Daily Bolus of LR: Syphilis

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February 7, 2011 by dailybolusoflr

Syphilis is an sexually transmitted infection caused by the bacteria Treponema Pallidum.

Primary syphilis most commonly presents with painless shallow ulcer known as a chancre. This will resolve without treatment in 3-6 weeks.

Secondary syphilis most commonly presents with a disseminated mucocutaneous rash. Lesions are often described as brown, flat, rough or scaly, but can appear in almost any way. The classic location associated with syphilis is palms and soles, which is a location often spared in other disease processes. The rash can present while the chancre is present or can take several weeks to present. Again, this rash can resolve without treatment but patients who are not treated are at risk for developing long term complications or latent disease.

Other associated features of secondary syphilis include:
Diffuse nontender LAD
Sore throat
Malaise
Alopecia

For some images. .see the online gallery below. This will take you to a picture of classic secondary syphilis. Picture 8 has a primary chancre. .you can see how given the location, it could be misdiagnosed as a perianal fistula or GI related complication.

http://depts.washington.edu/nnptc/online_training/std_handbook/gallery/pages/syphilisrash.html


Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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