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Syphilis

Syphilis is a sexually transmitted disease caused by the bacteria treponema pallidum. The spirochete is a wormlike, spiral-shaped organism that wiggles vigorously when viewed under a microscope. It infects the person by burrowing into the moist, mucous-covered lining of the mouth or genitals or rectum. It also may get into your body through cuts or broken skin. The spirochete produces a classic, painless ulcer known as a “chancre”.

There is now effective treatment available for syphilis infections, which can help to prevent the uncomfortable and painful symptoms of the disease. However, if left untreated syphilis can progress, causing serious and potentially life-threatening health complications.

There are four stages of syphilitic infection:

  • Primary (first) stage. The first signs (painless sores called chancres) of syphilitic infection appear. The disease can easily be passed to another person when sores are present. If not treated, the disease continues to the second stage.
  • Secondary (second) stage. Signs and symptoms include a skin rash. As in the first stage, the disease can be passed to another person when signs and symptoms are present. If not treated, the disease progresses to the next stage.
  • Latent (hidden) stage. The disease is no longer contagious and cannot be passed to another person anymore. Some people with latent syphilis have no further symptoms or problems.
  • Tertiary (third) or last stage. Some people with syphilitic infection go on to suffer damage to body organs. They can develop serious complications or die from the disease.

Syphilis transmission

Syphilis

Syphilis

Syphilitic infection is spread from person to person. Syphilis is contracted by coming into direct contact with the sores of an infected person. Sores occur at the site of infection, mainly on the external genitals, vagina, anus, or rectum. Sores can also be on the lips and in the mouth. Syphilis generally occurs during sexual activity, including:

  • vaginal intercourse
  • anal intercourse
  • oral intercourse

Pregnant women who are infected with the syphilis bacteria can also pass the disease on to their child during pregnancy. This is known as congenital syphilis.

Syphilis cannot be spread by contact with toilet seats, door knobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Risk groups

Any sexually active person is at risk for syphilis during sexual contact with an infected person or a person whose syphilis status is not known but risk of contracting the disease increases if you:

  • engage in unprotected sexual activity,
  • have multiple sex partners,
  • are a female between the ages of 20 and 24,
  • are a male between the ages of 35 and 39,
  • engage in male to male sexual intercourse.

Babies born to infected women are also at risk.

Symptoms

Syphilitic symptoms can be difficult to diagnose because they often resemble symptoms of other diseases, such as Chlamydia and gonorrhea. Additionally, syphilis symptoms are often mild in the initial stages of the disease, which means that many men and women do not even realize that they are infected. Symptoms occur in three stages:

Primary Syphilis: During the primary syphilis stage, men and women will notice the appearance of a small, red sore (called a chancre) on their bodies. This chancre generally appears at the site of infection (usually the genitals) within ten and 90 days of infection. This chancre will disappear on its own, leaving a small scar on the skin. If left untreated, symptoms will progress to the secondary syphilis stage.

Secondary Syphilis: Secondary syphilis symptoms generally appear within two and ten weeks of the primary stage. During this stage, the syphilis bacteria have entered the bloodstream and begin to travel throughout the body, causing numerous symptoms. The main symptom of secondary syphilis is the appearance of a reddish-brown rash on the palms of the hands and the soles of the feet. Additional symptoms include: fever, swollen lymph nodes, sore throat, weight loss, muscle and joint pain, and the appearance of lesions all over the body. Secondary syphilis symptoms will eventually disappear. However, without treatment, the syphilis infection will continue to progress.

Tertiary Syphilis: During the third stage of infection, the syphilis bacteria begin to affect the vital organs of the body, including the eyes, liver, kidneys, heart, and brain. Symptoms including memory loss, vision problems, and loss of muscle control may occur. A small percentage of those diagnosed with tertiary syphilis will experience life-threatening complications.

People with syphilis are also much more likely to get HIV (the virus that causes AIDS) if exposed to it.

Diagnosis

This infection can be diagnosed by scraping the base of the ulcer and looking under a special type of microscope (dark field microscope) for the spirochetes. However, since these spirochetes are rarely detected, the diagnosis is most often made and treatment is prescribed based upon the appearance of the chancre. Diagnosis of syphilis is complicated by the fact that the causative organism cannot be grown in the laboratory. Therefore, cultures of affected areas cannot be used for diagnosis.

Special blood tests can also be used to diagnose syphilis.

Complications

If treated promptly, this infection can be cured without causing any serious health complications. However, if left untreated, syphilis can become a very dangerous illness. The syphilis bacteria will begin to attack all areas of the body, including the joints and muscles, heart and lungs, spinal cord and brain. People with long-term syphilitic infection are at risk for:

  • blindness
  • deafness
  • muscle control problems
  • seizures
  • dementia

Because of the sores associated with syphilis, those infected with the disease are also at increased risk for contracting HIV, the virus that causes AIDS.

Pregnant women infected with syphilis are also at increased risk for miscarriage, preterm labor, and stillbirth.

Syphilis and pregnancy

Women suffering from syphilitic infection during pregnancy show similar symptoms to that of other women but they are facing additional risk of infecting newborns. Women with syphilitic infection can have miscarriages, stillbirths and even premature births.
If active syphilitic infection is not treated during pregnancy, mother will pass the infection to her unborn child. About 25% of these pregnancies result in stillbirth or neonatal death. About 40-70% of such pregnancies will yield a syphilis-infected infant.

Some infants with congenital syphilis could have symptoms at birth, but most develop symptoms between two weeks and three months later. These symptoms may include skin sores, rashes, fever, weakened or hoarse crying sounds, swollen liver and spleen, yellowish skin (jaundice), anemia, and various deformities. Care must be taken in handling an infant with congenital syphilis because the moist sores are infectious.

Rarely, the syphilitic symptoms go undetected in infants. As infected infants become older children and teenagers, they may develop the symptoms of late-stage syphilis including damage to their bones, teeth, eyes, ears, and brain.

Babies with congenital syphilitic infection could experience the following symptoms:

  • Skin sores
  • Seizures
  • Fever
  • Swollen liver and spleen
  • Jaundice
  • Anemia
  • Slow development
  • Death due to severe damage done by the disease.

SYPHILIS treatment

If caught in its early stages, syphilis is a very easy disease to treat. Depending on the stage of disease and the clinical manifestations, the treatment options for syphilis vary. Long-acting penicillin injections have been very effective in treating both early and late stage syphilis. The treatment of neuro-syphilis requires the intravenous administration of penicillin. Alternative treatments include oral doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) or tetracycline (Achromycin).

Penicillin should be also used in pregnant patients with syphilitic infection since other antibiotics do not effectively cross the placenta to treat the infected fetus. Left untreated, syphilis can lead to blindness or even death of the infant.

Some patients suffering from syphilitic infection with severe symptoms need to be hospitalized so that they can receive penicillin daily, through an intravenous line. Though treatment of syphilitic infection is effective at getting rid of the bacteria, it cannot reverse damage already done to your body by the disease.

Prevention of syphilitic infection

The following advises can prevent thousands of cases of syphilitic infection:

  • Know your sex partners well. Do not have sex with anyone who has genital sores.
  • Patients with syphilitic infection should abstain from sexual activity until rendered noninfectious by antibiotic therapy.
  • Use condoms – latex condoms used consistently and correctly are an effective means for preventing syphilitic infection.
  • Syphilitic infection cannot be prevented by washing the genitals, urinating, or douching after sex.
  • Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to seek health care right away. Notify all sex partners immediately so that they can seek care, too.
  • If you are pregnant, get a prenatal blood test. Because untreated syphilitic infection in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for this infection.

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