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Syphilis
Lauren M. Ladd, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      TERMINOLOGY

      • Definitions

        • Chronic systemic infectious disease caused by Treponema pallidum
          • T. pallidum is microaerophilic gram-negative bacteria of spirochete family
          • Acquired syphilis: transmitted by direct contact with moist infectious lesions of skin and mucous membranes (usually sexual contact)
            • Organism multiplies locally and spreads via perivascular lymphatics before primary lesion is evident
            • 4 stages divided into "early" and "late" acquired syphilis
            • Primary (early): chancre at site of inoculation + localized lymphadenopathy; appears 3-6 weeks after transmission
            • Secondary (early): dissemination to skin (generalized skin eruption), mucous membranes, CNS; ~ 6 weeks after 1° lesion
            • Latent (early/late): silent disease; variable, 4 months to 10 years
            • Tertiary (late): slowly developing immune response, can affect any organ; large destructive lesions (gummas) form in any organ, especially in skin and bone; 10-30 years
          • Congenital syphilis: placental transmission to fetus or by contact of infectious lesion in birth canal
            • Early congenital syphilis: presents < 2 years old
            • Late congenital syphilis: presents > 2 years old

      IMAGING

      • General Features

        DIFFERENTIAL DIAGNOSIS

          CLINICAL ISSUES

          • Demographics

            • Natural History & Prognosis

              • Treatment

                Selected References

                1. Colquhoun M et al: Osteolytic lesions as the sole presenting feature of secondary syphilis. BMJ Case Rep. 14(6), 2021
                2. Liang X et al: The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review. BMC Musculoskelet Disord. 19(1):251, 2018
                3. Zou Y et al: Congenital syphilis of bone: a potential mimicker of childhood histiocytoses. Am J Surg Pathol. 41(9):1283-9, 2017
                4. Bezalely S et al: Syphilis: an unusual manifestation? BMJ Case Rep. 2014, 2014
                5. Naraghi AM et al: Magnetic resonance imaging features of osseous manifestations of early acquired syphilis. Skeletal Radiol. 39(3):305-9, 2010
                6. Viens NA et al: Case report: Neuropathic arthropathy of the hip as a sequela of undiagnosed tertiary syphilis. Clin Orthop Relat Res. 468(11):3126-31, 2010
                7. Armangil D et al: Early congenital syphilis with isolated bone involvement: a case report. Turk J Pediatr. 51(2):169-71, 2009
                8. Centers for Disease Control and Prevention (CDC): Congenital syphilis--United States, 2002. MMWR Morb Mortal Wkly Rep. 53(31):716-9, 2004
                Related Anatomy
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                Related Differential Diagnoses
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                References
                Tables

                Tables

                KEY FACTS

                • Imaging

                  • Top Differential Diagnoses

                    TERMINOLOGY

                    • Definitions

                      • Chronic systemic infectious disease caused by Treponema pallidum
                        • T. pallidum is microaerophilic gram-negative bacteria of spirochete family
                        • Acquired syphilis: transmitted by direct contact with moist infectious lesions of skin and mucous membranes (usually sexual contact)
                          • Organism multiplies locally and spreads via perivascular lymphatics before primary lesion is evident
                          • 4 stages divided into "early" and "late" acquired syphilis
                          • Primary (early): chancre at site of inoculation + localized lymphadenopathy; appears 3-6 weeks after transmission
                          • Secondary (early): dissemination to skin (generalized skin eruption), mucous membranes, CNS; ~ 6 weeks after 1° lesion
                          • Latent (early/late): silent disease; variable, 4 months to 10 years
                          • Tertiary (late): slowly developing immune response, can affect any organ; large destructive lesions (gummas) form in any organ, especially in skin and bone; 10-30 years
                        • Congenital syphilis: placental transmission to fetus or by contact of infectious lesion in birth canal
                          • Early congenital syphilis: presents < 2 years old
                          • Late congenital syphilis: presents > 2 years old

                    IMAGING

                    • General Features

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Colquhoun M et al: Osteolytic lesions as the sole presenting feature of secondary syphilis. BMJ Case Rep. 14(6), 2021
                              2. Liang X et al: The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review. BMC Musculoskelet Disord. 19(1):251, 2018
                              3. Zou Y et al: Congenital syphilis of bone: a potential mimicker of childhood histiocytoses. Am J Surg Pathol. 41(9):1283-9, 2017
                              4. Bezalely S et al: Syphilis: an unusual manifestation? BMJ Case Rep. 2014, 2014
                              5. Naraghi AM et al: Magnetic resonance imaging features of osseous manifestations of early acquired syphilis. Skeletal Radiol. 39(3):305-9, 2010
                              6. Viens NA et al: Case report: Neuropathic arthropathy of the hip as a sequela of undiagnosed tertiary syphilis. Clin Orthop Relat Res. 468(11):3126-31, 2010
                              7. Armangil D et al: Early congenital syphilis with isolated bone involvement: a case report. Turk J Pediatr. 51(2):169-71, 2009
                              8. Centers for Disease Control and Prevention (CDC): Congenital syphilis--United States, 2002. MMWR Morb Mortal Wkly Rep. 53(31):716-9, 2004