Differential Diagnosis of Syphilis

A. The differential diagnosis of SI (Syphilis I)
        Basic diagnosis of S I as follows. In history it is known mass of incubation; there is no constitutional symptoms, as well as local symptoms ie no pain. In primary affective important there is erosion / ulceration were clean, Solitar, round / oval, regular, with indolent induration: T. pallidum positive. The disorder can be painful if accompanied by secondary infection. Regional nodes may be enlarged, indolent, no groups, no periadenitis, without suppuration. Serologic test after a few weeks of weak positive reaction.

As the differential diagnosis of various diseases can be put forward.

1. Herpes simplex This disease can be recurrent itchy, painful, vesicular lesions on the pedestal in the form of an erythematous skin, flocking. If you have broken the figures for erosion, often confluents and polycyclic, there is no induration.

2 pyogenic ulcers
As a result of trauma such as scratching may occur pyogenic infection. Ulcer looks dirty because it contains pus, pain, without induration. If there is a regional lymphadenitis accompanied by signs of acute inflammation that can occur simultaneously suppuration, and there is a leukocytosis in peripheral blood examination.

3 Scabies
Scabies lesions on multiple papules or vesicles form on the external genitalia, itchy at night. The same abnormalities are also in place predilection, for example folding fingers, perianal. People who live at home will also suffer from the same disease.

4. Balanitis
In balanitis, abnormalities in the form of superficial erosion on the glans penis accompanied by erythema, induration without. Predisposing factors: diabetes mellitus and were not circumcised.

5. Lymphogranuloma venereum (L.G.V.)
Primary affective L.G.V. not typical, may be papules, vesicles, pustules, ulcers, and usually quickly disappear. Which is typical of regional lymphadenitis, accompanied by signs of acute inflammation, suppuration is not simultaneous, there periadenitis. L.G.V. accompanied by constitutional symptoms: fever, malese, and arthralgia.

6. squamous cell carcinoma
Generally occurs in older people who are not circumcised. Skin disorders such as lumps, there is induration, bleed easily. For diagnosis, a biopsy needs.

7 Behcet's Disease
Superficial ulcers, multiple, usually on the scrotum / labia. There is also a mulct and ulceration of the lesion in the eye.

8. ulcers mole
The disease is now rare. Ulcer over skewers, accompanied by signs of acute inflammation, there is pus, the walls reverberate. Haemophilus ducreyi positive. In the event of a regional lymphadenitis also accompanied by signs of acute inflammation, suppuration simultaneously.

B. Differential diagnosis S II (Syphilis II)
         Basic diagnosis S II as follows. S II occur six to eight weeks after S I. As already explained, the S II is able to resemble a variety of skin diseases. To distinguish it from other diseases ads some grip. In anamnesis should be asked whether they have suffered genital injuries alai (SI) that is not painful.
Usually a significant clinical abnormality does not itch. In early S II disorder generalized, almost symmetric, hands / feet jugs subject. In the S II slow, there is a local aberration, flocking, can be arranged according to a specific arrangement, for example: arsinar, polycyclic, Corymbiform. Usually there is a generalized lymphadenitis. Strong positive serologic tests on the S II early, even more strongly on the S II further.

          As already explained, syphilis can mimic a variety of diseases because the differential diagnosis very much, but the only part that will be described.
1. allergic drug eruption
At the onset of allergy history is known as a drug that can be accompanied by fever. Various skin disorders, including erythema so that similar shaped roseala on the S II. The complaint is itchy, while in syphilis usually does not itch.

2 Morbili
Skin disorders such as erythema on the S II. The different is: on morbili accompanied by constitutional symptoms (looks sick, fever), no enlarged lymph nodes.
3 Pityriasis rosea
Consisting of many erythematous rash with scaling, especially on the edge smooth, elliptical, lenticular, parallel structure with folds of skin. The disease is not accompanied by generalized lymphadenitis as the S II.
4. Psoriasis
The similarity with the S II: there is erythema and scaling. In psoriasis found no generalized lymphadenitis; skuama layered and there are signs of wax droplets and Auspitz.
5. Seborrheic dermatitis
The similarity with the S II is the presence of erythema and scaling. The difference in seborrheic dermatitis; place at the site of predilection is seborrheic, scaly and yellowish oily, not accompanied by generalized lymphadenitis.
6. Condyloma akuminatum
The disease is similar to condyloma lata, both shaped papules. The difference: in condyloma acuminata usually tapered surface, while condyloma lata papules on a flat surface and exudative.

7.Alopesia areata
Local baldness; This disease like alopecia areolaris on the S II. The difference: the larger alopecia areata (numular) and only a few, while the smaller areolaris alopecia (lenticular) and more as well as moth bitten.

C. Differential diagnosis S III
      Primary skin disorder in the S III is guma. Guma also present in other diseases: tuberculosis, yaws, and deep mycoses. Serologic tests on the S III may be negative or weakly positive, because it is a matter of history, whether the patient suffers suspected SI or S II and histopathological examination.

       Mycosis in which may resemble S III is sporotrikosis and actinomycosis. The difference: the sporotrycosis shaped nodes located in accordance with the way the lymph vessels, and the breeding of fungus as the cause will be found. Actinomycosis is very rare in Indonesia. The disease is also composed of infiltrates were softened, as guma S III. The typical localization in the neck, chest, and abdomen. Different skin disorders, ie, there are multiple fistula; the pussy looks yellowish grains called sulfur granules. In the culture will grow Actinomyces.

     Tuberculosis cutis gumosa like guma S III. The way to distinguish is by histopathological examination. Similarly yaws advanced stage. Guma S III is chronic and destructive, because it is similar to malignant disorders. I tell the histopathological examination.

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