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.