Diagnostic Considerations
Syphilis, a reportable disease, is tracked by the Centers for Disease Control and Prevention (CDC). Syphilis has an extensive differential diagnosis. In particular, the extremely variable manifestations of tertiary syphilis produce an extremely broad differential diagnosis, and care must be taken to consider syphilis in cardiac, dermatologic, and neurologic disorders as is relevant. Patients diagnosed with syphilis should also be tested for other sexually transmitted diseases (STDs), including chlamydia, gonorrhea, trichomoniasis, bacterial vaginosis, and HIV infection.
When making a primary diagnosis of a generalized rash or an STD, always include syphilis in the differential diagnoses because of its varying manifestations.
Other problems to consider
Other problems to consider include the following:
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Brain tumors
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Carcinoma
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Congestive heart failure
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Fungal infection (superficial and deep)
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Lymphoma
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Mycotic infection
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Other CNS infections
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Sarcoid
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Seizures
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Stroke
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Trauma
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Traumatic superinfected lesions
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Venereal chlamydial infections
Differential Diagnoses
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Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
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Herpes Zoster
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Yaws
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Syphilis. These photographs depict the characteristic chancre observed in primary syphilis. Used with permission from Wisdom (Left) A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989. (Right) Centers for Disease Control and Prevention
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Syphilis. These photographs show the disseminated rash observed in secondary syphilis. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. These photographs show close-up images of gummas observed in tertiary syphilis. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. This photograph depicts primary syphilis "kissing" lesions. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. Palmar lesions observed in secondary syphilis. Used with permission from Wisdom (Left) A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989. (Right) Centers for Disease Control and Prevention
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These photographs illustrate examples of condylomata lata. The lesions resemble genital warts (condylomata acuminata). Fluids exuding from these lesions are highly infectious. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. These photographs illustrate typical facies of congenital syphilis. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. This photograph shows an example of Hutchinson teeth in congenital syphilis. Note notching. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilis. This photograph illustrates chorioretinitis of congenital syphilis. Used with permission from Wisdom A. Color Atlas of Sexually Transmitted Diseases. Year Book Medical Publishers Inc; 1989.
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Syphilitic chancre
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Secondary syphilis - Exanthem
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Secondary syphilis - Exanthem
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Lues hematoxylin and eosin stain. Histopathological examination shows a lichenoid infiltrate that is stereotypical of the secondary stage of syphilis. Note that vacuolar alteration of the superjacent epithelium can be seen much like a noninfectious form of lichenoid dermatitis. The subjunctional infiltrate is rich in histiocytes and plasmacytes. At times, an overtly granulomatous lichenoid infiltrate can be seen.
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Lues TP stain. Immunoperoxidase staining for T pallidum highlights many slender coiled organisms residing in the perijunctional zone. Occasionally, organisms can also be found in the upper dermis or around adnexal structures.