Syphilis

Syphilis is a chronic, infectious. sexually transmitted disease that begins in the mucous membranes and quickly becomes systemic, spreading to nearby lymph nodes and the bloodstream. Untreated, the disease progresses in four stages: primary, secondary, latent, and late (formerly called tertiary).

Incidence in the United States is highest among urban populations, especially in people between ages 15 and 39, drug users, and those infected with the human immunodeficiency virus (HIV).

Untreated syphilis can lead to crippling or death. With early treatment, the prognosis is excellent. The incubation period varies but typically lasts about 3 weeks.

Causes

Syphilis is caused by the bacterium Treponema pallidium. People become infected by close direct contact with a syphilitic ulcer, usually during sexual contact.

You cannot catch syphilis from towels, baths, toilets, or crockery.

Symptoms and Signs

• Painless sores
  • genital lesions (male and female)
  • mouth sores
  • skin lesions
  • sores or lesions on the rectum
• Enlarged lymph nodes in the area containing the chancre
• A chancre or sore that heals in 4 to 8 weeks

Diagnostic tests

Dark-field microscopy identifies T. pallidum from lesion exudate provides an immediate syphilis diagnosis. This method is most effective when moist lesions are present, as in primary, secondary, and congenital syphilis.

Nontreponemal serologic tests include the Venereal Disease Research Laboratory (VDRL) slide test, the rapid plasma reagin (RPR) test, and the automated reagin test. These tests can detect nonspecific antibodies, which become reactive within 1 to 2 weeks after the primary syphilis lesion appears or 4 to 5 weeks after the infection begins. Rapid and inexpensive, the tests are used for screening patients and blood products.

Treponemal serologic studies include the fluorescent treponemal antibody absorption test, the T. pallidum hemagglutination assay, and the microhemagglutination assay. These tests detect the specific antitreponemal antibody and can confirm positive screening results. Once reactive, a patient's blood samples will always be reactive.

Cerebrospinal fluid examination identifies neurosyphilis when the total protein level is above 40 mg/dl, the VORL slide test is reactive, and the white blood cell count exceeds five mononuclear cells/mm³.

Treatment

Antibiotic therapy - penicillin administered 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 may respond to penicillin G bepzathine I.M. (2.4 million units/week for 3 weeks).

Patients who are allergic to penicillin may be successfully treated with tetracycline or erythromycin ineither case, 500 mg by mouth four times a day for 15 days for early syphilis, 30 days for late infections). Tetracycline is contraindicated during pregnancy.

Prevantion

Safer sexual practices and consistent condom use are important measures in the prevention of syphilis. In addition, early diagnosis and treatment is needed to prevent ongoing transmission of this disease, as is screening during any evaluation for a sexually transmitted disease.

Screening of all pregnant women for syphilis is another measure to decrease the risk that the disease will be passed on to the fetus.

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