General Medical Information

Syphilis

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Manifestations of syphilis in the vulva of the child may be confusing. In the primary stage, instead of the classic chancre, the lesions frequently are superficial ulcerations, often with striking edema. As in the adult, they are asymptomatic, although for some patients they may cause irritation. In secondary syphilis, condyloma lata can be confused with condyloma acuminata, particularly in the perirectal area where the lesions may be raised and convoluted rather than flat grayish-white coalescing papules. Mucous patches that are painless grayish-white erosions occur most commonly in the oropharynx and perirectal area. Lymphadenitis usually is present and asymptomatic. Evaluation of preschool children with syphilis is confounded by several factors, including the possibility of congenital disease and problems with recognition of clinical disease. Household nonsexual transmission of syphilis from parents with secondary syphilis has been reported. Diagnosis is based on visualization of treponemas by dark-field microscopy of samples from genital or skin lesions in the primary stage and Warthin-Starry silver stain in condyloma lata. Screening by serology is more helpful in the secondary stage and accomplished by nontreponemal tests, which include the Venereal Disease Research Laboratory (VDRL) and the rapid plasma reagin (RPR) tests. Higher titers are indicative of active disease. Specific antitreponemal tests should be performed when necessary. The most commonly used tests are the microhemagglutination assay for antibodies to treponema pallidum (MHA-TP) and the fluorescent treponemal antibody-absorption (FTA-ABS) test. Penicillin remains the drug of choice for treatment of syphilis. Benzathine penicillin G in a single intramuscular dose is the treatment for primary and secondary syphilis. The dose is 50,000 U/kg, up to an adult dose of 2.4 million units. For latent syphilis of more than 1-year duration, three weekly doses are recommended. In the penicillin-allergic child, erythromycin is an adequate substitute for penicillin.