Syphilis

Last Updated: 2021-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: 1A6Z

Leonicenus, 1497

Lues, lues venerea, hard chancre, French disease, Schaudinn's disease.

  • Sexually transmitted disease caused by treponema pallidum. The infection can occur through sexual intercourse (syphilis acquisita) or through the birth process (syphilis connata).

Transmission occurs through smear infection, especially during sexual intercourse.

  • Stage I (early syphilis)
    • Incubation period: 2-3 weeks
    • Primary effect: Erythematous, indolent papule or ulcer (ulcus durum) in the area of the infection site
    • Indolent, bilateral lymphadenopathy (bubo)
    • Primary effect + bubo = primary complex
    • CAVE: in some cases, primary effect may also occur extragenitally, e.g. during oral sexual intercourse
  • Syphilis II (stage of generalised spirochetosis)
    • Approximately 25% of sufferers progress to stage II after 7-8 weeks after initial infection
    • ↓ general condition, fever, generalised lymphadenopathy, fatigue, arthralgias, myalgias
    • Maculopapular exanthema (roseolae) also with palmoplantar involvement
      • These exanthems are infectious!
      • Healing with de- or hyperpigmentation is possible
    • Lues maligna: Ulceration may occur with immunosuppression
    • Papular syphilid: erythematous, dermal, sometimes painful, symmetrical papules
    • Psoriasiform syphilid: arises from the papular syphilid, is often localised at the hairline. Characterised by scaling
    • Pustular syphilid: in the area of the papules, there is additional formation of pustules
    • Plaques muqueuses: Plaques in the area of the mucous membrane, especially on the hard and soft palate, erythematous macules appear
    • Plaques opalines: Formation of inflammatory, oedematous plaques in the area of the oral mucosa
    • Angina specifica: inflammatory induration of the tonsils with consequent dysphagia and difficulty swallowing
    • Hair loss (alopecia syphilitica): patchy, moth-eaten alopecia
    • Infestation of internal organs is possible: e.g. eye, kidney, liver
    • Recurrences (exanthema) are possible over 2-3 years. Without therapy, healing at approx. 60%
  • Stage III (late syphillis)
    • 2-5 years after infection
    • Development of granulomatous abscesses (gummata)
    • Asymmetrical arrangement
    • Low infectivity
    • Skin: Erythematous, partly brownish nodules.
    • Gums: Painful nodules, so-called gummata, which may also perforate. These can occur subcutaneously, on the muscles, bones, eyes, heart, liver, lungs, spleen and GI tract
    • Neurosyphilis
      • Tabes doralis: demyelination of the hindbrain with disturbance of the sense of movement as well as the sense of vibration
      • Paralysis progressiva: cephalgia, dementia, depression, personality changes

  • Anamnesis
  • Clinical picture
  • In stage I: collection of irritant secretions and dark-field microscopic search for spirochetes
  • PCR very sensitive, can replace dark-field microscopy
  • Laboratory
    • Screening tests:
      • TPHA serology
      • VDRL test
  • If negative and clinical suspicion continues, repeat serology after 3-6 months
  • Confirmatory reaction:
    • FTA test
    • FTA Abs test
  • Biopsy

  1. Rockwell DH. The Tuskegee Study of Untreated Syphilis. Arch Intern Med 1964;114:792.
  2. Posp, iacute, scaron, il L, Kratochvil F. Vor- und Nachteile des Peroxidase-Tests mit <i>Treponema pallidu</i><i>m</i> in der Serodiagnostik von Syphilis im Vergleich mit dem FTA-ABS-Test. Dermatology 1974;149:78-83.
  3. Crissey JT, Denenholz DA. Clinical picture of infectious syphilis. Clinics in Dermatology 1984;2:39-61.
  4. Prange HW. Diagnostische Maßnahmen und Kriterien der Neurosyphilis. DMW - Deutsche Medizinische Wochenschrift 1986;111:625-7.
  5. Marra C. Syphilis and Human Immunodeficiency Virus Infection. Seminars in Neurology 1992;12:43-50.
  6. van Voorst Vader PC. SYPHILIS MANAGEMENT AND TREATMENT. Dermatologic Clinics 1998;16:699-711.
  7. Brockmeyer NH. Syphilis.  Diagnostik und Therapie sexuell übertragbarer Krankheiten: Springer Science + Business Media; 2001:101-11.
  8. Goh BT, van Voorst Vader PC. European guideline for the management of syphilis. International Journal of STD & AIDS 2001;12:14-26.
  9. Augenbraun Michael H. Treatment of Syphilis 2001: Nonpregnant Adults. Clinical Infectious Diseases 2002;35:S187-S90.
  10. Doherty L. Syphilis: old problem, new strategy. BMJ 2002;325:153-6.
  11. Aquilina C, Viraben R, Denis P. Secondary syphilis simulating oral hairy leukoplakia. Journal of the American Academy of Dermatology 2003;49:749-51.
  12. Golden MR, Marra CM, Holmes KK. Update on Syphilis. JAMA 2003;290:1510.
  13. Calvo A M. Azitromicina, dosis única, en fases tempranas de sífilis. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. Riedner G, Rusizoka M, Todd J, Maboko L, Hoelscher M, Mmbando D, et al. N Engl J Med 2005; 353 (12): 1236-44. Rev chil infectol 2005;22.
  14. Potthoff A, Brockmeyer NH. Syphilis und HIV-Infektion. Hautarzt 2005;56:133-40.
  15. Cullen PA, Cameron CE. Progress towards an effective syphilis vaccine: the past, present and future. Expert Review of Vaccines 2006;5:67-80.
  16. Lautenschlager S. Cutaneous Manifestations of Syphilis. American Journal of Clinical Dermatology 2006;7:291-304.
  17. Symptomatic Early Neurosyphilis Among HIV-Positive Men Who Have Sex With Men—Four Cities, United States, January 2002–June 2004. JAMA 2007;298:732.
  18. Peterman TA, Furness BW. The resurgence of syphilis among men who have sex with men. Current Opinion in Infectious Diseases 2007;20:54-9.
  19. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H. IUSTI: 2008 European Guidelines on the Management of Syphilis. International Journal of STD & AIDS 2009;20:300-9.
  20. Marra CM. Update on neurosyphilis. Current Infectious Disease Reports 2009;11:127-34.
  21. Lee JY, Wu MC, Hsu CK, Chao SC, Ko WC, Sheu HM. Erythema Multiforme-Like Secondary Syphilis in a HIV-positive Bisexual Man. Acta Dermato Venereologica 2010;90:647-8.
  22. Seña Arlene C, White Becky L, Sparling PF. Novel Treponema pallidum Serologic Tests: A Paradigm Shift in Syphilis Screening for the 21st Century. Clinical Infectious Diseases 2010;51:700-8.
  23. Braun-Falco`s Dermatologie, Venerologie und Allergologie, 7. Auflage