Syphilis: Examination

General physical examination – including blood pressure, pulse, body weight, height; furthermore:

  • Inspection (viewing).
    • Skin, mucous membranes, sclerae (white part of the eye), abdominal wall, and inguinal region (groin area) [symptoms (secondary stage):
      • Alopecia specifica areolaris – moth-eaten hair loss.
      • Anemia (anemia)
      • Clavi syphilitici – excessive callus formation on the hands and feet.
      • Depigmentation – loss of color pigments of the skin, occurring mainly on the neck.
      • Generalized swelling of the lymph nodes
      • Bright to brown-red, blotchy rash all over the body, without itching
      • Icterus syphiliticus praecox – yellowing of the skin.
      • Leukoplakia oris – white areas in the oral mucosa that cannot be wiped off.
      • Plaques muqueuses – superficial mucosal erosions.
      • Polyscleradenitis – lymphadenitis with hardening of the lymph nodes.
      • Syphilides – skin manifestations of various kinds, such as a measles-like, non-itchy exanthema (rash).
      • Possible sequelae: skin ulcerations (ulcers) on the soles of the feet]
  • Auscultation (listening) of the heart.
  • Auscultation of the lungs
  • Palpation (palpation) of the abdomen (belly) etc. [Symptoms: hepatomegaly (liver enlargement)]
  • Examination of the genitals
    • Male (urological examination):
      • Inspection and palpation of the genitals (penis and scrotum; assessment of pubes hair (pubic hair), penis (penis length: between 7-10 cm when flaccid; presence of: Indurations (hardening of tissue), anomalies, phimosis/foreskin constriction?) as well as the position and size of the testis (if necessary by means of orchimeter); if necessary, the painfulness compared to the opposite side resp. Where is the punctum maximum of pain) [symptoms: painless primary effect (ulcus durum; ulcer) with hardening at the entry point of the pathogens; regional lymphadenopathy (lymph node enlargement); Condylomata lata – coarse, very pathogen-rich papules].
      • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of the prostate in size, shape and consistency, if necessary, detection of indurations (tissue hardening)). [if necessary, also here primary effect; secondary stage: Condylomata lata – coarse, very pathogen-rich papules].
    • Woman (gynecological examination):
      • Inspection
        • Vulva (external, primary female sex organs), vagina (vagina) [symptoms: painless primary (ulcus durum; ulcer) with induration at the site of pathogen entry; regional lymphadenopathy (lymph node enlargement); secondary: condylomata lata – coarse, very pathogen-rich papules]
        • Cervix uteri (cervix), or portio (cervix; transition from the cervix (cervix uteri) into the vagina (vagina)), taking a Pap smear (for early detection of cervical cancer).
      • Palpation (bimanual; palpation with both hands) of the internal genital organs:
        • Cervix uteri (cervix).
        • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
        • Adnexa (appendages of the uterus, i.e., the ovary (ovary) and uterine tubule (fallopian tube)) [Normal: free]
        • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
        • Pelvic walls [Normal: free]
        • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear].
  • If necessary, ophthalmological examination [due topossible secondary diseases:
  • If necessary, ophthalmological examination [due tosymptom: iritis (inflammation of the iris of the eye)]
  • If necessary, neurological examination [due tosymptom: meningitis (meningitis)]

In square brackets [ ] is referred to possible pathological (pathological) physical findings.