Syphilis Clinical Presentation and Management

Comprehensive vocabulary and clinical parameters for syphilis stages, diagnostic tests, treatment protocols, and follow-up procedures.

Primary syphilis (Chancre characteristics)

A lesion that is often (but not always) painless, has well-defined margins, and an indurated base.

Primary syphilis (Incubation period)

$10-90$ days, with an average of $3$ weeks.

Primary syphilis (Lymphadenopathy)

Enlarged, rubbery, and non-tender inguinal lymph nodes.

Condylomata lata

Warty growths in the anogenital area associated with secondary syphilis.

Secondary syphilis (Incubation period)

$2-24$ weeks, with an average of $6$ weeks.

Early latent syphilis

Defined as being infected for less than ($<$) $2$ years; characterized by positive serology and nil signs and symptoms.

Late syphilis (Infectiousness)

After $2$ years (late latent), patients are considered no longer infectious.

Tertiary syphilis (Presentation)

Complications such as gummas (skin lesions), cardiovascular disease, or neurological disease that may develop months or years later in $1/3$ of untreated cases.

EIA

Enzyme immunoassay.

TPPA

T pallidum particle agglutination assay.

TPHA

T pallidum hemagglutination assay.

RPR

Rapid plasma reagin.

Re-infection (RPR indication)

A $4$-fold ($2$-dilution) increase in RPR titre.

Early syphilis treatment

$2$ injections of Bicillin L-A (benzathine benzylpenicillin tetrahydrate) IMI, with each injection being $1.2$ million units/$2.3\text{mL}$ as a single dose.

Late syphilis treatment

$2$ injections of Bicillin L-A (benzathine benzylpenicillin tetrahydrate) IMI, with each injection being $1.2$ million units/$2.3\text{mL}$ given once weekly for $3$ weeks on days $1, 8,$ and $15$.

Jarisch-Herxheimer reaction

A common reaction occurring $6-12$ hours post-treatment in primary or secondary syphilis involving fever, headache, malaise, rigors, and joint pain.

Syphilis transmission risk

Greater than ($>$) $20\%$ per act of unprotected sexual intercourse (UPSI).

Contact Tracing: Primary syphilis

$3$ months plus the duration of symptoms.

Contact Tracing: Secondary syphilis

$6$ months plus the duration of symptoms.

Contact Tracing: Early latent syphilis

$12$ months.

Empirical treatment for contacts

Recommended because syphilis serology can take up to $90$ days to seroconvert after infection.

Cure for infectious syphilis (Test of Cure)

Defined by a consistent $4$-fold ($2$ dilutions) drop in RPR (e.g., from $1:32$ to $1:8$).

Follow-up serology (Infectious syphilis)

Repeat serology at $3, 6,$ and $12$ months.