What is this Condition?

A chronic 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 primary and secondary syphilis are reported each year in the United States. Incidence is highest among urban populations, especially in people between ages 15 and 39, drug users, and those infected with HIV Untreated syphilis leads to crippling or death, but the prognosis is excellent with early treatment.

What Causes it?

Infection by the organism Treponema pallidum causes syphilis. The disease spreads primarily through sexual contact during the primary, secondary, and early latent stages of infection. An infected mother can pass the disease to her fetus.

What are its Symptoms?

Primary syphilis develops after an incubation period of about 3 weeks. Initially, one or more chancres (small, fluid-filled lesions) erupt on the genitalia; others may erupt on the anus, fingers, lips, tongue, nipples, tonsils, or eyelids. Usually painless, these chancres start as pimples and then erode; they have hardened, raised edges and clear bases. Chancres typically disappear after 3 to 6 weeks, even when untreated. They’re usually associated with lymph node disease on one or both sides of the body. In women, chancres may be overlooked because they often develop internally, on the cervix or vaginal wall.

Secondary syphilis is marked by development of symmetrical lesions on mucous membranes and skin and general lymphadenopathy, which may develop within a few days or up to 8 weeks after the first chancres appear. The rash of secondary syphilis varies in appearance. 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.

Mild constitutional symptoms, which appear during the secondary stage, may include headache, malaise, lack of appetite, weight loss, nausea, vomiting, sore throat, and possibly a mild fever. Hair loss may occur, with or without treatment, and is usually temporary. Nails become brittle and pitted.

Latent syphilis lacks clinical symptoms but is detected in a serologic test for syphilis. Because infectious lesions may reappear when the infection is less than 4 years old, early latent syphilis is considered contagious. About two-thirds of people are symptom-free in the latent stage and remain so until death. The rest develop characteristic late-stage symptoms.

Late syphilis is the final destructive but noninfectious stage of the disease. It has three subtypes, any or all of which may affect the person: late benign syphilis, cardiovascular syphilis, and neurosyphilis. Late benign syphilis produces lesions 1 to 10 years after infection. They may appear on the skin, bones, mucous membranes, upper respiratory tract, liver, or stomach. In severe cases, late benign syphilis results in destruction of bones or organs, which eventually causes death.

How is it Diagnosed?

Microscopic identification of T. pallidum from a lesion confirms the diagnosis. Other tests may identifY this organism in tissue, eye fluid, cerebrospinal fluid, tracheobronchial secretions, and discharges from lesions.

Additional procedures may include the Venereal Disease Research Laboratory (VDRL) slide test, the rapid plasma reagin test, and cerebrospinal fluid analysis.

How is it Treated?

The treatment of choice is penicillin by intramuscular injection. Persons who are allergic to penicillin may be treated with Achromycin or Vibramycin by mouth for 15 days for early syphilis or for 30 days for late infections. Pregnant women should not be given Achromycin.

What can a Person with Syphilis do?

• Be sure to complete the entire course of drug therapy, even after symptoms subside.

• Arrange for testing after 3,6, 12, and 24 months to detect possible relapse. If you’ve been treated for latent or late syphilis, have blood tests every 6 month for 2 years.

• Inform sexual partners of your infection so they can receive treatment.

• Get tested for HIV.