Presentation
–Alopecia syphilitica: a non-inflammatory and non-cicatricial hair loss that can present in diffuse pattern, moth eaten pattern or a combination of both. –Mucous patches are present in up to 30% of cases. [dermatologyadvisor.com]
Leptomeninges Lesions of latent syphilis occur very frequently in the meninges, being present in the great majority of cases. [annals.org]
Cleft lip as a presentation of congenital syphilis. Indian J Sex Transm Dis. 2012; 33 :58–9. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ncbi.nlm.nih.gov]
Fiumara's stature; however, I find it presently impossible to agree with the routine outlined for the treatment of late latent syphilis in his report, "The Treatment of Syphilis," in the May 28 issue of the Journal .His department is said to examine the [nejm.org]
LATE LATENT syphilis presents a therapeutic problem that is unique. [jamanetwork.com]
Entire Body System
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Pathologist
This book is of value to pathologists, endocrinologists, clinicians, and medical researchers. Table of Contents Preface to the Second Edition Preface to the First Edition Chapter I.—Introduction Chapter II. [elsevier.com]
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Goiter
This book is composed of 15 chapters, and begins with a brief introduction to the pathology of syphilis, followed by chapters on the physiologic changes in the thyroid gland, including thyroid enlargement and goiter formation, in early syphilis. [elsevier.com]
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Hutchinson's Triad
’s triad (composed of Hutchinson’s teeth, interstitial keratitis and sensorineural deafness), Clutton’s joints (synovitis and joint effusion), short maxillae and a high arched palate. [dermatologyadvisor.com]
Gastrointestinal
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Dysphagia
—Notes on Nervous Dysphagia, with Special Reference to Its Cause Chapter VIII.—Syphilis and Nervous Dyspepsia Chapter IX.—Syphilis and the 'Chronic Abdomen' Chapter X.—Abdominal Adhesions in Latent Syphilis Chapter XI. [elsevier.com]
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Dyspepsia
—Syphilis and Nervous Dyspepsia Chapter IX.—Syphilis and the 'Chronic Abdomen' Chapter X.—Abdominal Adhesions in Latent Syphilis Chapter XI.—Some Clinical Features in Latent Syphilis Chapter XII. [elsevier.com]
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Dysphagia
—Notes on Nervous Dysphagia, with Special Reference to Its Cause Chapter VIII.—Syphilis and Nervous Dyspepsia Chapter IX.—Syphilis and the 'Chronic Abdomen' Chapter X.—Abdominal Adhesions in Latent Syphilis Chapter XI. [elsevier.com]
Musculoskeletal
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Bowing of Tibia
The most important signs include frontal and parietal bossing (bony prominences of forehead), saber shins (sharp anterior bowing of tibia), saddle nose, Hutchison’s incisors (small, notched, peg-shaped upper incisors), mulberry molars (multiple rounded [dermatologyadvisor.com]
Skin
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Hyperkeratosis
When the lesions are pruritic and when hyperkeratosis is pronounced, the eruption may resemble psoriasis. The occasional presence of the Koebner phenomenon further contributes to this confusion. [dermatologyadvisor.com]
Psychiatrical
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Visual Hallucination
Three patients developed a progressive impairment of their cognitive function in the form of visual hallucination and peripheral neuromuscular affections. [sjkdt.org]
Neurologic
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Areflexia
[…] syphilis ) tooth abnormalities (congenital syphilis ) necrotising funisitis (congenital syphilis ) mouth ulcer asymptomatic ( latent syphilis ) tremor headache meningismus eye pain hearing loss seizures peripheral oedema jaundice peripheral neuropathy areflexia [tripdatabase.com]
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Limb Weakness
Progressive painless lower limbs weakness in a dialyzed patient: Undiagnosed tertiary syphilis: A case report. Cases J 2010;3:23. [ PUBMED ] 5. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H; IUST. [sjkdt.org]
Workup
Microbiology
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Staphylococcus Aureus
aureus septicaemia with endophthalmitis showcased by multimodal retinal imaging and with 2-year follow-up. 38 Prajapati R...Kelly SP 30567135 2018 15 Risk of sexually transmitted infections following depressive disorder: A nationwide population-based [malacards.org]
Treatment
[…] spinal fluids of patients with adequately treated late latent syphilis a year after treatment, "and if this is negative, to repeat it at the end of the second post-treatment year." [nejm.org]
[…] in pregnancy 15 4.1 Maternal assessment 15 4.2 Prenatal assessment 16 4.2.1 Ultrasound findings 16 4.3 Treatment of syphilis in pregnancy 17 4.4 Treatment of late latent or syphilis of unknown duration 17 4.5 Monitoring serological response to treatment [tripdatabase.com]
Treatment Of Skin Diseases. 2010. pp. 730-733. (An excellent brief review of treatment of syphilis with annotated references and review of controversies in treatment.) “Sexually transmitted diseases guidelines 2010”. MMWR. vol. 59. 2010. pp. 1-106. [dermatologyadvisor.com]
If any benefit is to result from treatment, it must be, therefore, through a reduction in the frequency of subsequent clinical progression. [jamanetwork.com]
She was treated with injection procaine penicillin 12 lakhs units deep intramuscularly after test dose daily for 21 days for treatment of late latent syphilis. [ncbi.nlm.nih.gov]
Prognosis
Only by comparing final results in large numbers of patients, treated and untreated, can it be shown that the prognosis in latent syphilis can be altered by therapy. [jamanetwork.com]
Syphilis Prognosis Primary, secondary, and early latent syphilis can be treated successfully with antibiotics. Late latency (more than 1 year after the secondary stage) is difficult to treat. [healthcommunities.com]
Prognosis and Patient Counseling. Patients should be counseled on safe sex practices as well as signs and symptoms of partially treated/latent infection. VI. Patient Safety and Quality Measures A. Core Indicator Standards and Documentation. [cancertherapyadvisor.com]
Etiology
periodontitis), but their role as primary etiologic agents is unclear. [accessmedicine.mhmedical.com]
Its exact etiology is unclear, although it may be due to an immunological reaction to the rupture of spirochetes. Management of this reaction often involves symptomatic treatment (eg, with antipyretics and analgesics) and observation. [emedicine.medscape.com]
Etiology T. pallidum is a motile, corkscrew-shaped spirochete. Spirochetes are gram negative and have a flagellar bundle running through their periplasmic space causing the cells to move in a corkscrew fashion. Its size varies from 6 to 20um. [dermatologyadvisor.com]
Etiology Pathogen Treponema pallidum : gram-negative, spiral-shaped bacteria belonging to the spirochete family Transmission Sexual contact (via small mucocutaneous lesions) Vertical Treponema bacteria (particularly during stages I/II) are highly contagious [amboss.com]
Trichomonas vaginalis is another cause of persistent urethritis, but for men, there is no FDA-approved NAAT for this etiology, Dr. Choi noted. [acpinternist.org]
Epidemiology
38 Arando M...Vall-Mayans M 29775498 2018 18 Characteristics of Persons With Repeat Syphilis-Idaho, 2011 to 2015. 38 Kassem AM...Carter KK 29543622 2018 19 The Epidemiology of Syphilis in New York City: Historic Trends and the Current Outbreak Among Men [malacards.org]
Reexamining syphilis: An update on epidemiology, clinical manifestations, and management. Ann Pharmacother 2008;42:226-36. [ PUBMED ] 10. Singh AE, Wong T, Prithwish DE. [sjkdt.org]
Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
CHANGING EPIDEMIOLOGY OF INFECTIVE SYPHILIS Infective syphilis is caused by the anaerobic filamentous spirochete, Treponema pallidum. [scielo.br]
Ulcers should always be tested for herpes simplex virus and/or chancroid (if epidemiologically appropriate; see Chancroid chapter) and/or lymphogranuloma venereum (if epidemiologically appropriate; see Lymphogranuloma venereum chapter). [canada.ca]
Pathophysiology
References: [3] [4] Pathophysiology Clinical features Incubation period 10–90 days ; on average 21 days Primary syphilis Primary lesion ( chancre ) Typically starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm [amboss.com]
Prevention
Early syphilis : screen and treat to prevent transmission Prescrire IN ENGLISH - Spotlight ''Early syphilis : screen and treat to prevent transmission'', 1 March 2018 {1} {1} {1} Early syphilis : screen and treat to prevent transmission Spotlight Every [tripdatabase.com]
31277590 2019 5 Otosyphilis: Resurgence of an Old Disease. 38 Theeuwen H...Litvack JR 30592050 2019 6 Syphilis. 38 Arando Lasagabaster M...Otero Guerra L 30738716 2019 7 A Nationwide Spatiotemporal Analysis of Syphilis Over 21 Years and Implications for Prevention [malacards.org]
[…] recommendation that all the pregnant women should be screened for syphilis in the first antenatal visit in the first trimester and again in late pregnancy[ 8 ] for syphilis and treatment with penicillin is an effective measure to prevent the pregnancy [ncbi.nlm.nih.gov]
From the Centers for Disease Control and Prevention. Primary and secondary syphilis. United States, 2000–2001. JAMA 2002; 288: 2963–2965. 4. Centers for Disease Control and Prevention (CDC). [medicaljournals.se]
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2018. Atlanta, GA: Department of Health and Human Services; October 2019. 3. Centers for Disease Control and Prevention. [cdc.gov]