Syphilis Treponema pallidum

• Facts:
  T. pallidum (spirochete)
• History / PE:
  Primary
  Painless ulcer (chancre)
  
  Secondary
  Maculopapular rash on palms and soles
  Condylomata Lata
  
  Tertiary
  Granulomatous gummas
  Neurosyphilis (tabes dosalis, meningitis , Argyll-Robertson pupil)
  Cardiovascular (aortic root aneurysms, aortitis, AR)
  
• Diagnosis:
  Dark field microscopy (see motile spirochetes)
  VDRL/RPR (many false positives)
  FTA-ABS (confirmatory test)
  TPPA (T. pallidum agglutination test)
• Treatment:
  Benzathine penicilllin IM X 1 day (primary/secondary)
  Benzathine peniciilin q week X 3 weeks (latent infection)
  Penicillin IV (neurosyphilis)
• Complications:
  Jarisch-Herxheimer reaction (post treatment)
• See Also:
  Congenital syphilis
• Associated With:
  Alopecia areata
• Differential Diagnosis:
  VDRL false +'s
  
  Viruses (mono, HSV, HIV, hepatitis )
  Drugs
  Rheumatic fever
  Rheumatoid arthritis
  SLE
  Leprosy