[ Syphilis ]

What is Syphilis?

Syphilis is a sexually transmitted disease caused by a bacterium called Treponema pallidum. The Centers for Disease Control reported in November 2002 that the number of cases rose from 5,979 in 2000 to 6,103 in 2001, the first increase since 1990. Those with syphilis are at a higher risk of transmitting and acquiring HIV, the virus that causes AIDS.

The infection is almost always transmitted by sexual contact. An infected person with the initial chancre spreads syphilis to the skin or mucous membranes of the genital area, mouth, or anus of an uninfected sexual partner. It can also be passed through broken skin on other areas.

Women risk passing it to their infants during pregnancy with serious mental and physical problems as a result of this infection. Miscarriage may occur in as many as 25 to 50 percent of women acutely infected with syphilis, and between 40 to 70 percent of women will give birth to a syphilis-infected infant. Infants with congenital syphilis may have symptoms at birth, but most appear 2 weeks to 3 months later. In some cases, symptoms may not be detected until childhood or adolescence.

Symptoms

The initial infection causes a painless ulcer, but many organs are damaged over time, due to the bacteria moving throughout the body. The disease can go through three active stages and a latent (inactive) stage. In the primary stage, the chancre can appear within 10 days to 3 months after exposure, but it generally appears within 2 to 6 weeks. Because it may be painless and inside the body, it may go unnoticed. The ulcer usually appears in an area exposed to the partner's infection, such as the penis, mouth, vagina, or anal region, and sometimes is accompanied with painless, swollen lymph nodes. The ulcer can go away on its own, only for the disease to recur months later as secondary syphilis.

Secondary syphilis is a systemic stage of the disease, where it can involve various organ systems of the body. A skin rash with brown sores about the size of a penny, covering the whole body or a few areas, commonly develops in this chronic stage. Contact with the broken skin of an infected person may spread the infection at this stage. The rash usually heals within several weeks or months. Other symptoms may come and go over the next 1 to 2 years such as mild fever, fatigue, headache, sore throat, patchy hair loss, and swollen lymph glands. These symptoms may be very mild and usually disappear without treatment.

If untreated, syphilis may lapse into a latent stage, which can last as long as twenty or more years, during which the disease is no longer contagious and no symptoms are present.

Approximately one-third of those who have had secondary syphilis go on to develop tertiary syphilis in which the bacteria can damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body, resulting in mental illness, blindness, other neurologic problems, heart disease, or death. Approximately 3 to 7 percent of persons with untreated syphilis develop neurosyphilis, which could be a serious disorder of the nervous system.

Treatment

Left untreated, an infected person may infect others during the first two stages which usually last 1 to 2 years. Untreated in its late stages, although not contagious, can cause serious heart abnormalities, mental disorders, blindness, other neurologic problems, and death.

The usual treatment is penicillin, given by injection, but other antibiotics can be used for patients allergic to penicillin. 24 hours after starting treatment, a person is usually no longer contagious. Some patients do not respond to the usual doses of penicillin and must have periodic blood tests to make sure they have been cured. Proper treatment will cure syphilis, but the damage done to body organs in the late stages cannot be reversed.

NOTE

A mutant syphilis strain which is resistant to azithromycin was reported in the New Englnand Journal of Medicine (July 8, 2004). The researchers at the University of Washington in Seattle have discovered this strain in at least 10% of syphilis samples from four cities. Experts find that patients treated with azithromycin must have a follow-up exam to be sure they are cured.

Testing

Because its early symptoms are similar to those of many other diseases, syphilis is sometimes called "the great imitator". Those who have been treated for another STD should include testing for syphilis, especially if they have a sore or rash in the genital area.

Blood tests, a Venereal Disease Research Laboratory (VDRL ) or a Rapid Plasma Reagent (RPR) provide evidence of infection by identifying antibodies, but not specifically syphilis antibodies. There are possibilities of false-positives and false-negatives, so two blood tests are usually used. Another test would be to identify syphilis bacteria from a sample from a chancre under a microscope. This is referred to as a dark field.