Syphilis

Syphilis is a sexually transmitted disease (STD) often called “the great imitator” because many of its symptoms are indistinguishable from those of other diseases.

Although some people infected with syphilis may not have any symptoms for years, they are still at risk for serious complications or death if the infection goes untreated. Pregnant women who have syphilis can infect their babies during pregnancy or birth, or a stillbirth (a baby born dead) could occur.

The bacteria Treponema pallidum causes syphilis. After it infects a person, it enters the blood stream and attaches to cells and damages organs over time. If left untreated, the syphilis infection progresses through four stages, each stage with its own unique symptoms. Those stages are primary, secondary, latent, and tertiary (or late).

Reporting

Syphilis is an uncommon sexually transmitted disease (STD) in the United States. According to the Center for Disease and Control (CDC), 9,756 cases of syphilis were reported in 2006. Males had approximately 5.6 times more reported cases than females had. (source)
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Transmission

Syphilis is most easily spread during the primary stage because symptoms can go unnoticed. During this stage, syphilis can be transmitted through direct contact with a syphilitic sore (called a chancre). The sores occur in the vagina, on the penis, in the rectum, or on the anus. They can also occur on the lips, tongue, and in the mouth. The most common ways people come in direct contact with these sores is during vaginal, anal, and oral sex.

During vaginal, anal, and oral sex, when the mucous membrane (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts) or an abrasion or cut comes in contact with an infected sore, transmission can occur, even if there is no penetration.

Syphilis in the secondary stage can be transmitted through direct contact with infected lesions or syphilitic “warts” during vaginal, anal, and oral sex. As in the first stage, direct contact must occur with the mucous membrane or an abrasion or cut. Penetration is not required either.

People in the primary and secondary stages can have unrecognizable sores and can unknowingly infect others. People in the latency stage can also infect others because the symptoms of the secondary stage can reoccur.

Men who have sex with other men are at risk of being infected from anal and oral sex. Women who engage in oral sex or vulva (outer female genital area) to vulva contact are also at risk of infection.

Kissing is another way syphilis can be transmitted if one of the people involved has infected sores or lesions in his or her mouth.

Syphilis can also be transmitted when there is no sexual contact. If an abrasion or cut on the hands or anywhere on the body comes in contact with a syphilitic sore, lesion, or wart, transmission can occur. This can put health care workers at risk. Infected donor blood can also cause transmission.

The syphilis bacterium is extremely sensitive to air, light, and changes in temperature, which means direct physical contact with an infected person is needed for transmission. Transmission will not occur through contact with doorknobs, toilet seats, swimming pools, hot tubs, bathtubs, towels, shared clothing, or eating utensils.

An infected woman who is pregnant can transmit syphilis to her baby during pregnancy or during birth. Infected newborns can die shortly after birth or have serious complications later in life. See Congenital Syphilis.

Being treated and cured of syphilis does not make a person immune to re-infection. A person who has been cured can be re-infected if he or she is exposed to it again.
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Symptoms

Syphilis occurs in four stages, each having its own symptoms, besides the latent stage. However, many people infected with the bacteria do not have any symptoms for years or will not have any noticeable symptoms during the first two stages.

Primary Stage

The primary stage of syphilis is marked by the appearance of a single sore (called a chancre), within ten to ninety days (average twenty-one days) after being infected with syphilis. The chancre appears at the spot where syphilis entered the body and is usually firm, small, round, and painless.

It is possible more than one chancre will occur. They can appear anywhere on the body, but mainly on the vulva (outer genital female area), the clitoris and around the opening of the urethra, on the cervix in women and on the penis and foreskin in men, around the anus, and on the tongue and lips in both men and women.

The chancre(s) are very infectious. They will last three to six weeks and will heal with or without treatment. However, without treatment, the infection will progress to the secondary stage.

Secondary Stage

The secondary stage of syphilis is characterized by a skin rash and mucous membrane lesions. This stage can develop seventeen days to six and a half months after infection and typically starts with the development of a rash, which usually does not itch, on one or more areas of the body.

The rash associated with the secondary stage can appear as the chancres from the primary stage are healing or several weeks after they have healed. The rash may appear as rough, red or reddish brown spots on both the bottoms of the feet and palms of the hands. However, rashes with a different appearance, sometimes resembling rashes caused by other diseases, may occur on other parts of the body. Furthermore, sometimes the rashes that occur are so faint that they are not noticeable.

Other symptoms of the secondary stage can include: flat, warty-looking growths or moist, raised skin lesions around the anus or genital area; flat, round, grayish-white sores appearing on the mouth, throat, and cervix; patchy hair loss on the head and other parts of the body; or, swollen lymph glands, fever, headaches, weight loss, muscle aches, or fatigue (feeling tired all the time).

When any of these symptoms are present, syphilis is very infectious. They will last two to six weeks, and will heal with or without treatment. However, without treatment, the infection will progress to the latent and late stages of the disease.

Latent Stage

The latent stage of syphilis is defined as the time there are no signs or symptoms and begins when the symptoms of the secondary stage disappear. This stage can occur two to thirty or more years after infection. During the first two years of this stage, a relapse of the secondary stage can occur. If treatment is not received, the infection will progress to the late stage (tertiary).

Late Stage (Tertiary)

The late stage of syphilis can be serious enough to cause death. This stage can occur two to thirty or more years after infection. During this stage syphilis can damage the internal organs, including the brain, nerves, eyes, blood vessels, heart, liver, joints, and bones.

The symptoms of this stage include gummas (small bumps or tumors that can develop on the skin, bones, liver, and other organs), problems with heart and blood vessels, headaches, memory loss, difficulty coordinating muscle movement, incontinence (inability to control passage of urine), numbness, paralysis, gradual blindness, and dementia.
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Congenital Syphilis

Congenital Syphilis occurs when a newborn is infected with syphilis during pregnancy or in child birth by an infected mother. The infant may be born without signs or symptoms of the disease. However, without immediate treatment, the infant may become developmentally delayed, have seizures, or die.

In cases that go unnoticed and the infant makes it to childhood or adolescence, late congenital syphilis can develop. It has similar symptoms to the late stage of syphilis in adults, though heart complications rarely occur.
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Testing / Diagnosis

There are several different laboratory tests that are used to diagnose syphilis. Examining a sample taken from a sore, lesion, or wart using a special microscope called a dark-field microscope can be performed. If there are no sores, lesions, or warts, a blood sample can be drawn. The blood sample will be screened for certain antibodies with a test called a nontreponemal blood test, but not specifically syphilis antibodies. If its results are positive, a second more specific test called a treponemal blood test will be preformed to confirm the positive result.

It may be helpful to speak to a health care provider to find out what testing options are available.
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Treatment

Syphilis is most commonly treated and cured with the antibiotic penicillin. It is important for patients to tell their health care provider about any allergies to penicillin. If a patient does have an allergy to penicillin, there are other antibiotics available that can treat syphilis. Women should tell their health care provider if there is a chance they could be pregnant.

Syphilis in the primary stage can be easier to treat than in the later stages. Later stages may require daily doses of antibiotics intravenously and may need to be treated in a hospital. On the first day of treatment, a reaction known as the Jarish-Herxheimer reaction may be experienced. Symptoms of this reaction include chills, fever, nausea, achy pain, and headache. This reaction usually does not last more than one day and is probably caused by many bacteria dying at once.

Being treated and cured of syphilis will prevent it from causing the body’s organs further damage. However, any damage that was caused in the later stages can not be reversed.
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Complications

Some people with syphilis will not have any symptoms for years, but are still at risk for serious complications or death if it goes untreated.

When syphilis begins to affect the nervous system (the nerves, spinal cord, and brain) it is called neurosyphilis. Neurosyphilis does not always cause symptoms. When it does, they may be experienced as headaches, memory loss, difficulty coordinating muscle movement, incontinence (inability to control passage of urine), numbness, paralysis, gradual blindness, and dementia. Neurosyphilis can occur five to thirty-five years after exposure and only occurs in a few of the people who go untreated. It affects men more often than women and Caucasians more than African-Americans.

Syphilis that begins to affect the heart and blood vessels is called cardiovascular syphilis. It usually occurs five to ten years after exposure, but may not occur until twenty to thirty years afterwards. Cardiovascular syphilis can lead to scarring of the heart valves, heart failure or heart attack, or the formation of an aortic aneurysm (an abnormal blood-filled expansion of a blood vessel).

Another complication of syphilis is periosteal inflammation (inflammation of the membrane surrounding the bones). This inflammation can cause pain and leads to thickening of the bones. The thickening most often occurs on the leg bones, breastbone, ribs, and skull.

Syphilis can also damage the skin. This damage can include scaling of the skin and alopecia (thinning or loss of the hair on the head or other parts of the body).

Besides causing damage to the body, syphilis makes acquiring Human Immunodeficiency Virus (HIV) more likely. People with open sores or lesions are more likely to acquire HIV if exposed to HIV during sexual activity. People with syphilis and HIV are also more likely to transmit both diseases during sexual activity because the open sores and lesions have an increased amount of the virus in them.

Pregnant women can experience complications as well. Those include miscarriages, premature births, stillbirths (a baby born dead), or death of the newborn shortly after birth. Infants who live and go untreated may become developmentally delayed or have seizures. Other complications for untreated infants can include fever, rash, swollen liver and spleen, anemia, and jaundice (a yellowing of the skin, tissues, or certain body fluids). Infants who live long enough can also experience the complications from late-stage syphilis, which include damage to the eyes, ears, bones, and brain.
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Prevention

Abstaining from sexual contact is the surest way to avoid the transmission of syphilis. A mutual monogamous relationship with a trusted partner known to be tested and uninfected is another way.

Correctly using latex condoms during vaginal or anal sex can reduce the risk of transmission. Correctly using a condom can also reduce the risk of transmission during oral sex (mouth to penis). For other forms of oral sex (mouth to vulva, outer female genital area, or oral to anal also known as rimming) using a dental dam, plastic wrap, or a latex condom cut up and opened flat can be risk reducers. However, syphilitic sores, lesions, and warts can occur on parts of the body that a condom or other forms of protection may not cover, and therefore will not offer protection from transmission in those cases.

It is recommended to use latex condoms or any of the above methods at the very beginning of sexual contact, because transmission of syphilis can occur even if the penis or tongue does not penetrate the vagina, rectum, or mouth. To best keep the risk of transmission low, the protection used should be kept on until there is no longer any skin contact.

Health care providers and people who may come in contact with blood should wear gloves to protect themselves from being infected by syphilis.
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