Syphilis - Revision history

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Ostermayer: /* Evaluation */

2025-09-12T12:46:41Z

Evaluation

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 *All newly diagnosed [[HIV]] patients should be tested for syphilis and vice versa
 *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture
 ==Management==

Rossdonaldson1: /* Background */

2024-12-11T19:05:22Z

Background

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	==Background==		==Background==
			[[File:Treponema pallidum Bacteria (Syphilis).jpg\|thumb\|Treponema pallidum bacteria on electron micrograph (colorized).]]
	*Syphilis is caused by the spirochete ''Treponema pallidum''. <ref>Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.</ref>		*Syphilis is caused by the spirochete ''Treponema pallidum''. <ref>Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.</ref>
	*Usually sexually transmitted		*Usually sexually transmitted

Rossdonaldson1: /* Jarisch-Herxheimer Reaction */

2024-12-11T19:02:29Z

Jarisch-Herxheimer Reaction

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	===[[Jarisch-Herxheimer Reaction]]===		===[[Jarisch-Herxheimer Reaction]]===
			[[File:Jarisch-Herxheimer reaction in patient (cropped).jpg\|thumb\|[[Jarisch-Herxheimer]] reaction in a person with syphilis.]]
	*Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension		*Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension
	*Usually resolves within 12-24 hours		*Usually resolves within 12-24 hours

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2024-12-09T21:32:25Z

corrected misspelling

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	'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>		'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>

	''~~VDLR~~ and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis. Both are only 70-80% sensitive.''		''VDRL and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis. Both are only 70-80% sensitive.''
	Rapid Plamsa Reagin (RPR)		Rapid Plamsa Reagin (RPR)
	**Faster and easier to perform		**Faster and easier to perform

Ostermayer: /* Latent Syphilis */

2023-12-04T20:41:11Z

Latent Syphilis

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	*Less common complications include: [[hepatitis]], nephropathy, [[gastritis]], [[proctitis]], rectosigmoid mass, [[arthritis]], periositis, [[optic neuritis]], [[iritis]], [[uveitis]], pupillary abnormalities		*Less common complications include: [[hepatitis]], nephropathy, [[gastritis]], [[proctitis]], rectosigmoid mass, [[arthritis]], periositis, [[optic neuritis]], [[iritis]], [[uveitis]], pupillary abnormalities
	===Latent Syphilis===		===Latent Syphilis===
	*Detectable by serologic testing only		*Detectable by serologic testing only (FTA-ABS and TP-PA)
	*May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation		*May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation
	*Spontaneous cure is rare		*Spontaneous cure is rare
			*Non-treponemal tests may be negative in 30% of latent cases. Therefore in suspected cases a TP-PA test is used in addition to CSF (CSF-VRDL and FTA-ABS)sampling for neurosyphilis diagnosis.<ref>The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol. 2005 Jan-Feb; 16(1): 45–51. PMID: 18159528</ref>

	===Tertiary Syphilis===		===Tertiary Syphilis===
	*Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations		*Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations

Cmb23: /* Evaluation */

2023-10-28T16:58:35Z

Evaluation

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	'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>		'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>

	''VDLR and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis''		''VDLR and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis. Both are only 70-80% sensitive.''
	Rapid Plamsa Reagin (RPR)		Rapid Plamsa Reagin (RPR)
	**Faster and easier to perform		**Faster and easier to perform

Elcatracho: /* Background */

2022-01-12T02:51:05Z

Background

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	==Background==		==Background==
	*Syphilis is caused by the spirochete Treponema pallidum. <ref>Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.</ref>		*Syphilis is caused by the spirochete ''Treponema pallidum''. <ref>Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.</ref>
	*Usually sexually transmitted		*Usually sexually transmitted
	*Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency		*Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency

Elcatracho: /* Evaluation */

2021-02-10T22:27:19Z

Evaluation

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	==Evaluation==		==Evaluation==
	'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>		'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>

	''VDLR and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis''		''VDLR and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis''
	Rapid Plamsa Reagin (RPR)		Rapid Plamsa Reagin (RPR)

Elcatracho: /* Evaluation */

2021-02-10T22:26:59Z

Evaluation

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	==Evaluation==		==Evaluation==
	'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>		'''Nontreponemal Tests:'''<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>
			''VDLR and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis''
	Rapid Plamsa Reagin (RPR)		Rapid Plamsa Reagin (RPR)
	**Faster and easier to perform		**Faster and easier to perform

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	===System Specific===		===System Specific===
	~~'''~~CNS~~'''~~		CNS
	*CSF-VDRL preferred test<ref>Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis. 2012 Jun;39(6):453-7.</ref>		*CSF-VDRL preferred test<ref>Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis. 2012 Jun;39(6):453-7.</ref>
	*Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits		*Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits
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	**Patients with early syphilis who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV		**Patients with early syphilis who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV
	*'''Meningeal:''' [[Headache]], [[nausea/vomiting]], neck stiffness, [[cranial nerve palsies\|cranial nerve involvement]], [[seizures]], [[AMS\|changes in mental status]], [[uveitis]], [[iritis]] or [[hearing loss]]		*'''Meningeal:''' [[Headache]], [[nausea/vomiting]], neck stiffness, [[cranial nerve palsies\|cranial nerve involvement]], [[seizures]], [[AMS\|changes in mental status]], [[uveitis]], [[iritis]] or [[hearing loss]]
	*~~'''~~Meningovascular:~~'''~~ [[Meningitis]] together with inflammatory [[vasculitis]] leading to [[stroke]] syndrome		*Meningovascular: [[Meningitis]] together with inflammatory [[vasculitis]] leading to [[stroke]] syndrome
	**Subacute encephalitic prodrome of [[headaches]], [[vertigo]], [[insomnia]], and psychological abnormalities		**Subacute encephalitic prodrome of [[headaches]], [[vertigo]], [[insomnia]], and psychological abnormalities
	*~~'''~~Parenchymal:~~'''~~ [[weakness\|Paresis]], hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/[[hallucinations]], memory defects, [[dysarthria\|speech changes]].		*Parenchymal: [[weakness\|Paresis]], hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/[[hallucinations]], memory defects, [[dysarthria\|speech changes]].
	**Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light		**Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light
	**Tabes dorsalis presents with a wide based gait [[ataxia]], foot drop, [[paresthesias]], bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations• Cardiovascular		**Tabes dorsalis presents with a wide based gait [[ataxia]], foot drop, [[paresthesias]], bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations• Cardiovascular

	~~'''~~Cardiovascular~~'''~~		Cardiovascular
	*10-40 years after infection		*10-40 years after infection
	*Endarteritis obliterans of the vasa vasorum leads		*Endarteritis obliterans of the vasa vasorum leads
	*Aortitis, [[aortic regurgitation]], saccular aneurysm (usually ascending), coronary ostial stenosis		*Aortitis, [[aortic regurgitation]], saccular aneurysm (usually ascending), coronary ostial stenosis

	~~'''~~Gumma~~'''~~		Gumma
	*Commonly involves skin and skeletal system		*Commonly involves skin and skeletal system
	*Solitary lesions ranging from microscopic to several centimeters		*Solitary lesions ranging from microscopic to several centimeters
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	*Painless, indurate nodular or ulcerative lesions		*Painless, indurate nodular or ulcerative lesions

	~~'''~~Congenital Syphilis~~'''~~		Congenital Syphilis
	*Transmission across the placenta may occur at any stage of pregnancy<ref>Rosenberg AA, Grover T. The Newborn Infant. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e.New York, NY: McGraw-Hill; 2013.</ref>		*Transmission across the placenta may occur at any stage of pregnancy<ref>Rosenberg AA, Grover T. The Newborn Infant. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e.New York, NY: McGraw-Hill; 2013.</ref>
	*Treatment before the 16th week of pregnancy should prevent fetal damage		*Treatment before the 16th week of pregnancy should prevent fetal damage
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	==Evaluation==		==Evaluation==
	~~'''~~Nontreponemal Tests:~~'''~~<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>		Nontreponemal Tests:<ref name="test">Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.</ref>

	''VDRL and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis. Both are only 70-80% sensitive.''		''VDRL and RPR may be falsely negative for up to four weeks after the appearance of a chancre and cannot reliably rule out primary syphilis. Both are only 70-80% sensitive.''
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	*Toludine Red Unheated Serum Test (TRUST)		*Toludine Red Unheated Serum Test (TRUST)

	~~'''~~Most commonly in the ED, the VDRL and RPR will be the ordered screening test~~'''~~		Most commonly in the ED, the VDRL and RPR will be the ordered screening test

	~~'''~~Treponemal Test:~~'''~~<ref name="test"></ref>		Treponemal Test:<ref name="test"></ref>
	*Fluorescent treponemal antibody absorption (FTA-ABS)		*Fluorescent treponemal antibody absorption (FTA-ABS)
	*Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)		*Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)
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	*Treponema pallidum enzyme immunoassay (TP-EIA)		*Treponema pallidum enzyme immunoassay (TP-EIA)

	~~'''~~[[LP\|CSF]]~~'''~~		[[LP\|CSF]]
	*Pleocytosis (>5 WBC/uL), increased protein (>45mg/dL) or VDRL reactivity		*Pleocytosis (>5 WBC/uL), increased protein (>45mg/dL) or VDRL reactivity
	*May be confounded by [[HIV]] infection<ref>Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.</ref>		*May be confounded by [[HIV]] infection<ref>Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.</ref>
	*CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary.		*CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary.

	~~'''~~HIV-infected patients~~'''~~		HIV-infected patients
	*All newly diagnosed [[HIV]] patients should be tested for syphilis and vice versa		*All newly diagnosed [[HIV]] patients should be tested for syphilis and vice versa
	*RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture		*RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture
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	Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease<ref>Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the [[HIV]] Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207</ref>		Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease<ref>Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the [[HIV]] Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207</ref>

	~~'''~~Treat those exposed within the past 3 months.~~'''~~		Treat those exposed within the past 3 months.

	===Early Stage===		===Early Stage===