"Syphilis is the result of infection with the gram-negative spirochete Treponema pallidum, subspecies pallidum. It results in a heterogeneous spectrum of disease with many systems that can potentially be involved, which are discussed separately."
"Primary syphilis is characterised by a lesion at the site of T. pallidum inoculation, most commonly the genitals, usually within three weeks of inoculation 1,2. The lesion is typically a single red-brown chancroid 1,2. The lesion begins as a macule before developing into a papule and finally the chancroid - a firm, painless, non-pruritic clean-based ulceration 1,2. There is often painless unilateral regional lymphadenopathy associated with the chancroid. If left untreated, the chancroid usually heals spontaneously after 4-5 weeks 1,2."
"Secondary syphilis occurs up to eight weeks after inoculation and reflects T. pallidum bacteraemia 1,2. This stage may self-resolve after approximately six weeks and become latent or may relapse during the first two years before latency manifests 1,2. Due to being mediated by bacteraemia, these patients not only have non-specific constitutional symptoms such as low-grade fever, malaise, headache, and generalised lymphadenopathy, but there may also be multi-organ involvement 1,2:"
"This heterogenous disease results from infection by Treponema pallidum, subspecies pallidum 1-3. The bacteria is usually transmitted through direct lesion contact, although transplacental transmission also occurs 1,2."
"This spirochete is closely related to other members of the Treponema pallidum subspecies, including 2:"
"Treponema pallidum, subspecies endemicum, which causes bejel"
"Treponema pallidum, subspecies carateum, which causes pinta"
"Treponema pallidum, subspecies pertenue, which causes yaws"
"T. pallidum enzyme immunoassay (TP-IgM EIA) - favoured method"
"T. pallidum particle agglutination assay (TP-PA)"
"T. pallidum haemagglutination assay (TPHA)"
"microhaemagglutination test for antibodies to T. pallidum (MHA-TP)"
"characterised initially by meningovascular syphilis, which may not have presented in the secondary syphilitic time-frame 1,2,8"
"This heterogenous disease results from infection by Treponema pallidum, subspecies pallidum 1-3. The bacteria is usually transmitted through direct lesion contact, although transplacental transmission also occurs 1,2."
"Treponema pallidum, subspecies endemicum, which causes bejel"
"Treponema pallidum, subspecies carateum, which causes pinta"
"Treponema pallidum, subspecies pertenue, which causes yaws"
"T. pallidum enzyme immunoassay (TP-IgM EIA) - favoured method"
"T. pallidum particle agglutination assay (TP-PA)"
"T. pallidum haemagglutination assay (TPHA)"
"T. pallidum enzyme immunoassay (TP-IgM EIA) - favoured method"
"T. pallidum enzyme immunoassay (TP-IgM EIA) - favoured method"
"T. pallidum particle agglutination assay (TP-PA)"
"T. pallidum haemagglutination assay (TPHA)"
Expected headings
"Primary syphilis"
"Secondary syphilis"
"Tertiary syphilis"
"Congenital syphilis"
"Diagnosis"
"Musculoskeletal syphilis"
"Neurosyphilis"
"Cardiovascular syphilis"
"Gummatous syphilis"
"Congenital syphilis"
"Primary syphilis is characterised by a lesion at the site of T. pallidum inoculation, most commonly the genitals, usually within three weeks of inoculation 1,2. The lesion is typically a single red-brown chancroid 1,2. The lesion begins as a macule before developing into a papule and finally the chancroid - a firm, painless, non-pruritic clean-based ulceration 1,2. There is often painless unilateral regional lymphadenopathy associated with the chancroid. If left untreated, the chancroid usually heals spontaneously after 4-5 weeks 1,2."
"Secondary syphilis occurs up to eight weeks after inoculation and reflects T. pallidum bacteraemia 1,2. This stage may self-resolve after approximately six weeks and become latent or may relapse during the first two years before latency manifests 1,2. Due to being mediated by bacteraemia, these patients not only have non-specific constitutional symptoms such as low-grade fever, malaise, headache, and generalised lymphadenopathy, but there may also be multi-organ involvement 1,2:"
"many decades later, neurosyphilis may present with general paresis, dementia with marked personality changes, and tabes dorsalis, characterised by ataxia and sensory pains due to dorsal column involvement of the disease 1,2,8"
"typically, the proximal ascending aorta is involved (syphilitic aortitis), resulting in aortic root dilation, thoracic aortic aneurysm (luetic aneurysm), aortic valve regurgitation, and eventual congestive heart failure 1,2"
"Musculoskeletal manifestations of syphilis are discussed separately. The radiographic features are in keeping with the clinical presentation, including synovitis, osteitis, periostitis, osteomyelitis, and pathological fractures 6,10. Despite these associations with the clinical presentation, it has been further reported that syphilitic bone lesions can resemble any sort of bony lesion, and thus atypical radiographic features are common 6,10."
"Neurosyphilis, both early and late manifestations, is discussed separately. It is the result of CSF invasion by the infection, and subsequent sequential invasion into the meninges, leptomeningeal vessels, and finally the brain parenchyma and spinal cord tracts 8,11,12. Thus, radiographic features are highly variable depending on the temporal stage of the disease, but can potentially include those of leptomeningitis (e.g. leptomeningeal enhancement), cerebral vasculitis, ischaemic stroke, cerebral atrophy, and spinal cord atrophy 11,12."
"Congenital syphilis is discussed separately. Due to congenital syphilis having very different early and late presentations, there is a wide array of radiographic features 16,17. The best-described features are the musculoskeletal anomalies, which include periostitis (including the Higoumenakis sign), metaphysitis (including Wimberger sign and saw-tooth metaphysis in Wegner sign), diaphyseal osteomyelitis, pathological fractures, joint effusions, sabre shin, dactylitis, and a variety of craniofacial anomalies (including Hutchinson teeth and the Hennebert sign) 16,17. Some of these features, in addition to other signs of congenital syphilis such as fetal intrahepatic calcification, can be detected antenatally, but most will only manifest after birth 16,17."