SYPHILIS
“THE GREAT IMITATOR”—–The new great imitator may be HIV (Bob Wenninger)

“To know Syphilis is to know Medicine”
ALSO KNOWN AS “LUES OR POX”
Caused by the Spirochete Treponema Pallidum.
Lyme Disease (Caused by the Spirochete Borrelia Burgdorferi-Carried by the Tick Ixodes Dammini Pacificus) may cause similar symptoms.
Distinct Clinical Stages:
Incubation Period:  Usually 3 weeks, ASx
Primary Stage: Primary Chancre; Painless, Resolves in 3-6 weeks. PRIMARY LOCATION IN THE UPPER AERODIGESTIVE TRACT = PALATINE TONSIL
Secondary Stage: “Mucocutaneous Sx”Extremely contagious, rash, LAD, loss of eyelashes and alopecia.  Constitutional Sx.  Snail Track Ulcers in the OP. “RULE OF 1/3RDS”— 1/3 RESOLVE, 1/3 Indefinite Latency, 1/3 Progress to Tertiary Syphilis.
TERTIARY SYPHILIS:  Gummas, Aortic Dilatation, Optic Neuritis, Personality Changes.
Tabes Dorsalis (Positive Rhomberg)
Argyll Robertson (Prostitutes) Pupil
Condylomata latum
Central (Vs. Peripheral with Cogan’s) Interstitial Keratitis.
Saddle Nose (Post. Boney Septal Perfs).
“Demarquay’s Sign” (Absence of Laryngeal Elevation due to Syphilitic Induration)
OTOLOGIC
Bilateral Flat SNHL: Can be Asymmetric, can be fluctuating; Often poor SDS with Recruitment.
+/- Hennebert’s Sign (more with negative pressure)–T-BONE OSTEITIS
+/- Tullio’s Phenom.
Vertigo/Nystagmus
Decreases Caloric Responses
Otorrhea/Aural Polyps
ECOG Similar to Menier’s Disease.
CONGENITAL SYPHILIS
RASH, RHINORHEA, PSEUDOPARALYSIS
Interstitial Keratitis
Rhagades (Radiating scars and fissures about the mouth)
Hutchinson’s Incisors.,PEG LATERALS, CORKSCREW “NOTCHED” SCREWDRIVER INCISORS
Atrophic glossitis
Mulberry Molars–SEVERE DECAY OF 1ST AND 2ND MOLARS
Short Maxilla and Protruding Mandible
Saber Shins (Tibial Periostitis)
Frontal Bossing (Bossae of Parrot)
High arched palate
Saddle Nose
Charcot Joints
Aortitis
Fordyce’s Granules
Dx:
HISTORY
PE
DARKFIELD MICROSCOPY
SEROLOGY:
Non-Trepenemal tests (VDRL)
Specific Trepenemal tests (FTA-ABS/MHATP)
Stays Positive Indefinitely
May be +CSF with -Serum
Penicillin and Probenecid.  Some sources say to Desensitize if PCN Allergic, others advocate Tetracycline.
Steroids.  May temporarily improve the SNHL.
Beware of the Jarisch-Herxheimer Reaction: From release of a Heat Stable Exotoxin 2-12 hours post treatment.