- A chronic, systemic infectious disease caused by the spirochete Treponema pallidum
- Transmitted sexually by direct contact with an active lesion; also transmitted vertically (maternal–fetal) and via blood transfusions
- Untreated disease includes four overlapping stages.
- Primary: single (usually) painless chancre at point of entry; appears in 10 to 90 days; chancre heals without treatment in 3 to 6 weeks.
- Secondary: appears 2 to 8 weeks after primary chancre; nonpruritic rash on palms or soles of feet, mucous membrane lesions, headache, fever, lymphadenopathy, alopecia
- Latent: seroreactive without evidence of disease
- Early latent: acquired within the last year; late latent: exposure >12 months prior to diagnosis
- Tertiary (late): Serology may be negative (fluorescent treponemal antibody absorption [FTA-ABS] test typically positive).
- Gumma, cardiovascular, and late neurosyphilis; may be fatal
- Neurosyphilis: any type of CNS involvement; can occur at any stage
- Psychosis, delirium, dementia
In noncongenital cases, consider child abuse.
- Syphilis rate decreased through 2000 and have since increased (primarily in men who have sex with men [MSM]) (2).
- All stages: 41 per 100,000
- Congenital: 57/100,000 live births (2)
Etiology and Pathophysiology
T. pallidum enters through intact mucous membranes or breaks in skin. The organism quickly enters the lymphatics to cause systemic disease. Highly infectious; exposure to as few as 60 spirochetes is associated with ~50% chance of infection.
MSM, multiple sexual partners, exposure to infected body fluids, injection drug use, transplacental transmission, adult inmates, high-risk sexual behavior, people living with HIV (PLWH)
Commonly Associated Conditions
HIV infection, hepatitis B, other sexually transmitted infections (STIs)
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