What is Syphilis?
Syphilis is a sexually transmitted infection (STI), once responsible
for devastating epidemics. It is caused by a bacterium called
Treponema pallidum. The rate of primary and secondary syphilis in
the United States declined by 89.2% from 1990 to 2000. The number of
cases rose, however, from 5,979 in 2000 to 6,103 in 2001. The U.S.
Centers for Disease Control and Prevention reported in November 2002
that was the first increase since 1990.
Of increasing concern
is the fact that syphilis increases by 3-to 5-fold the risk of
transmitting and acquiring HIV, the virus that causes AIDs.
How Is Syphilis
The syphilis bacterium is very fragile, and the infection is
almost always transmitted by sexual contact with an infected person.
The bacterium spreads from the initial ulcer (sore) of an infected
person to the skin or mucous membranes (linings) of the genital
area, mouth, or anus of an uninfected sexual partner. It also can
pass through broken skin on other parts of the body.
In addition, a
pregnant women with syphilis can pass T. pallidum to her unborn
child, who may be born with serious mental and physical problems as
a result of this infection.
What are the
Symptoms of Syphilis?
The initial infection causes an ulcer at the site of infection. The
bacteria, however, move throughout the body, damaging many organs
over time. Medical experts describe the course of the disease by
dividing it into four stages: primary, secondary, latent, and
tertiary (late). An infected person who has not been treated may
infect others during the first two stages, which usually last 1 to 2
years. In its late stages, untreated syphilis, although not
contagious, can cause serious heart abnormalities, mental disorders,
blindness, other neurologic problems, and death.
The first symptom of primary syphilis is an ulcer called a chancre
("shan-ker"). The chancre can appear within 10 days to 3 months
after exposure, but it generally appears within 2 to 6 weeks.
Because the chancre may be painless and may occur inside the body,
the infected person might not notice it. It usually is found on the
part of the body exposed to the infected partner's ulcer, such as
the penis, vulva, or vagina. A chancre also can develop on the
cervix, tongue, lips, or other parts of the body. The chancre
disappears within a few weeks whether or not a person is treated. If
not treated during the primary stage, about one-third of people will
go on to the chronic stages.
A skin rash, with brown sores about the size of a penny, often
marks this chronic stage of syphilis. The rash appears anywhere from
3 to 6 weeks after the chancre appears. While the rash may cover the
whole body or appear only in a few areas, it is almost always on the
palms of the hands and soles of the feet.
bacteria are present in the sores, any physical contact-sexual or
nonsexual-with the broken skin of an infected person may spread the
infection at this stage. The rash usually heals within several weeks
Other symptoms also
may occur, such as mild fever, fatigue, headache, sore throat,
patchy hair loss, and swollen lymph glands throughout the body.
These symptoms may be very mild and, like the chancre or primary
syphilis, will disappear without treatment. The signs of secondary
syphilis may come and go over the next 1 to 2 years of the disease.
If untreated, syphilis may lapse into a latent stage during
which the disease is no longer contagious and no symptoms are
present. Many people who are not treated will suffer from not
further signs and symptoms of the disease.
Approximately one-third of people who have had secondary
syphilis go on to develop the complications of late, or tertiary,
syphilis, in which the bacteria damage the heart, eyes, brain,
nervous system, bones, joints, or almost any other part of the body.
This stage can last for years, or even for decades. Late syphilis
can result in mental illness, blindness, other neurologic problems,
heart disease, and death.
How is Syphilis
Syphilis is sometimes called "the great imitator" because its
early symptoms are similar to those of many other diseases. Sexually
active people should consult a doctor or other health care worker
about any rash or sore in the genital area. Those who have been
treated for another STI, such as gonorrhea, should be tested to be
sure they do not also have syphilis.
There are three ways
to diagnose syphilis:
- Recognizing the signs and symptoms
- Examining blood samples
- Identifying syphilis bacteria under a microscope
The doctor usually
uses all these approaches to diagnose syphilis and decide upon the
stage of infection.
Blood tests also
provide evidence of infection, although they may give false-negative
results (not show signs of an infection despite its presence) for up
to 3 months after infection. False-positive tests (showing signs of
an infection when it is not present) also can occur. Therefore, two
blood tests are usually used. Interpretation of blood tests for
syphilis can be difficult, and repeated tests are sometimes
necessary to confirm the diagnosis.
How is Syphilis
Unfortunately, the early symptoms of syphilis can be very mild,
and many people do not seek treatment when they first become
Doctors usually treat
patients with syphilis with penicillin, given by injection. They use
other antibiotics for patients allergic to penicillin. A person
usually can no longer transmit syphilis 24 hours after starting
treatment. Some people, however, do not respond to the usual doses
of penicillin. Therefore, it is important that people being treated
for syphilis have periodic blood tests to check that the infectious
agent has been completely destroyed.
neurosyphilis may need to be retested for up to 2 years after
treatment. In all stages of syphilis, proper treatment will cure the
infection. But in late syphilis, damage already done to body organs
cannot be reversed.
Can Syphilis Cause
Syphilis bacteria frequently invade the nervous system during
the early stages of infection. Approximately 3 to 17 percent of
persons with untreated syphilis develop neurosyphilis, a sometimes
serious disorder of the nervous system. In some instances, the time
from infection to developing neurosyphilis may by up to 20 years.
Some people with
neurosyphilis never develop any symptoms. Other have headaches,
stiff neck, and fever that result from an inflammation of the lining
of the brain. Some people develop seizures. People whose blood
vessels are affected may develop symptoms of stroke with numbness,
weakness, or visual problems. Neurosyphilis may be more difficult to
treat, and its course may be different, in people with HIV infection
Note: All information
is based upon materials published by the National Institute of
Allergy and Infectious Diseases (NIAD).
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