications such as hepatitis, iritis, nephritis, and neurological problems may develop at this stage. However, it resolves in four to eight weeks without treatment and patient enters into asymptomatic latent phase. About a quarter of patients may develop recurrence of similar symptoms in one year. If left untreated, 35% of patients may develop tertiary syphilis which include complications such as cardiovascular involvement in 15-30 years(80-85%, aortic aneurysm, aortic regurgitation, angina, heart failure), neurologic infection in 10-15 years (5-10%, cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities) and gummatous lesions involving skin, bone and joints which is associated with significant morbidity and mortality.[1][2][3][4]

Complications

Complications that can develop as a result of syphilis are:

Ocular

Auditory

Neurological

Cardiovascular

Renal

Musculoskeletal

Dermatological

Gastrintestinal

Gummatous lesions

Prognosis

The prognosis of syphilis varies by stage of disease:[2][3][4]

Primary and secondary syphilis

Prognosis is good with treatment.

Tertiary syphilis

Prognosis varies by site of involvememnt and duration of disease:

  • 90% of patients with neurosyphilis respond to treatment.
  • Gummatous lesions reverse with treatment.
  • Mortality rates are high with cardiovascular complications.
  • 20% of patients with tertiary syphilis die of complications.

References

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