The clinical spectrum of syphilis in adolescence.

Syphilis, due to the spontaneous healing of the initial lesion, is often overlooked by adolescent patients. If undetected and untreated the condition may bring disastrous consequences. To investigate how syphilis first appears, we reviewed the medical history of 33 patients diagnosed from 1977 to 1981. The following main symptoms were found: typical chancre (9%), atypical chancre (9%), rash (45.5%), and marked lymphadenopathy (12%). Four patients were discovered only by a positive serology; four patients with low titers were discovered to have been previously treated and were monitored for evidence of cure. All patients had a positive RPR and FTA-ABS. Eleven patients (33%) had a concomitant venereal disease or a positive past history. A significant number (48%) were troubled, delinquent, or homosexual; 10% were victims of sex abuse. Contrary to general belief, most patients do not consult for a primary chancre. Instead, they present with a broad spectrum of clinical manifestations ranging from a variety of dermatologic signs to diverse degrees of lymphadenopathy, to being completely asymptomatic. Syphilis was not the initial diagnosis in over one-third of our patients. Those caring for adolescents should maintain a high index of suspicion for this disease.