What are the symptoms of herpes and syphilis?

Clinical Appearance of Herpes and Syphilis

Herpes and syphilis present with distinctive lesions that require prompt recognition for proper diagnosis and treatment to prevent serious complications and transmission.

Herpes Simplex Virus (HSV) Appearance

Clinical Presentation

• Primary infection:
  • More severe and prolonged than recurrent episodes 1
  • Begins with localized erythema (redness)
  • Progresses to papules, then vesicles (fluid-filled blisters)
  • Vesicles rupture forming ulcers, then crusts
  • Heals without scarring 1
  • Often accompanied by systemic symptoms (fever, malaise)

Genital Herpes Characteristics

• Location: External genitals, perineum, buttocks, thighs 1
• Appearance:
  • Vesicular lesions that rupture to form painful ulcers
  • Classically begins with a patch of redness followed by papules then vesicles 2
  • Vesicles contain clear fluid with thousands of infectious viral particles 2
  • After rupture, shallow ulcers or erosions form that eventually crust and heal 2
• Associated symptoms:
  • Dysuria (painful urination)
  • Vaginal or urethral discharge
  • Inguinal lymphadenopathy (swollen lymph nodes) 1
• Duration: Episodes usually last less than 10 days if untreated 2

Oral Herpes Characteristics

• Location: Lips, mouth, or chin 1
• Appearance:
  • Vesicles and ulcers on affected areas
  • Classic "cold sore" presentation
• Prodrome: Tingling, itching, burning sensation before visible lesions 3, 4
• Duration: 7-10 days without treatment 1

Recurrent Episodes

• Less severe than primary infection
• Preceded by prodromal symptoms (tingling, itching, burning, pain) 3, 4
• Recurs 1-12 times per year, often triggered by sunlight or stress 1
• HSV-1 recurs less frequently than HSV-2 in genital area 1

Syphilis Appearance

Primary Syphilis

• Chancre (hallmark lesion):
  • Single, painless ulcer at site of infection 2
  • Clean base with indurated (hard) edges
  • Appears 2-3 weeks after infection
  • Most commonly on genitals but can appear anywhere infection occurred
  • Heals spontaneously within 3-6 weeks even without treatment 5
• Lymphadenopathy: Regional lymph nodes become firm, non-tender, and enlarged 2

Secondary Syphilis

• Occurs 4-10 weeks after primary infection
• Rash: Polymorphic (many forms), non-itchy, often involves palms and soles 2
• Mucocutaneous lesions: Flat, broad-based, moist lesions (condyloma lata) in warm, moist areas 2
• Generalized lymphadenopathy
• Systemic symptoms: Fever, malaise, headache, sore throat 5

Latent Syphilis

• No visible symptoms
• Diagnosed only through serologic testing 2

Tertiary Syphilis

• Gummas: Rubbery, painless nodules that can ulcerate
• Cardiovascular manifestations: Aortic aneurysm, aortic regurgitation
• Neurologic manifestations: Tabes dorsalis, general paresis 2

Key Diagnostic Differences

Appearance

• Herpes: Painful, grouped vesicles that rupture to form ulcers
• Syphilis: Painless, indurated ulcer (chancre) in primary stage; widespread rash in secondary stage

Pain

• Herpes: Typically painful lesions
• Syphilis: Typically painless lesions

Number of Lesions

• Herpes: Multiple grouped vesicles
• Primary Syphilis: Usually single chancre

Duration

• Herpes: Episodes last about 7-10 days
• Syphilis Chancre: Persists 3-6 weeks then resolves spontaneously

Important Clinical Considerations

1. Co-infection is possible: Patients may have both herpes and syphilis simultaneously 6

2. Laboratory confirmation is essential:

   • For herpes: PCR from vesicle fluid is most sensitive; viral culture is an alternative 1
   • For syphilis: Darkfield microscopy of lesion exudate and serologic testing (both nontreponemal and treponemal tests) 2

3. Treatment differences:

   • Herpes: Antiviral medications (acyclovir, valacyclovir, famciclovir) 3, 4
   • Syphilis: Penicillin remains the treatment of choice 5

4. Complications:

   • Herpes: Neonatal herpes, increased HIV acquisition risk, superinfection 1
   • Syphilis: Cardiovascular, neurologic, and multiorgan damage if untreated 2

Remember that clinical diagnosis alone is insufficient for both conditions, and laboratory confirmation should always be sought to ensure proper treatment and prevent complications.