Syphilis
Syphilis is a curable sexually transmitted
disease caused by the Treponema pallidum spirochete.
The route of transmission of syphilis is almost always
by sexual contact, although there are examples of congenital
syphilis via transmission from mother to child in utero.
The signs and symptoms of syphilis are numerous; before
the advent of serological testing, precise diagnosis
was very difficult. In fact, the disease was dubbed
the "Great Imitator" because it was often
confused with other diseases, particularly in its tertiary
stage. Syphilis (unless antibiotic-resistant) can be
easily treated with antibiotics including penicillin.
The oldest and still most effective method is an intramuscular
injection of benzathine penicillin. If not treated,
syphilis can cause serious effects such as damage to
the heart, aorta, brain, eyes, and bones. In some cases
these effects can be fatal. In 1998, the complete genetic
sequence of T. pallidum was published which may aid
understanding of the pathogenesis of syphilis.
• Primary Syphilis
Primary syphilis is typically acquired via direct sexual
contact with the infectious lesions of a person with
syphilis.[15] Approximately 10-90 days after the initial
exposure (average 21 days), a skin lesion appears at
the point of contact, e.g. the genitalia. Syphilis can
not be contracted through toilet seats, daily activities,
hot tubs, or sharing eating utensils or clothing.[
• Secondary Syphilis
Secondary syphilis occurs approximately 1-6 months
(commonly 6 to 8 weeks) after the primary infection.
There are many different manifestations of secondary
disease. There may be a symmetrical reddish-pink non-itchy
rash on the trunk and extremities. Other symptoms common
at this stage include fever, sore throat, malaise, weight
loss, headache, meningismus, and enlarged lymph nodes.
• Latent Syphilis
Latent syphilis is defined as having serologic proof
of infection without signs or symptoms of disease. Latent
syphilis is further described as either early or late.
Early latent syphilis is defined as having syphilis
for two years or less from the time of initial infection
without signs or symptoms of disease. Late latent syphilis
is infection for greater than two years but without
clinical evidence of disease.
• Tertiary Syphilis
Tertiary syphilis usually occurs 1-10 years after the
initial infection, though in some cases it can take
up to 50 years. This stage is characterized by the formation
of gummas which are soft, tumor-like balls of inflammation
known as granulomas.
• Neurosyphilis
Neurosyphilis refers to a site of infection involving
the central nervous system (CNS). Neurosyphilis may
occur at any stage of syphilis. Before the advent of
antibiotics, it was typically seen in 25-35% of patients
with syphilis. Neurosyphilis is now most common in patients
with HIV infection.
Management
While abstinence from any sexual activity is very effective
at helping prevent Syphilis, it should be noted that
T. pallidum readily crosses intact mucosa and cut skin,
including areas not covered by a condom. Proper and
consistent use of a latex condom can reduce, but not
eliminate, the spread of syphilis.
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