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U N I T 1 1
Genitourinary and Reproductive Function
contagious at this stage, but because the symptoms are
mild, it frequently goes unnoticed. The chancre usually
heals within 3 to 12 weeks, with or without treatment.
The timing of the second stage of syphilis varies
even more than that of the first, lasting from 1 week to
6 months. The symptoms of a rash (especially on the
palms [Fig. 41-10] and soles), fever, sore throat, stomati-
tis, nausea, loss of appetite, and inflamed eyes may come
and go for a year but usually last for 3 to 6 months.
Secondary manifestations may include alopecia and gen-
ital lesions called
condylomata lata
. These elevated 2- to
3-cm red-brown lesions, which contain many spirocetes
and are highly infectious, may ulcerate and produce a
foul discharge.
After the second stage, syphilis frequently enters a
latent phase that may last the lifetime of the person or
progress to tertiary syphilis at some point. Persons can
be infective during the first 1 to 2 years of latency.
Tertiary syphilis is a delayed response to the untreated
disease. Approximately one third of people with untreated
syphilis develop syphilis after a latent period of 5 years or
more.
9
When syphilis does progress to the symptomatic
tertiary stage, it commonly develops into one of three
forms: localized destructive lesions called
gummas
, cen-
tral nervous system lesions, or cardiovascular manifesta-
tions. The syphilitic gumma is a peculiar, rubbery, necrotic
lesion that is caused by noninflammatory tissue necrosis.
Gummas can occur singly or multiply and vary in size
from microscopic lesions to large, tumorous masses. They
most commonly are found in the liver, testes, and bone.
Central nervous system lesions can produce dementia,
blindness, or injury to the spinal cord, with ataxia and
sensory loss (i.e., tabes dorsalis). Cardiovascular manifes-
tations usually result from scarring of the medial layer of
the thoracic aorta with aneurysm formation. These aneu-
rysms produce enlargement of the aortic valve ring with
aortic valve insufficiency.
Diagnosis andTreatment
The diagnosis of syphilis can be made rapidly by dark-
field microscopic examination of the exudate from skin
lesions. However, the test is reliable only when a speci-
men with actively motile
T. pallidum
is examined imme-
diately by a trained microscopist.
Treponema pallidum
does not survive transport to a laboratory and it cannot
be cultured. It does, however, evoke a humoral immune
response and production of antibodies that provide the
basis for serologic tests.
Although PCR tests have been developed for syphilis,
serology tests remain the mainstay for diagnosis. Two
general types of serology tests are available: nonspe-
cific (nontreponemal) tests and the specific treponemal
tests.
4
The
nontreponemal tests
measure immunoglobin
(Ig) G and IgM antibodies developed against molecules
released from damaged cells during the early stages of
the infection and present on the cell surface of trepone-
mas. These antibodies are detected by tests such as the
FIGURE 41-9.
Syphilitic chancre of the penis shaft. (From
the Centers for Disease Control and Prevention Public Health
Image Library. No. 6758. Courtesy of Gavin Hart, N. J. Fiumara.)
FIGURE 41-10.
A maculopapular rash is present on the
palm due to secondary syphilis. Note that some of the rash
is sparsely distributed to areas of the forearm as well. (From
the Centers for Disease Control and Prevention Public Health
Image Library. No. 3478. Courtesy of Susan Lindsley.)
