Summary
Definition
Syphilis is a sexually transmitted infection caused by the spirochaetal bacterium
Treponema pallidum
, subspecies
pallidum
. It is found only in human hosts. Acquired infection is transmitted through direct person-to-person sexual contact with an individual with early syphilis. Vertical transmission from mother to baby causes a congenital infection. Most sexual transmission of syphilis probably occurs from the genital and mucous membrane lesions of primary and secondary syphilis. Syphilis has often been described as the great imitator because many of the symptoms and signs are difficult to distinguish from other diseases.
[1]
[Figure caption and citation for the preceding image starts]:
Electron micrograph of
Treponema pallidum
on cultures of cotton-tail rabbit epithelium cells
CDC/Dr David Cox
[Citation ends].
History and exam
Key diagnostic factors
- presence of risk factors
- genital ulcer
- lymphadenopathy
- diffuse rash
- constitutional symptoms
- fatigue
- rhinitis (congenital syphilis)
- hepatosplenomegaly (congenital syphilis)
- patchy alopecia
- condylomata lata
- memory impairment, altered mood, confusion, or dementia
- visual disturbance
- Argyll-Robertson pupils
- loss of sense of vibration, proprioception, and position sense
- ataxia
- loss of anal and bladder sphincter control
- positive Romberg's sign
- diastolic murmur
- rubbery nodules with a necrotic centre
- miscarriage or stillbirth (congenital syphilis)
- premature labour and intrauterine growth retardation (congenital syphilis)
- neonatal skin rash (congenital syphilis)
- tibial bowing (congenital syphilis)
- craniofacial malformation (congenital syphilis)
- tooth abnormalities (congenital syphilis)
- necrotising funisitis (congenital syphilis)
Other diagnostic factors
- mouth ulcer
- asymptomatic (latent syphilis)
- tremor
- headache
- meningismus
- eye pain
- hearing loss
- seizures
- peripheral oedema
- jaundice
- peripheral neuropathy
- areflexia
- angina
- dyspnoea
- organomegaly
- skin or visceral organ perforation or collapse of structure
- neonatal neurological abnormalities (congenital syphilis)
Risk factors
- sexual contact with an infected person
- men who have sex with men
- illicit drug use
- commercial sex workers
- multiple sexual partners
- people with HIV or other STDs
- syphilis during pregnancy (risk for congenital syphilis)
Diagnostic investigations
1st investigations to order
- dark-field microscopy of swab from lesion
- serum treponemal enzyme immune assay (EIA)
- serum T pallidum particle agglutination (TPPA)
- serum T pallidum haemagglutination (TPHA)
- serum fluorescent antibody absorption (FTA-ABS) tests
- immunocapture assay (ICA)
- INNO-LIA test
- serum rapid plasma reagin (RPR) test
- serum Venereal Disease Research Laboratory (VDRL) test
- serum cardiolipin-based test
Investigations to consider
- lumbar puncture, CSF analysis
- CXR
- echocardiogram
- CT brain
- MRI brain
- HIV test
- fetal ultrasound scan
- FBC
- cranial ultrasound
- long-bone x-rays
- LFTs
- evoked auditory potentials
- audiometry
Emerging tests
- point of care (POC) testing with either treponemal or combination treponemal/non-treponemal antibody
- T pallidum PCR (sample taken directly from ulcerative lesions)
Treatment algorithm
Contributors
Authors VIEW ALL
Professor and Chair
Department of Pediatrics
University of Connecticut School of Medicine
Hartford
CT
Disclosures
JCS is the author of references cited in this monograph.
Assistant Professor of Pediatrics
Adjunct Assistant Professor of Pharmacy
Department of Pediatrics
University of Connecticut School of Medicine
Hartford
CT
Disclosures
NB declares that he has no competing interests.
Research Associate
CIDEIM
Cali
Columbia
Disclosures
AC declares that she has no conflicting interests.
Dr Juan C. Salazar, Dr Nicholas Bennett, and Dr Adriana Cruz would like to gratefully acknowledge Patrick French and Nooshin Barmania, previous contributors to this monograph. PF is an author of a reference cited in this monograph. NB declares that she has no competing interests.
Peer reviewers VIEW ALL
Associate Professor of Medicine
University of Southern California
Keck School of Medicine
Los Angeles
CA
Disclosures
RAL declares that he has no competing interests.
Assistant Professor of Medicine
Harvard Medical School
Director of Research
Global Health Delivery Project
Harvard School of Public Health
Boston
MA
Disclosures
WR declares that he has no competing interests.
Consultant Paediatrician
Croydon University Hospital
Croydon
UK
Disclosures
JH declares that she has no competing interests.
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