Overview

Treponema pallidum, the bacteria that cause syphilis. Note the spiral shape of the organism. Credit: NIAID

Presentation

Primary syphilitic chancre

it typically presents as a crusted superficial erosion that becomes a round or oval, indurated, slightly elevated papule, with an eroded, but not ulcerated surface that exudes a serous fluid. The lesion is usually painless. The regional lymph nodes on one or both sides are usually enlarged, firm, nontender and do not suppurate.

Initial diagnostic test: Darkfield, VDRL/RPR

Secondary features - occurs 6-10 weeks after primary infection

• systemic symptoms: fevers, lymphadenopathy
• rash on trunk, palms and soles
• buccal 'snail track' ulcers (30%)
• condylomata lata (painless, warty lesions on the genitalia )

Initial diagnostic test: VDRL/RPR and FTA

Condyloma Lata

Tertiary Syphilis

Neurological involvement: Tabes dorsalis, Argyll-Robertson pupil, general paresis, rarely a gumma or aortitis and ascending aortic aneurysms

Initial diagnostic test: VDRL/RPR and FTA, LP for neurosyphilis (test CSF with VDRL and FTA, although CSF VDRL is only 50% sensitive)