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Section 3. Summaries of Infectious Diseases
Syphilis
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS:
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Congenital Syphilis. Intrauterine infection can result in stillbirth, hydrops fetalis, or prematurity. Infants may have hepatosplenomegaly, snuffles, lymphadenopathy, mucocutaneous lesions, osteochondritis and pseudoparalysis, edema, rash, hemolytic anemia, or thrombocytopenia at birth or within the first months of life. Untreated infants, regardless of whether they have manifestations in early infancy, may develop late manifestations, which usually appear after 2 years of age and involve the central nervous system (CNS), bones and joints, teeth, eyes, and skin. Some consequences of intrauterine infection may not become apparent until many years after birth, such as interstitial keratitis (5–20 years of age), eighth cranial nerve deafness (10–40 years of age), Hutchinson teeth (peg-shaped, notched central incisors), anterior bowing of the shins, frontal bossing, mulberry molars, saddle nose, rhagades, and Clutton joints (symmetric, painless swelling of the knees). The first 3 manifestations are referred to as the Hutchinson triad.
Acquired Syphilis. Infection can be divided into 3 stages. The primary stage appears as one or more painless indurated ulcers (chancres) of the skin or mucous membranes at the site of inoculation. These lesions most commonly appear on the genitalia. The secondary stage, beginning 1 to 2 months later, is characterized by rash, mucocutaneous lesions, and lymphadenopathy. The polymorphic maculopapular rash is generalized and typically includes the palms and soles. In moist areas around the vulva or anus, hypertrophic papular lesions (condylomata lata) can occur. Generalized lymphadenopathy, fever, malaise, splenomegaly, sore throat, headache, and arthralgia can be present. A variable latent period follows but sometimes is interrupted during the first few years by recurrences of symptoms of secondary syphilis. Latent syphilis is defined as the period after infection when patients are
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