Syphilis is an acute and chronic treponemal disease characterized clinically by a primary lesion, a secondary
eruption involving skin and mucous membranes, long periods of latency, and late lesions of skin, bone viscera, the
CNS, and the cardiovascular system. The primary lesion (chancre) appears about three weeks after exposure as an
indurated, painless ulcer with serous exudate at the site of initial invasion. Invasion of the bloodstream precedes
development of the initial lesion, and a firm, nonfluctuant, painless lymph node (bubo) commonly follows.
Infection might occur without a clinically evident chancre; that is, it might be in the rectum or on the cervix. After
four–six weeks, even without specific treatment, the chancre begins to involute, and, in approximately one-third of
untreated cases, a generalized secondary eruption appears, often accompanied by mild constitutional symptoms.
This symmetrical maculopapular rash involving the palms and soles, with associated lymphadenopathy is classic.
Secondary manifestations resolve spontaneously within weeks to 12 months. Again, about one-third of untreated
cases of secondary syphilis become clinically latent for weeks to years. In the early years of latency, infectious
lesions of the skin and mucous membranes might recur. Specific treatment includes long-acting penicillin G
(benzathine penicillin), 2.4 million units given in a single IM dose on the day that primary, secondary or early
latent syphilis is diagnosed. This ensures effective therapy, even if the client fails to return. Serologic testing is
important to ensure adequate therapy. Tests are repeated three and six months after treatment and later as needed.
In HIV-infected clients, testing should be repeated one, two, and three months after treatment, and at three-month
intervals thereafter. Any fourfold titer rise indicates the need for retreatment.Physiological Adaptation
