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Syphilis infection

Última revisão: 11 Aug 2025
Última atualização: 10 Dec 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • anogenital 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 changes
  • Argyll-Robertson pupils
  • loss of sense of vibration, proprioception, and position sense
  • ataxia
  • loss of anal and bladder sphincter control
  • positive Romberg sign
  • diastolic murmur
  • rubbery lesions/nodules with a necrotic center
  • miscarriage, stillbirth, or neonatal death (congenital syphilis)
  • premature labor and intrauterine growth retardation (congenital syphilis)
  • neonatal skin rash (congenital syphilis)
  • tibial bowing (congenital syphilis)
  • craniofacial malformation (congenital syphilis)
  • tooth abnormalities (congenital syphilis)
  • necrotizing funisitis (congenital syphilis)
Detalhes completos

Outros fatores diagnósticos

  • mouth ulcer
  • asymptomatic with positive serology (latent syphilis)
  • tremor
  • headache
  • meningismus
  • eye pain
  • hearing loss
  • seizures
  • peripheral edema
  • jaundice
  • peripheral neuropathy
  • areflexia
  • angina
  • dyspnea
  • organomegaly
  • skin or visceral organ perforation or collapse of structure
  • neonatal neurologic abnormalities (congenital syphilis)
Detalhes completos

Fatores de risco

  • sexual contact with an infected person
  • men who have sex with men (MSM)
  • illicit drug use
  • commercial sex workers
  • multiple sexual partners
  • people with HIV or other STIs
  • syphilis during pregnancy (risk for congenital syphilis)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • dark-field microscopy of swab from lesion
  • serum treponemal enzyme immunoassay (EIA)
  • serum Treponema pallidum particle agglutination (TPPA)
  • serum Treponema pallidum hemagglutination (TPHA)
  • serum fluorescent treponemal antibody absorption (FTA-ABS) test
  • immunocapture assay
  • line immunoassay (LIA) serologic test
  • serum rapid plasma reagin (RPR) test
  • serum Venereal Disease Research Laboratory (VDRL) test
Detalhes completos

Investigações a serem consideradas

  • lumbar puncture, cerebrospinal fluid (CSF) analysis
  • chest x-ray
  • echocardiogram
  • computed tomography brain
  • magnetic resonance imaging brain
  • HIV test
  • fetal ultrasound scan
  • complete blood count
  • long-bone x-rays
  • liver enzymes (aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase) and bilirubin
  • auditory brainstem response
  • audiometry
  • fetal skeletal survey
Detalhes completos

Novos exames

  • Treponema pallidum polymerase chain reaction (PCR) (sample taken directly from ulcerative lesions)
  • point of care (POC) testing with either treponemal or combination treponemal/nontreponemal antibody

Algoritmo de tratamento

Inicial

adults with suspected early infection or sexual contacts of patients with confirmed infection

AGUDA

adults without neurosyphilis

adults with neurosyphilis

congenital syphilis

Colaboradores

Autores

Juan C. Salazar, MD, MPH, FAAP

Professor and Chair

Department of Pediatrics

University of Connecticut School of Medicine

Physician in Chief

Connecticut Children’s

Hartford

CT

Declarações

JCS is the author of references cited in this topic.

Agradecimentos

Dr Juan C. Salazar would like to gratefully acknowledge Adriana R. Cruz, Jairo M. Montezuma-Rusca, Nicholas Bennett, Patrick French, and Nooshin Barmania, previous contributors to this topic. We would also like to acknowledge our infectious diseases expert panel member, Dr Elisabeth Adderson, for her contribution to this topic.

Declarações

PF is an author of a reference cited in this topic. EA, ARC, JMMR, NB, and NB declare that they have no competing interests.

Revisores

Robert A. Larsen, MD

Associate Professor of Medicine

University of Southern California

Keck School of Medicine

Los Angeles

CA

Declarações

RAL declares that he has no competing interests.

William Rodriguez, MD

Assistant Professor of Medicine

Harvard Medical School

Director of Research

Global Health Delivery Project

Harvard School of Public Health

Boston

MA

Declarações

WR declares that he has no competing interests.

Jennifer Handforth, MB ChB, MRCPCH, DTM&H

Consultant Paediatrician

Croydon University Hospital

Croydon

UK

Declarações

JH declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sex Health. 2015 Apr;12(2):103-9.Texto completo  Resumo

British Association for Sexual Health and HIV (BASHH). UK national guidelines on the management of syphilis. December 2015 [internet publication].Texto completo

World Health Organization. Guidelines for the treatment of Treponema pallidum (syphilis). 2016 [internet publication].Texto completo

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Texto completo  Resumo

World Health Organization. WHO guideline on syphilis screening and treatment for pregnant women. 2017 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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  • Diagnósticos diferenciais

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    • Chancroid
    • Primary HIV infection
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  • Diretrizes

    • Reducing sexually transmitted infections
    • UK national guideline on the management of sexually transmitted infections and related conditions in children and young people
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Syphilis: what is it?

    Syphilis: how is it diagnosed and treated?

    Mais Folhetos informativos para os pacientes
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Venepuncture and phlebotomy: animated demonstration

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