Pathogenesis, clinical manifestations, and treatment of early syphilis
- Charles B Hicks, MD
Charles B Hicks, MD
- University of California, San Diego
- P Frederick Sparling, MD
P Frederick Sparling, MD
- Professor of Medicine and Microbiology and Immunology
- University of North Carolina at Chapel Hill
Syphilis is a chronic infection caused by the bacterium Treponema pallidum. The manifestations of disease are notoriously protean, occurring in any one individual in different stages over time .
The epidemiology, pathogenesis, clinical manifestations, diagnosis, and therapy of early syphilis will be reviewed here. Late syphilis and the pathophysiology, natural history, and serologic diagnosis of syphilis are discussed separately. Syphilis in the HIV-infected patient is discussed elsewhere. (See "Pathogenesis, clinical manifestations, and treatment of late syphilis" and "Pathophysiology, transmission, and natural history of syphilis" and "Diagnostic testing for syphilis" and "Epidemiology, clinical presentation, and diagnosis of syphilis in the HIV-infected patient".)
Early syphilis — Early syphilis is defined as the stages of syphilis that typically occur within the first year after acquisition of the infection. These include primary, secondary, and early latent syphilis (see "Pathophysiology, transmission, and natural history of syphilis"). Central nervous system associated diseases (ie, neurosyphilis) can also occur within the first year after infection. (See "Neurosyphilis".)
Latent syphilis — Latent syphilis is characterized by asymptomatic infection with a normal physical examination in association with a positive serology. Latent syphilis is categorized as "early" or "late" depending upon the established date of infection. Early latent syphilis infers infection within one year. All other cases are referred to as late latent syphilis . (See "Pathophysiology, transmission, and natural history of syphilis", section on 'Latent syphilis'.)
The importance of correct classification is related to the risk of transmission and duration of treatment:
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- Early syphilis
- Latent syphilis
- Men who have sex with men
- HIV-infected patients
- Women and minority groups
- CLINICAL MANIFESTATIONS
- Incubating syphilis
- Primary syphilis
- Secondary syphilis
- - Rash
- - Systemic symptoms
- - Lymphadenopathy
- - Alopecia
- - Hepatitis
- - Gastrointestinal abnormalities
- - Musculoskeletal abnormalities
- - Renal abnormalities
- - Neurologic abnormalities
- - Ocular abnormalities
- DIFFERENTIAL DIAGNOSIS
- Benzathine penicillin G
- - Early syphilis
- - Early versus late latent syphilis
- - Jarisch-Herxheimer reaction
- Penicillin allergic patients
- - Tetracyclines
- - Macrolides
- - Ceftriaxone
- PATIENT MONITORING
- SCREENING AND PREVENTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS