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Source: Knodel LC, Duhon B, Argamany J. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146072585. Accessed March 9, 2017.
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Causative organism: Treponema pallidum, a spirochete.
Usually acquired by sexual contact with infected mucous membranes or cutaneous lesions.
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Highly contagious infection that can progress to chronic, seriously disabling, or fatal, systemic disease.
Strong evidence of association between syphilis and HIV infection.
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CLINICAL PRESENTATION
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Clinical presentation of syphilis varies, with progression through multiple stages possible in untreated or inadequately treat patients (Table 1).
Primary syphilis.
Secondary syphilis.
Characterized by variety of mucocutaneous eruptions, resulting from widespread hematogenous and lymphatic spread of T. pallidum.
Lesions may be generalized or localized to a small portion of the body, and are mostly (except for follicular lesions) nonpruritic.
Signs and symptoms of secondary syphilis disappear in 4–10 weeks; however, in untreated patients, lesions may recur at any time within 4 years.
Latent syphilis.
Positive serologic test but no other evidence of disease.
Early latency (1 year from onset of infection, up to 2–4 years): patient is considered potentially infectious.
Late latency: mostly considered noninfectious, except in pregnancy, disease can pass from mother to fetus.
Most untreated patients with latent syphilis have no further sequelae.
Tertiary syphilis and neurosyphilis.
If untreated, syphilis can produce an inflammatory reaction in any organ in the body.
Neurosyphilis: any patient with CSF abnormalities consistent with CNS infection (affects approximately 40% of patients with primary or secondary syphilis).
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