Syphilis

Definition of Syphilis

Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum, a type of bacterium known as a spirochete. Sometimes, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as congenital syphilis.

What is going on in the body?

A person can develop syphilis 10 to 90 days after contact with thebacteria. Most people develop symptoms about 3 weeks after contact. This initial infection is known as primary syphilis.

If thebacteria are not effectively killed at this time, the person may develop secondary syphilis. This stage of the infection may show up right after the initial infection clears, or it may be delayed for several weeks.

If the syphilis is not treated effectively, the bacteria remain in the body after the symptoms of secondary syphilis have disappeared. This period is known as latent syphilis.

Treponema pallidum bacteria travel to many vital organs, sometimes infecting the brain, heart, eyes, nerves, and bones. Many years later, the person may develop tertiary syphilis.

What are the signs and symptoms of the infection?

Primary syphilis can cause one or more painless sores, also known as ulcers or chancres, at the point where the bacteria entered the body. These sores are usually on the genitals, but may also be found around the anus, in the rectum or vagina, on the lips, and in the mouth.

Secondary syphilis involves a generalized rash that usually appears on the palms and soles. The usual rash appears as red spots that can be flat or raised. However, many different skin rashes and other symptoms can occur.

Physicians in past decades have called syphilis "the great imitator" because the variety of symptoms can mimic many other diseases. These other symptoms include:

• fatigue
• fever
• hair loss
• headache
• joint pain
• loss of appetite
• sore throat
• weight loss

Meningitis, an inflammation of the membrane lining the brain and spinal cord, occasionally occurs as part of the picture of secondary syphilis. Eye, kidney, and liver symptoms have also been seen with syphilis.

Tertiary syphilis can involve any organ of the body. When the brain is involved, it is called neurosyphilis. Some of the problems neurosyphilis can cause are as follows:

• blindness
• deafness
• dementia
• loss of speech
• psychiatric disturbances
• seizures
• weakness or paralysis

Infants with congenital syphilis can have no obvious signs of the disease. In these cases, the condition is suspected because of a history of syphilis in the mother, and confirmed by blood testing and X-rays. On the other hand, an infant may be severely affected and may not survive.

As with syphilis that is acquired sexually, congenital syphilis can affect any organ in the body. Some of the more common findings in congenital syphilis include:

• bone abnormalities
• enlarged liver and spleen
• enlarged lymph nodes
• low blood count
• rash

If left untreated, the late signs of congenital syphilis include subtle bone malformations, malformed teeth, and eye and brain abnormalities.

What are the causes and risks of the infection?

Treponema pallidum is the cause of syphilis. The organism is spread from one person to another through direct contact with a syphilis chancre. These sores are usually seen on the genitals or anus, but can also be found on the lips and inside the mouth. Therefore, syphilis can be spread by vaginal, anal, or oral sex.

Syphilis can also be passed from a pregnant woman to her unborn child. Rarely, a case of syphilis results from other types of direct contact with blood, such as a puncture wound to the hand during surgery. Blood collected for transfusion is screened for syphilis, to prevent transmission by this route.

What can be done to prevent the infection?

Safer sex practices can reduce, but not eliminate, the risk of syphilis. Male and female condoms provide some degree of protection against infection. Anyone diagnosed with syphilis should encourage his or her recent sexual partners to be screened and treated.

People with HIV (the AIDS virus), or with other sexually transmitted infections should be tested for syphilis. Pregnant women should be screened for syphilis and treated promptly if positive.

How is the infection diagnosed?

The medical history is important for finding out who the person's sexual partners have been, the timing of the sexual exposures, and the types and timing of symptoms of syphilis. On physical exam, the healthcare professional can look for a syphilis chancre at the sites of sexual exposure, and for symptoms of secondary syphilis.

The diagnosis of syphilis, however, depends primarily on antibody tests made on a blood specimen. One type of test is used to screen for syphilis (such as the VDRL or RPR) and another group of more specific tests (such as FTA-ABS or MHA-TP) is used to confirm the diagnosis.

The healthcare professional can also look for the organism in a sample of genital secretions or fluid from a chancre, under a microscope.

What are the long-term effects of the infection?

If left untreated, syphilis is very serious. It can result in neurosyphilis, cardiovascular syphilis, and tumors of the skin, bones, and other organs.

What are the risks to others?

Syphilis is an infection that is spread from person to person sexually. It can also be passed from a pregnant woman to her baby.

What are the treatments for the infection?

A single dose of penicillin can cure syphilis, if the individual has had it for less than a year. A person who has had syphilis for longer than a year will need additional doses of penicillin. Other antibiotics may be used for people who are allergic to penicillin.

What are the side effects of the treatments?

Penicillin and other antibiotics may sometimes cause rashes, allergic reactions, diarrhea, stomach upset, and nausea.

What happens after treatment for the infection?

If syphilis is treated effectively and on time, the person will usually have no further difficulty. One episode of syphilis, however, does not protect against another infection if the person is exposed again.

How is the infection monitored?

Successful treatment is accompanied by a decreasing antibody level to T. pallidum. Any new or worsening symptoms should be reported to the healthcare professional.