Syphilis clinical presentation

The clinical presentation of syphilis is varied, with progression through multiple stages possible in untreated or inadequately treat patients (Table 46-5). 

MGN may be primary or secondary to other conditions (e.g., hepatitis B, malaria, congenital syphilis, SEE, drugs, and neoplasms). The latter cases predominate in children (Cameron 1990). Clinical presentation is with NS and microhaematuria... 

Secondary syphilis Without appropriate treatment, primary syphilis will advance to secondary syphilis, a stage usually apparent from its clinical symptomatology. Symptoms include fatigue, diffuse rash, fever, lymphadenopathy, and genital or perineal condyloma latum. Also, the skin is most often affected and a rash may present as macular, macropapular, or pustular lesions, or involve skin surfaces including the palms of the hands and soles of the feet. 

Recognized in 1961 (KIO), these are now well described (B18) and mimic the syndrome of mixed cryoglobulinemia (see 6.13). Skin lesions in this condition are raised, painful, and edematous with or without necrosis. Biopsy always reveals arteritis with a mononuclear and neutro-phile infiltrate. There is in most cases a preceding history of rheumatoid arthritis, Sjogren s syndrome, syphilis, sarcoidosis or other hyperimmune states, and this will dominate the clinical findings. Rarely the protein interactions build up to a level presenting as a viscosity syndrome so that this group can overlap with 7.7.1 unless the serum is carefully examined. 

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