What are the symptoms associated with syphilis?

Symptoms Associated with Syphilis

Syphilis presents with a wide spectrum of symptoms that vary by stage, including painless chancres in primary syphilis, widespread rash involving palms and soles in secondary syphilis, asymptomatic periods during latent syphilis, and potentially severe cardiovascular and neurological complications in tertiary syphilis. 1

Primary Syphilis

• Painless, indurated ulcer (chancre) at the site of infection 1, 2
• Typically appears 3-6 weeks after exposure
• Regional lymphadenopathy - usually non-tender, firm enlargement of nearby lymph nodes 2
• Chancres spontaneously heal within 3-6 weeks even without treatment 2

Secondary Syphilis (2-8 weeks after primary infection)

• Skin manifestations:

  • Macular, maculopapular, papulosquamous, or pustular rash 1
  • Characteristically involves palms and soles 3
  • Non-pruritic and typically begins on trunk and spreads peripherally 1
  • Condyloma lata in moist genital or intertriginous areas 3, 1

• Constitutional symptoms:

  • Fever
  • Malaise
  • Anorexia
  • Arthralgias
  • Headache 3, 1

• Generalized lymphadenopathy 3, 1, 2

• Other manifestations:

  • Mucous patches in oral cavity (specific angina) 2
  • Ocular involvement (uveitis, iritis, chorioretinitis) 1
  • Hepatitis with jaundice 1
  • Renal involvement with nephrotic syndrome 1
  • Acute syphilitic meningitis (may resemble acute HIV infection) 3, 1

Latent Syphilis

• Asymptomatic period 3, 2
• Positive serologic tests without clinical manifestations 3
• May experience relapses of secondary symptoms, most commonly in first 1-4 years 3, 1
• Divided into early (<1 year) and late (>1 year) latent stages for epidemiologic purposes 4

Tertiary/Late Syphilis (occurs in approximately 25% of untreated cases)

• Gummatous lesions: granulomatous inflammatory lesions that can affect any organ system 3, 2

  • Superficial nodular syphilids and gummas in the skin 2
  • Can involve bones and other tissues 2

• Cardiovascular syphilis:

  • Syphilitic aortitis
  • Aortic aneurysm
  • Aortic regurgitation
  • Coronary artery involvement 5
  • Increased risk of acute myocardial infarction, heart failure, and atrial fibrillation 5

• Neurosyphilis:

  • Can occur at any stage but more common in tertiary syphilis 3, 1
  • Asymptomatic neurosyphilis: CSF abnormalities without symptoms 3
  • Symptomatic neurosyphilis: meningitis, meningovascular disease, or parenchymatous disease 3
  • Late manifestations include tabes dorsalis and progressive paralysis 2
  • Increased risk of ischemic and hemorrhagic stroke 5

Congenital Syphilis

• Early manifestations (in infants <2 years):

  • Hepatosplenomegaly
  • Rash
  • Condyloma lata
  • Snuffles (rhinitis)
  • Jaundice (non-viral hepatitis)
  • Pseudoparalysis
  • Anemia
  • Edema 3

• Late manifestations (stigmata in older children):

  • Interstitial keratitis
  • Nerve deafness
  • Anterior bowing of shins
  • Frontal bossing
  • Mulberry molars
  • Hutchinson teeth
  • Saddle nose
  • Rhagades
  • Clutton joints 3

Special Considerations in HIV Co-infection

• Clinical manifestations may be similar to those in HIV-uninfected persons, especially in early stages 3
• May present with more apparent clinical lesions and accelerated disease progression 1
• Higher likelihood of concomitant uveitis and meningitis 3, 1
• Neurologic complications may progress more rapidly or occur earlier in the disease course 3

Clinical Pitfalls and Caveats

• Secondary syphilis can mimic many other conditions due to its protean manifestations 3, 2
• Acute syphilitic meningitis must be distinguished from acute primary HIV infection 3
• Symptoms of secondary syphilis may persist from days to weeks before spontaneously resolving 3, 1
• Without treatment, syphilis can persist for decades with periods of activity and latency 2, 6
• Serologic tests may be atypical (higher, lower, or delayed) in HIV-infected patients 3

Understanding these varied clinical manifestations is crucial for early diagnosis and treatment, as untreated syphilis can lead to significant morbidity and mortality across multiple organ systems.