Your Path

  • Syphilis


  • T pallidum (Spirochete)

Risk Factors

  • Ivdu
  • Drug/etoh abuse
  • Hx other sti's
  • Men who have sex w/men
  • Unprotected intercourse
  • Sex w/prostitutes
  • Sex w/somone known hiv +
  • Transfusion w/unscreened blood


  • Primary causes painless ulcer at site of entry (genital, peri-rectal or oral) ~3w (range 2-6w) following exposure - though can go unrecognized
  • Secondary occurs weeks-to-2 months later w/rash on soles/palms, condyloma in genital/rectal area, peri-rectal pain or d/c, generalized adenopathy, fever, sweats, alopecia, mucosal patches; hepatitis, nehpritis (lab findings)
  • Early latent: within 1y of acquiring, no symptoms or findings; + serological evidence dz
  • Late latent: > 1y after acquiring, no symptoms or findings; + serological evidence dz; can remain in late latent phase for life (i.e. doesn't have to become tertiary)
  • Tertiary: years later, w/aortitis/aneurysms, granuloma development in skin, bones, ocular, otic, other organs
  • Neurosyphilis: can occur at any stage; assoc w/CNS related numbness, weakness, balance problems/ataxia, dementia, eye symptoms (red eye, pain, decreased vision)

Physical Exam Findings

  • Primary: painless genital, peri-rectal or oral ulcer, sometimes w/regional adnenopathy
  • Secondary: generalized non-puritic rash (can be macules and papules), w/predilection for palms, and soles, generalized adenopathy, Fever, sweats; condyloma lata--> frond-like growth in genital area
  • Tertiary (late): aortic regurgitation; organomegaly, skin/bone involvement w/gummas
  • Neurosyphilis: numbness, weakness, balance issues/ataxic gait, incontinence, confusion/dementia; decreased vision, painful red eye, anterior or posterior uveitis