Chancres that start as painless papules and then erode; have indurated, raised edges and clear bases. Found on genitals, lips, tongue, nipples, tonsils, anus, fingers, and eyelids
Macular, papular, pustular, or nodular rash. Lesions are uniform in size, well defined, generalized. Lesions may enlarge and erode, producing highly contagious pink or grayish-white lesions (condylomata lata). Found on palms, arms, soles, face, scalp, perineum, scrotum, vulva, and between rolls of body fat.
Absence of lesions. Gummas: Chronic, superficial nodules or deep, granulomatous lesions. Solitary, asymmetric, painless, indurated. Found on bones and in organs.
If a chancre exists, palpate the surrounding lymph nodes for hard, painless nodules. Also inspect the scalp, skin, and mucous membranes for hair loss, rashes, or mucoid lesions, which are characteristic of the secondary stage. Inspect the fingernails for signs of pitting.
If late syphilis is suspected, assess the patient for the characteristic complications. Observe for joint deformities or disfiguring lesions on the palate. Note areas of numbness or paralysis and hyperactive reflexes. Assess the pupils for size and reaction to light. Assess the patient for pulmonary congestion. Auscultate for heart sounds to determine irregularities, which may indicate valvular degeneration.
PSYCHOSOCIAL. The patient with syphilis is usually embarrassed by the infection and may be reluctant to seek out and continue treatment. Be nonjudgmental. Assure the patient that her or his privacy and confidentiality will be maintained during examination, diagnosis, and treatment, although all sexual partners need to be notified so that they can be examined and treated as needed.
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