Assessment for syphilis

There is primary (acute phase), secondary, latent and late (tertiary) syphilis.

Primary syphilis - most infectious stage, Incubation period ranges from 2 days to 12 weeks after exposure and averages 3 weeks.

• ulcerative, painless lesions (chancre) produced by spirochetes appears at the point of entry into the body
  • small fluid filled lesion (chancres) on the genitalia, orifice, finger, lips and or tongue
    
  • female patients may have chancres on the cervix or lady partsl wall
    
  • unilateral or bilateral adenopathy in these same areas

  [*]untreated, the chancres of primary syphilis heal in 2 to 8 weeks and disappear without leaving any scar

Secondary syphilis - highly infective stage occurs about 3 to 6 weeks after the primary stage - this stage may overlap with the primary stage - new lesions appear on the skin and mucous membranes along with systemic symptoms and generalized lymphadenopathy

• headache
  
• malaise
  
• nausea and vomiting
  
• weight loss and anorexia
  
• sore throat
  
• fever
  
• mucocutaneous lesions
  
• a macular, papular, pustular or nodular rash
  
• uniform, well defined, generalized lesions that are widespead and bilateral
  
• macules that erupt between rolls of fat on the trunk and the proximal arms, palms, soles, of the feet, face and scalp
  
• enlarged, erosive pink or grayish white lesions (condylomata lata) in the moist body areas, particularly the perineum, vulva and groin - they are highly contagious
  
• chancres appearing in this stage may become necrotic
  
• alopecia
  
• brittle, pitted nails
  
• generalized lymphadenopathy

Latent syphilis

• usually no physical signs as the infection lie dormant
  
• possible recurrence of the mucocutaneous lesions seen in secondary syphilis

Late or tertiary syphilis - the spirochetes have entered into the internal organs, causing permanent damage with symptoms occurring 10 to 30 years after the untreated primary lesions

• Depends on the organs involved. There are 3 subtypes
  • Neurosyphilis
    • when meningovascular tissue is affected: headache, vertigo, insomnia, hemiplegia, seizures, psychological difficulties
      
    • when parenchymal tissue is affected: paresis, altered intellect, paranoia, illusions, hallucinations, Argyll Robertson pupil, ataxia, slurred speech, trophic joint changes, positive Romberg's sign and facial tremor

    [*]Late Benign syphilis

    • gummas (chronic, superficial or deep, granulomatous nodular lesions that develop 1 to 10 years after infection on the skin and muccocutaneous tissues
      
    • lesions affecting bones and other organs

    [*]Cardiovascular syphilis

    • decreased cardiac output that leads to decreased urine output, decreased sensorium as a result of hypoxia, pulmonary congestion
      
    • deterioration of the aortic valve and aorta

http://www.fpnotebook.com/ID214.htm - Syphilis on Family Practice Notebook. Lists all stage and symptoms along with treatment.