Syphilis in Darker Skin: Clinical Manifestations and Differential Diagnosis

00:01 So what are some of the clinical manifestations of syphilis? So in primary syphilis one gets an ulcer that we call a chancre. It is a painless ulcer which is 1 to 2cm in size with a raised indurated margin.

00:16 The base is usually non exudative.

00:20 Now let's have a look at the predilection sites for the chancre.

00:24 The chancre may occur on the external genitalia and this is the most common site.

00:28 It may also occur around the anus.

00:32 The fingers may also be involved.

00:34 The nipples and the mouth.

00:37 And you'll recognize that these are the areas where, during intimacy, there may be contact between the mouth and the lesions.

00:45 It may also occur on the tongue as well as the oropharynx, so it's important to look through inside the mouth for these lesions.

00:55 The following are some of the features of primary syphilis.

00:59 One may have regional lymphadenopathy, which is most often bilateral as chancre, which usually heals within 4 to 8 weeks without treatment and it usually heals faster with treatment.

01:13 The differential diagnosis includes chancroid, so with a chancroid you see a dip undermined petulant ulcer with painful inguinal lymphadenitis.

01:26 And this is completely different from the presentation of a chancre.

01:32 Another differential is genital herpes, where one presents with multiple shallow, painful, painful ulcers that may be vesicular at times, but because this is a superficial vesicle, it tends to break down easily, and most of the time you are unable to see the intact vesicle.

01:56 So several weeks to a couple of months after the appearance of a chancre.

02:01 Then one develops secondary syphilis and this presents as a localized or diffuse rash.

02:08 It may present with subtle or rough reddish or brown papules or patches.

02:13 These are usually non-pruritic and asymptomatic in most cases, but they tend to be bilateral and symmetrical.

02:23 This is a patient with secondary syphilis presenting with a maculopapular rash on the trunk.

02:29 Another typical feature of syphilis is the involvement of the palms and soles, and it's always crucial to always examine the palms and the soles when you are suspecting secondary syphilis.

02:43 Another feature of secondary syphilis is a moth eaten alopecia, which is a patchy hair loss that you find mainly on the scalp.

02:54 Mucous patches is a raw and red mucosal surfaces inside the mouth or throat or genital area, or in the vagina and anus, and this is also part of syphilis.

03:07 Co ndylomata Lata. These are grayish white, moist raised patches in the groin or in the inner thighs or armpits, or under the breasts. Usually find these in areas where there's two surfaces coming together.

03:26 Secondary syphilis may also present with generalized symptoms, and that's the list of the symptoms that one m ay see in patients with secondary syphilis.

03:39 The generalized lymphadenopathy may occur on all these illustrated areas over there. The following organs may be involved in secondary syphilis: central nervous system, the liver, kidneys and the joints.

03:57 So what are some of the differential diagnoses of syphilis? Pityriasis rosea that we spoke about.

04:03 This is a pink and flaky, oval shaped rash which followed, which is followed by clusters of smaller, more numerous patches of rash.

04:12 And you tend to get the Christmas tree pattern at the back.

04:17 Viral exanthems are actually another big differential for secondary syphilis. Now let's take a look at tertiary syphilis.

04:27 Tertiary syphilis. You get involvement of your cardiovascular system and classically get involvement of the thoracic aorta, which starts as a vasculitis in the vasa vasorum.

04:39 We call syphilitic aortitis.

04:42 The inflammation weakens the wall of the aorta, leading to aortic aneurysm.

04:47 Another type of tertiary syphilis is gametocyte syphilis.

04:51 Here you find solitary granulomatous lesions, which we call gammas, and may be found on the skin, on the throat and bones.

05:01 Now we are going to talk about neurosyphilis as part of tertiary syphilis.

05:05 This can occur long after the initial infection, up to 25 years. And the different clinical manifestations for example general paresis, tabes dorsalis or tabetic neurosyphilis.

05:21 And this is a picture showing demyelination of the posterior columns of the spinal cord in Tabes dorsalis.

05:28 The other differential diagnosis of tertiary syphilis may include the following that have been listed there.