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Syphilis - Symptoms & Treatment

A chronic, infectious, sexually transmitted disease, syphilis begins in the mucous membranes and quickly becomes systemic, spreading to nearby lymph nodes and the bloodstream. This disease, when untreated, is characterized by progressive stages: primary, secondary, latent, and late (formerly called tertiary).

About 34,000 cases of syphilis, in primary and secondary stages, are reported annually in the United States. Incidence is highest among urban populations, especially in persons between ages 15 and 39, drug users, and those infected with the human immunodeficiency virus (HIV).

Untreated syphilis leads to crippling or death, but the prognosis is excellent with early treatment.

Causes

The syphilis bacterium is passed from person to person through direct contact with a syphilis sore. Sores mainly occur on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Signs and symptoms

Each stage produces distinctive signs and symptoms.

Primary syphilis : The first symptom of syphilis infection is usually a small painless sore (chancre) in the area of sexual contact (penis, vagina, anus, rectum, or mouth). The sore usually appears about 2-6 weeks after exposure and disappears within a few weeks

Secondary syphilis

The development of symmetrical mucocutaneous lesions and general lymphadenopathy signals the onset of secondary syphilis, which may develop within a few days or up to 8 weeks after the onset of initial chancres.

The rash of secondary syphilis can be macular, papular, pustular, or nodular. Lesions are of uniform size, well defined, and generalized. Macules often erupt between rolls of fat on the trunk and on the arms, palms, soles, face, and scalp. In warm, moist areas (perineum, scrotum, vulva, between rolls of fat), the lesions enlarge and erode, producing highly contagious, pink, or grayish-white lesions (condylomata lata).

Mild constitutional symptoms of syphilis appear in the second stage and may include headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat and, possibly, slight fever. Alopecia may occur, with or without treatment, and is usually temporary. Nails become brittle and pitted.

Late or Latent syphilis

The final, destructive, but noninfectious stage of the disease, late syphilis has three subtypes, any or all of which may affect the patient: late benign syphilis, cardiovascular syphilis, and neurosyphilis.

After the secondary stage, some people with syphilis progress to a latent stage where they have no more symptoms. Others go on to have symptoms of late syphilis that can appear even years later and affect the eyes, large blood vessels, heart, and bones. Neurosyphilis, by definition, is an infection of the central nervous system. The symptoms of this late stage of syphilis may include memory loss, problems with mental function, walking, balance, bladder control, and vision, in addition to impotence and loss of feeling, particularly in the legs.

Diagnosis

The proper diagnostic tests for syphilis depend on the stage of the disease and may include: dark field examination of primary lesion (in primary syphilis), and blood tests such as VDRL or RPR and FTA-ABS. In the case of neurosyphilis, a spinal tap is required to make the diagnosis and may be sent for VDRL and/or FTA-ABS.

Treatment

Administration of penicillin I.M. is the treatment of choice. For early syphilis, treatment may consist of a single injection of penicillin G benzathine I.M. (2.4 million units). Syphilis of more than 1 year's duration should be treated with penicillin G benzathine I.M. (2.4 million units/week for 3 weeks).

Nonpregnant patients who are allergic to penicillin may be treated with oral tetracycline or doxycycline for 15 days for early syphilis; 30 days for late infections. Nonpenicillin therapy for latent or late syphilis should be used only after neurosyphilis has been excluded. Tetracycline is contraindicated in pregnant women.

Prevention

To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex:

• Avoid sex, or limit sexual relations to a single, uninfected partner.
• If you don't know the STD status of your partner, use a latex condom with each sexual contact.
• Avoid excessive use of alcohol or other drugs, which can cloud judgment and lead to unsafe sexual practices.