Syphilis is a sexually transmitted infection caused by Treponema pallidum that moves through stages over months to years if untreated. Cases, including congenital syphilis, have risen sharply in the US, and benzathine penicillin G cures it.
Key symptoms
- Painless sore (chancre) on the genitals, anus or mouth
- Rash, often on the palms and soles, weeks later
- Fever, sore throat, fatigue and swollen lymph nodes
- Patchy hair loss or moist wart-like lesions
- Vision or hearing changes, headache or confusion at any stage
What you find on exam
- Firm, clean-based, painless ulcer with rubbery nodes
- Copper-colored rash on the palms and soles
- Condylomata lata and mucous patches
- Neurologic, eye and hearing exam
Tests
- Nontreponemal test (RPR) plus a treponemal test
- RPR titers to follow response after treatment
- Lumbar puncture if neurologic signs
- HIV and other STI testing; screen all pregnant patients
Treatment basics
- Benzathine penicillin G 2.4 million units IM once for primary, secondary or early latent syphilis
- Three weekly doses for late latent or unknown duration
- IV penicillin G for 10 to 14 days for neurosyphilis or eye disease
- Pregnant patients with penicillin allergy: desensitize, then give penicillin
- Notify and treat partners; warn about the Jarisch-Herxheimer reaction
Red flags
- Vision loss, hearing loss or new neurologic symptoms
- Syphilis in pregnancy
- Newborn with rash, snuffles or enlarged liver (congenital syphilis)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.