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Syphilis

Overview

Syphilis is a bacterial infection that is sexually transmitted and highly contagious. A person infected with syphilis may remain asymptomatic for days. Initially, it affects the genitals, anus, or mouth and causes a painless sore but has three stages of illness, each having different signs and symptoms. It can be transferred to the baby during pregnancy and delivery. It can also be transmitted through blood products and direct contact with the sores. It is usually treated with antibiotics, but it can have serious complications involving the heart, brain, eyes, joints, and other organs if left untreated. It is prevented by having safe sex.

Causes

A bacterium treponema pallidum causes syphilis. It is spread by direct contact with the lesion during sex. The bacteria penetrate through cuts and abrasions. It can also spread through blood products and sharing injection needles. An infected mother can transmit the disease to the unborn baby and also during delivery. An asymptomatic person can act as a carrier and spread the disease without knowing. It is not transmitted by using the same toilet seats, baths, swimming pools, utensils.

Epidemiology

Syphilis is a very common sexually transmitted disease (STD). It is more prevalent in males than females. It is common during the peak ages of sexual activity that is 20- 29 years. It also increases the risk of acquiring HIV.

Risk Factors

The reasons that increase your chances of getting the infection are

  • Having unprotected sex
  • Men having sex with men
  • Sharing needles for using drugs
  • Sex with multiple partners
  • Sex with a person who is not screened for STD

Signs And Symptoms

The incubation period (the period between the inoculation with the bacteria and the appearance of symptoms) for syphilis is 21 days but can range from 10 – 90 days. Some people may be asymptomatic for years and be a reason for transmission. Syphilis causes disease in different stages, each with different signs and symptoms.
Primary stage:
In the primary stage, syphilis presents as a firm, painless, non-itchy ulceration called a chancre on genitals, i.e., penis in men and vulva or cervix in females. Less commonly, it can occur around the anus or mouth. It is highly infectious and contains bacteria. Some people may have multiple sores. Lymph nodes around the lesion may be enlarged. Since it’s painless, it can go unnoticed. Without treatment, it heals within 3-6 weeks.
Secondary stage:
It occurs after four to six weeks of primary syphilis. It affects the skin, mucous membranes, and lymph nodes. It causes symmetrical, reddish-pink, non-itchy rashes on the trunk, hands, legs, even palms, and soles. On mucous membranes, it appears as wart-like lesions known as condyloma latum. All these lesions are highly infectious and contain bacteria.
You may also feel fever, malaise, nausea, fatigue, headache, swollen lymph nodes, and weight loss.
The symptoms resolve in three to six weeks.
Latent stage:
In this stage, the virus goes hidden, and you may have no symptoms even for years. It comes after the secondary stage. After this stage, the symptoms may never return, or you may proceed to the tertiary stage.
Tertiary stage:
This stage appears after three to ten years of initial infection. In this stage, the bacteria are not usually contagious. It can affect any organ but is usually divided into three forms:

  • Gummatous syphilis: In this form, soft, disfiguring tumor-like masses can appear anywhere in the body, especially the skin, bone, liver.
  • Heart: it can damage the valves, blood vessel (aorta)
  • Brain (neurosyphilis): in this form, it damages the nervous system resulting in paralysis, headaches, dementia, movement and balance problems, eye problems.
    Congenital syphilis:
    It occurs if syphilis is transmitted to the newborn baby by an infected mother. It can remain asymptomatic until two years, after which it can affect the liver, spleen, causing enlargement, skin rashes, neurosyphilis, lung problems. Late congenital syphilis can cause teeth problems (Hutchinson’s teeth) and saddle nose deformity. Early in pregnancy, it can cause miscarriage.

Diagnosis

 Diagnosis is made by following tests:
Blood tests:  They test for antibodies in the blood (treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs).
Direct testing: the bacteria can be visualized directly using a special method called dark field microscopy of the serous fluid taken from the chancre. PCR test can also be done directly on chancre. It checks for syphilis genes. 
Cerebrospinal fluid testing (CSF): if you are suspected of having neurosyphilis, your CSF sample will be collected through a lumbar puncture.
Syphilis is a notifiable disease. Once you are tested positive, you need to notify the authorities, and they can trace the contacts for detection and treatment of the disease to prevent further spread.

Differential Diagnosis

Due to its multiple presentations of symptoms in different stages, many diseases can be similar to syphilis like

  • STDs with gonorrhea, chlamydia
  • Urinary tract infection
  • Other ulcerative diseases like condyloma acuminatum
  • Fungal infection
  • Sarcoid
  • Dermatitis
  • Genital warts
  • Herpes simplex and herpes zoster infections
  • HIV infection
  • Granuloma inguinale

Treatment

The drug of choice for all stages of syphilis is penicillin (Benzathine penicillin G). It is given in the form of intramuscular injection. People who are allergic to penicillin can be given doxycycline.
 You may have a fever, malaise, headache, and increased heart rate when the treatment is started. This is due to the release of inflammatory substances by dying bacteria. This reaction is called Jarisch–Herxheimer reaction. It is managed by giving pain and fever medicines.

Prognosis

Syphilis is a curable disease. If treated on time with the correct medications, it can heal completely. If left untreated, it can cause serious health problems and badly affect various organs of the body like the heart, brain, skin, and bones, causing debilitating symptoms. It can also increase the chances of getting HIV. It can put the pregnancy at risk and can cause congenital syphilis in babies.

Prevention

You can prevent yourself from getting infected with syphilis by;

  • Adapting safe sex (using condoms)
  • Having limited sexual partners
  • Not having sex with someone suffering from STD
  • Avoid sex until completing your entire course of antibiotics
  • Avoid sharing a needle for drugs

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