FIGURE 65-3 Condyloma lata. (Reproduced with permission from Horsager R, Roberts S, Roger V, et al (eds): Williams Obstetrics 24th Edition Study Guide, New York, McGraw Hill Education, 2014; Photo contributor: Dr. Jonathan Willms.) lesion typically has a raised, firm border and a red, smooth ulcerated base without signiicant pus (Fig. 65-1). Nonsuppurative lymphadenopathy may develop. A chancre will usually resolve spontaneously in 2 to 8 weeks, even if untreated. Multiple lesions, if found, are predominantly in HIV-1 coinfected women.
2. Secondary syphilis stems from dissemination of spirochetes to afect multiple organ systems. Manifestations develop 4 to 10 weeks after the chancre appears and include dermatological abnormalities in up to 90 percent of women. A difuse macular rash, plantar and palmar targetlike lesions, patchy alopecia, and mucous patches may be seen (Fig. 65-2). Condylomata lata are flesh-colored papules and nodules found on the perineum and perianal area (Fig. 65-3). These papules are teeming with spirochetes and are highly infectious. Most women with secondary syphilis also express constitutional symptoms such as fever, malaise, headache, and myalgias.
FIGURE 65-2 Secondary syphilis. A.Target lesions on the palms. B. Mucous patches around the nose and mouth. (Used with permission from Dr. Devin Macias.)
Hepatitis, nephropathy, ocular changes, anterior uveitis, and periostitis can also develop.
3.
Latent syphilis develops when primary or secondary syphilis is not treated but clinical manifestations still resolve. It is identified instead by serological testing. Eary latent syphilis is subclinical disease acquired within the preceding 12 months. Disease diagnosed beyond 12 months is either late latent syphilis or latent syphilis of unknown duration.
4. Tertiary syphilis is a slowl) progressive disease afecting any organ system but is rarely seen in reproductive-aged women.
Without screening and treatment, approximately 70 percent of infected women will have an adverse pregnancy outcome (Hawkes, 201l). Maternal infection can lead to preterm labor, fetal death, fetal-growth restriction, or fetal infection (Gomez, 2013). Because of immune incompetence prior to midpregnancy, the fetus generally does not manifest the immunological inlammatory response characteristic of clinical disease before this time (Silverstein, 1962). Once fetal syphilis develops, however, it manifests as a continuum. Fetal hepatic abnormalities are followed by anemia and thrombocytopenia, then ascites and hydrops (Hollier, 2001). Stillbirth remains a major complication (Lawn, 2016; Su, 2016). he newborn may have jaundice with petechiae or purpuric skin lesions, lymphadenopathy, rhinitis, pneumonia, myocarditis, nephrosis, or long-bone involvement (Fig. 65-4).