Syphilis

DDx

Primary syphilis (genital ulcer)

  • Herpes simplex virus (HSV)
  • Chancroid
  • Granuloma inguinale
  • Lymphogranuloma venereum
  • Trauma
  • Neoplasm
  • Behçet’s syndrome
  • Systemic lupus erythematosus (SLE)
  • Lichen planus
Secondary syphilis (rash, condyloma lata, lymphadenopathy)
  • Rash: pityriasis rosea, tinea corporis, psoriasis, nummular eczema, viral exanthem, drug eruption, lichen planus, discoid lupus erythematosus
  • Condyloma lata: genital warts (condyloma acuminata), vulvar cancer
Tertiary syphilis (neurosyphilis, cardiovascular, gummas)
  • Gummas: skin cancer; lipomas; sarcoidosis; ulcer due to pyoderma gangrenosum, vasculitis, mycobacterial infection, deep fungal infection, yaws
  • Aortic root disease: Marfan syndrome, aortic dissection, temporal (giant cell) arteritis, ankylosing spondylitis, syphilis, Reiter’s syndrome (reactive arthritis), cystic medial necrosis, sinus of Valsalva aneurysm, relapsing polychondritis
  • Neurosyphilis: primary neurologic lesions or other chronic meningitis

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