Syphilis

	Dr. Sue G. DeCotiis Internal Medicine & Skin Care	Syphilis
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Syphilis Syphilis is a sexually transmitted disease caused by a type of bacteria called Treponema pallidum. In its earliest stage, syphilis produces an open sore (ulcer) that leaks fluid filled with syphilis bacteria. Syphilis can be transmitted by contact with this initial ulcer, or by contact with other infectious sores later in the disease, usually during vaginal, oral or anal sex. If untreated, syphilis progresses in a series of stages that affect different parts of the body according to the following patterns (although overlap between stages frequently exists):

	Primary syphilis - In this first stage, syphilis causes a painless ulcer called a chancre, usually in the genital area where syphilis bacteria enter the body. This stage begins 10 to 90 days (average three weeks) after a person has been exposed to someone with syphilis. It resolves without treatment in about four to eight weeks.
	Secondary syphilis - In this stage, the spread of syphilis bacteria causes a generalized rash over most of the body together with fever, aches and pains and other symptoms. This stage begins six to eight weeks after a person is exposed to syphilis, and it lasts up to one year.
	Latent syphilis - This stage begins when the secondary stage ends. Although there are no symptoms, the patient remains infected. This stage can last for many years --even for the rest of a patient's life. About one-third of cases of latent syphilis progress to tertiary syphilis.
	Tertiary syphilis - In this stage, syphilis bacteria can cause severe damage to many different internal organs, including the brain and spinal cord. It usually begins within 10 years of infection and can end in death.

Pregnant women with syphilis can pass the bacteria to their babies, causing a condition known as congenital syphilis. Congenital syphilis causes a variety of skin and organ problems in infants, and it can be deadly. Pregnant women with syphilis also have about a 40-percent chance of having a baby that is stillborn.

In 1995, more than 68,000 American adults were diagnosed with syphilis and more than 1,500 infants were born with congenital syphilis. Currently more than 80 percent of cases of syphilis in the United States are diagnosed in the Southern states.

What are Symptoms of Syphilis?

Symptoms of syphilis vary depending on the specific stage of the illness:

Primary syphilis - Usually, a single ulcer (chancre) appears at the site of initial infection. The genitals are the most common location for chancres to develop, but these ulcers can also form around the mouth or anus. The chancre is firm and painless, and it oozes fluid that contains syphilis bacteria. Sometimes, lymph nodes (swollen glands) become painlessly enlarged in the area of the ulcer. The chancre of primary syphilis usually heals after one to five weeks, although the patient remains infected.

Secondary syphilis - A typical symptom of secondary syphilis is:

	A rash, which may look like rough "copper penny" spots on the palms of the hands and soles of the feet; fine red dots (like a prickly heat rash)
	Small blotches or indented circles; small blisters filled with pus; thick gray or pink patches (called condylomata lata)
	White patches inside the mouth. Without treatment, rash symptoms usually clear after two to six weeks.

Other symptoms may include enlarged lymph nodes (swollen glands), fever, headaches, muscle aches, sore throat, poor appetite, weight loss and an extremely tired feeling. Without treatment, these other symptoms generally last about one year.

Latent stage - This stage causes no symptoms. However, one-third of cases progress to the tertiary stage.

Tertiary syphilis - In this stage, syphilis causes symptoms related to severe body organ damage. These symptoms may include:

	Destructive tumors, called gummas, in the mouth, nose, tongue, bones, skin, liver or other organs
	Symptoms related to heart-valve damage or damage to the wall of the aorta (the major blood vessel bringing blood from the heart to the rest of the body)
	Symptoms related to any joint damage
	Symptoms of damage to the nerves and brain, including paralysis, coordination problems, loss of sensation, blindness, deterioration of intellectual function, personality changes and impotence

How is Syphilis Diagnosed?

If syphilis is expected, your doctor will look for any of the typical symptoms of the disease, especially for a chancre in the genital area. Your doctor can make the diagnosis of syphilis by taking a sample of fluid from a suspicious ulcer and having that fluid examined under a microscope for the presence of syphilis bacteria.

The diagnosis of syphilis also is suggested by detecting certain antibodies in your blood. Some of these tests detect antibodies that are not directed specifically at the syphilis bacteria, but which often are present in people with syphilis. Examples include the VDRL (Venereal Disease Research Laboratory) and the RPR (rapid plasma regain) tests.

However, in some cases, people without syphilis test positive for these antibodies. A positive test may require confirmation with a second test, such as the fluorescent treponemal antibody absorbed (FTA-ABS) test, which detects antibodies specifically directed at the syphilis bacteria.

Because of the high risk of HIV infection in patients with syphilis, public health officials advocate formal HIV testing for all patients infected with syphilis.

Treatment

Patients in the early stages of syphilis (within the first year of infection) usually can be cured with a single injection of the antibiotic penicillin. Patients in later stages require longer penicillin treatment. All sex partners of patients with syphilis must be contacted about the infection so that they can be treated as well. Babies born with congenital syphilis must be treated with penicillin for 10 days.

Expected Duration

Unless treated, syphilis is a lifelong illness.

How Can I Prevent an Infection?

A person who has symptoms of primary or secondary syphilis can pass a syphilis infection to their sex partner. To prevent this from happening, any sexually active person who is not in a monogamous (only one sex partner) relationship with an uninfected person should always use a condom during sexual activity. To prevent the consequences of syphilis infection in babies, every pregnant woman should have a blood test for syphilis.

When Should I Call a Physician?

Call your doctor if you develop any of the symptoms of syphilis, especially if you are pregnant. If you have a sex partner who is diagnosed with syphilis, call your doctor immediately so that you can be treated for syphilis.

What is the Prognosis?

With proper penicillin treatment, early syphilis infection can be cured without causing permanent damage. Although later stages of syphilis also respond to penicillin, this antibiotic will not repair any organ damage caused by the disease. Without treatment, about one-third of patients with latent syphilis progress to tertiary syphilis, and these patients risk severe organ damage and death.

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