(a) Late benign syphilis. Lesions called gummas may appear on the
skin, bones, mucous membranes, upper respiratory tract, liver, or stomach. Since
gummas can be found on any bone and in any organ, the possibilities for damage are
great. Often the patient suffers blindness and weight loss, but also bones and organs
may be destroyed causing death.
(b) Respiratory and cardiovascular problems. Gummas involving the
respiratory tract can cause respiratory problems. Cardiovascular problems may be
caused by damage to the elastic tissue of the aorta.
(c) Neurosyphilis. About eight percent of the patients with tertiary
untreated syphilis develop neurosyphilis. Neurosyphilis is syphilis of the nervous
system. The central nervous system has been affected by syphilis with possible effects
including madness, palsies, wide-based gait, inability to walk in the dark, and a general
e. Diagnosis. Although syphilis is usually diagnosed by a blood test, correct
diagnosis also depends on some additional tests. Diagnosis proceeds as follows:
(1) History. Take the patient's history to include information about any
previous infection, any parental infection, recent antibiotics taken, and signs or
symptoms the patient remembers.
(2) Physical examination. The physical examination is done to determine
the general health of the patient as well as to look for signs and symptoms of syphilis.
The physician will be looking for chancres (characteristic of primary syphilis), symmetric
mucocutaneous lesions and general lymphadenopathy (beginning secondary syphilis),
gummas (lesions typical of late syphilis). These and other signs/symptoms help
determine the stage of the disease.
(3) Laboratory. A variety of tests are used including the Fluorescent
Treponemal Antibody-Absorption (FTA-ABS) test, the Venereal Disease Research
Laboratory (VDRL) slide test, and the Rapid Plasma Reagin (RPR) test.
f. Differential Diagnosis. If there is some question as to whether the patient
has syphilis or a disease whose symptoms resemble those of syphilis, a differential
diagnosis must be done. A differential diagnosis is one in which the signs and
symptoms of two or more diseases are systematically compared and contrasted to
decide which disease is making the patient ill. If you suspect that the patient has
primary syphilitic chancre, compare and contrast that sore with lesions that might be
chancroid, granuloma inguinale, or herpes progenitalis. If you suspect that the patient
has secondary syphilis, remember that other skin conditions (measles and drug
reactions, for example) can be mistaken for the maculopapular skin rash of secondary