Syphilis | Infections-STDs

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What is Syphilis?

Syphilis is a sexually transmitted disease (STD) caused by a microscopic organism called Treponema pallidum. This organism fits in a category of organisms called spirochetes. It is easily treated, but can cause serious complications if not treated early. Both men and women can have syphilis, and it can be passed from an infected pregnant woman to her unborn infant. Syphilis is generally divided into a number of different stages which define how long the infection has been present, what organs and tissues are involved or not involved and the amount of injury or damage that has been caused to the body, its tissues and organs. Syphilis can involve the skin, bones, heart, brain, nervous tissues and reproductive organs.

How Do You Know You Have It?

Syphilis occurs in three stages, and is often silent until the very latest stages, unless diagnosed along the way by special blood testing procedures. It is important to always consider the possibility of syphilis when any unusual pattern of symptoms occurs and have a blood test to rule it out or make a diagnosis.

Primary Syphilis

The first stage, often referred to as Primary Syphilis, is recognized by a hard, usually painless, sore on the genitals, mouth, lip or other point of sexual contact. This sore is called a chancre. Lymph glands can be swollen but are usually not tender and painless. This sore will usually appear two to six weeks after infection, but it can appear any time from ten to ninety days after infection. It normally heals completely within four weeks from the time it first appears. Even though symptoms disappear without treatment you remain infectious.

Diagnosis depends on the demonstration of the organism T pallidum by dark-field microscopy. There is no merit in performing this test on oral lesions because other treponemal, microscopically indistinguishable from T pallidum often occur in the mouth. A presumptive diagnosis can be made if a typical ulcer is associated with a consistent history of syphilis in sex partners and/or serologic pattern before or after treatment in the patient. An infected, untreated person may remain infectious through sexual contact for up to two years.

Primary Syphilis - Chancre

Secondary Syphilis

Typical lesions of secondary syphilis include a flat red rash on the body, one or more weeping sores or lumps on the genitals, called condylomata lata, hair loss, fever, or general tiredness. In more advanced cases the liver, bones, joints and the iris of the eye can become infected. Lymph glands can become swollen. These symptoms may appear two to four months after infection and last several weeks. If not treated they often come back. The rash can be over the whole body, and is very contagious.

The blood test, VDRL or RPR are positive and increase (sometimes as much as fourfold within 6 months) and a correspondingly fall after treatment. In secondary syphilis the RPR titer will usually be 1:8 or greater.

Secondary Syphilis Rash

Latent Syphilis

The third stage generally referred to as Latent Syphilis occurs many years after the initial infection. It only occurs in about a third of untreated individuals, and may involve the brain or the heart, producing severe complications. This stage is no longer infectious. It is often divided in to three substages, Early and Late Latent Syphilis and Later or Tertiary Syphilis.

Early Latent Syphilis

Most people with early latent syphilis are asymptomatic patient with positive RPR and TPHA and one of the following:

Negative serology within the previous 2 years

Fourfold increase in RPR titer on subsequent testing

Fourfold decline in RPR within 12 months after treatment

Late Latent (Hidden) Syphilis

Late symptomatic syphilis is suggested when a positive RPR may turn negative in association with typical neurologic or cardiovascular signs. There are no symptoms yet neurosyphilis is suggested by positive serology and a positive Cerebrospinal fluid (CSF) -VDRL. CSF examination is indicated:

Before treatment of any patient with a non-penicillin regimen

For patients who do not respond adequately or relapse after therapy

For patients with positive serology and signs of neurosyphilis

Late latent syphilis is characterized by a positive TPHA or FTA-ABS tests and a negative or stable low titer RPR test. This same pattern may be due to adequately treated syphilis or a false positive treponemal test.

For all HIV positive patients who have syphilis

Late (Tertiary) Syphilis

Late syphilis can and often does involve the aorta, aneurysm and aortic valvular disease. The central nervous system is effected including degenerative changes, pain in extremities, dementia and psychosis.

Diagnosis and Treatment

Syphilis is diagnosed by blood tests. Penicillin is the most effective treatment.

How Can it Be Prevented?

Use of condoms and being selective or sexual partners is essential as with all other STDs

You should not have sex until your partner has been tested and treated.

After treatment regular blood tests Should be taken to confirm a cure.

Use condoms during sex. A condom used properly will reduce the risk of infection. If you have syphilis, do not have further sex until treatment is finished.

Follow-Up

If you have had a positive test for syphilis and been treated with medication should be followed up 4 weeks after treatment. At that time a clinical assessment will be made and review of whether sex partner have been notified and treated. Subsequent medical reevaluations should be planned at 3, 6 and 12 months. At each of these visits clinical assessment and repeat serology testing will likely be performed.