🦠 Syphilis Staging & Penicillin Treatment Simulator

Primary Syphilis — The Chancre

Placeholder: firm painless ulcer marks initial Treponema pallidum inoculation.

• ~21 days: Incubation (Placeholder range 10–90 days)
• 3–6 wks: Chancre duration (Placeholder self-healing)
• ~78%: RPR sensitivity (Placeholder early stage)
• 2.4 MU IM: Treatment (Placeholder single dose)

Chancre presentation

Placeholder: painless indurated ulcer at exposure site, often unnoticed.

Diagnosis

Placeholder: darkfield microscopy or PCR of lesion exudate confirms infection.

Placeholder: treat presumptively if chancre plus exposure history.

Secondary Syphilis — Disseminated Rash

Placeholder: hematogenous spread produces widespread mucocutaneous rash.

• 4–10 wks: Onset (Placeholder after chancre)
• ~50–80%: Palm/sole rash (Placeholder classic finding)
• ~100%: RPR sensitivity (Placeholder peak titers)
• 2.4 MU IM: Treatment (Placeholder single dose)

Clinical features

Placeholder: maculopapular rash, condyloma lata, lymphadenopathy, fever.

Serology peak

Placeholder: RPR/VDRL titers typically highest during this stage.

Placeholder: highly infectious stage — counsel on transmission risk.

Early Latent Syphilis

Placeholder: seroreactive but asymptomatic, infection acquired under one year ago.

• <1 year: Duration (Placeholder since infection)
• None: Symptoms (Placeholder asymptomatic)
• Possible relapse: Infectiousness (Placeholder mucocutaneous)
• 2.4 MU IM: Treatment (Placeholder single dose)

Definition

Placeholder: documented seroconversion or exposure within the past year.

Management

Placeholder: treated same as primary/secondary with single injection.

Placeholder: partner notification and testing recommended.

Late Latent Syphilis

Placeholder: asymptomatic infection of unknown or over one year duration.

• >1 year: Duration (Placeholder or unknown)
• None: Symptoms (Placeholder asymptomatic)
• Low: Relapse risk (Placeholder vs early latent)
• 2.4 MU IM ×3: Treatment (Placeholder weekly doses)

Definition

Placeholder: no reliable timeline for infection onset established.

Extended regimen

Placeholder: three weekly injections needed for cure.

Placeholder: rule out neurosyphilis if neurologic signs present.

Tertiary Syphilis — Gummas, Neuro & Cardiovascular Disease

Placeholder: late-stage destructive disease years to decades after infection.

• 1–30 yrs: Onset (Placeholder post-infection)
• Skin/bone/organ: Gummas (Placeholder granulomas)
• CNS invasion: Neurosyphilis (Placeholder tabes, paresis)
• IV PCN if neuro: Treatment (Placeholder 10–14 days)

Cardiovascular disease

Placeholder: aortitis and aneurysm from vasa vasorum destruction.

Neurosyphilis

Placeholder: tabes dorsalis, general paresis, argyll robertson pupils.

Placeholder: requires aqueous IV penicillin, not IM benzathine.