Causes and Risks: Syphilis is an infectious disease caused by the spirochete Treponema pallidum, which penetrates broken skin or mucous membranes. Transmission occurs most frequently by sexual contact. Syphilis can also be transferred to the fetus via the placenta after the 10th week of pregnancy. Syphilis has 3 stages. In the primary stage, painless sores, called chancres, appear 10 days to 6 weeks after exposure which can disappear on their own. The secondary stage can begin a week to 6 months after the primary stage. A skin rash is the hallmark of this stage, and lesions may appear again. The lesions are very infectious in this stage. A latent or tertiary phase follows during which no symptoms are present, but syphilis can be diagnosed by blood tests. If the disease has not been effectively treated, bacteria continue to invade the body, and there will be a relapse. The tertiary phase is a widespread infection that infects the internal organs, bones, the heart, and the brain. Approximately 30,000 cases of syphilis in adults are reported each year in the U.S. Congenital syphilis occurs in 1:10,000 live births. Transplacental transmission of syphilis can result in stillbirth. The risk of transmission to the fetus in untreated primary or secondary syphilis is approximately 100%.

Prevention: Avoidance of sexual contact is the only completely reliable method of prevention. Standard condoms offer some protection, but they are not fail-safe. Multiple sexual partners increase the risk of acquiring sexually transmitted diseases. Safer sexual practices are beneficial. Serologic tests for syphilis should be done on high risk, pregnant women.

Symptoms: Untreated syphilis passes through three stages: primary, secondary, and latent or tertiary.

Primary symptoms:

• painless sores on genitals, rectum, mouth, or fingers
• enlarged lymph nodes in the area containing the sores
• sore heals in 4 to 8 weeks

• skin rash, diffuse including palms and soles
• extensive lymph node enlargement
• mucous patches (painless silvery ulcerations of mucous membranes)
• headache
• aches and pains in bones
• loss of appetite
• fever
• fatigue
• secondary stage persisting for a year

• infiltrative tumors of skin, bones, or liver
• cardiovascular syphilis, which affects the aorta causing aneurysms or valve disease
  • central nervous system disorders

• vaginal bleeding between periods
• swallowing difficulty
• nosebleed - symptom
• mouth sores
• hearing loss
• groin lump
• genital lesions (female)
• limited range of motion

Signs and Tests:

• VDRL
• FTA-ABS fluorescent treponemal antibody test
• dark field examination of primary lesion

• serology
• RPR
• FTA-ABS
• febrile/cold agglutinins
• ESR
• Donath-Landsteiner test

Treatment: The objective of treatment is to eliminate the infection with antibiotic therapy. Contact and treatment of all sexual partners is essential. Penicillin (see Penicillin V) is the best choice for all forms of syphilis (or oral tetracycline for those sensitive to penicillin).

The infection must be reported to public health authorities for assistance in identifying and treating contacts. Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure the infection has been eliminated.

There must be abstinence from sexual conduct until 2 follow-up tests have indicated that the infection has been cured. The disease is extremely contagious in the primary and secondary stages.

Prognosis: Lesions associated with syphilis are self-limiting and disappear with little residual damage. Late syphilis may be permanently disabling and lead to death. In untreated persons, about one-third will develop serious late lesions.

Complications:

• tissue destruction of almost any body organ in tertiary infection

Call for an appointment with your health care provider if symptoms worsen or do not improve with treatment, or if new symptoms develop.