syphilis
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Syphilis

Syphilis

Definition

Syphilis is an infectious systemic disease that may be either congenital or acquired through sexual contact or contaminated needles.

Description

Syphilis has both acute and chronic forms that produce a wide variety of symptoms affecting most of the body's organ systems. The range of symptoms makes it easy to confuse syphilis with less serious diseases and ignore its early signs. Acquired syphilis has four stages (primary, secondary, latent, and tertiary) and can be spread by sexual contact during the first three of these four stages.

Syphilis, which is also called lues (from a Latin word meaning "plague"), has been a major public health problem since the sixteenth century. The disease was treated with mercury or other ineffective remedies until World War I, when effective treatments based on arsenic or bismuth were introduced. These were succeeded by antibiotics

after World War II. At that time, the number of cases in the general population decreased, partly because of aggressive public health measures. This temporary decrease, combined with the greater amount of attention given to AIDS in recent years, leads some people to think that syphilis is no longer a serious problem. In fact, the number of cases of syphilis in the United States rose between 1980 and 2001. This increase affected both sexes, all races, all parts of the nation, and all age groups, including adults over 60. The number of women of childbearing age with syphilis is the highest that has been recorded since the 1940s. About 25,000 cases of infectious syphilis in adults are reported annually in the United States. It is estimated, however, that 400,000 people in the United States need treatment for syphilis every year, and that the annual worldwide total is 50 million persons.

In 1999, the Centers for Disease Control and Prevention (CDC) joined several other federal agencies in announcing the "National Plan to Eliminate Syphilis in the United States." Eliminating the disease was defined as the absence of transmission of the disease; that is, no transmission after 90 days following the report of an imported index case. The national goals for eliminating syphilis include bringing the annual number of reported cases in the United States below 1000, and increasing the number of syphilis-free counties to 90% by 2005. In November 2002, the CDC released figures for 20002001, which indicate that the number of reported cases of primary and secondary syphilis rose slightly. This rise, however, occurred only among men who have sex with other men. The CDC also stated that the number of new cases of syphilis has actually declined among women as well as among non-Hispanic blacks.

The increased incidence of syphilis since the 1970s is associated with drug abuse as well as changes in sexual behavior. The connections between drug abuse and syphilis include needle sharing and exchanging sex for drugs. In addition, people using drugs are more likely to engage in risky sexual practices. As of 2002, the risk of contracting syphilis is particularly high among those who abuse crack cocaine.

With respect to changing patterns of conduct, a sharp increase in the number of people having sex with multiple partners makes it more difficult for public health doctors to trace the contacts of infected persons. Women are not necessarily protected by having sex only with other women; in the past few years, several cases have been reported of female-to-female transmission of syphilis through oral-genital contact. In addition, the incidence of syphilis among men who have sex with other men continues to rise. Several studies in Latin America as well as in the United States reported in late 2002 that unprotected sexual intercourse is on the increase among gay and bisexual men.

Changing patterns of sexual behavior have led to a striking increase in the number of cases of syphilis in eastern Europe since the collapse of the Soviet Union; Slovenia reported an 18-fold increase in reported cases of syphilis just between 1993 and 1994. Over half of the new cases were linked to a source of infection in another European country.

In general, high-risk groups for syphilis in the United States and Canada include:

  • sexually active teenagers
  • people infected with another sexually transmitted disease (STD), including AIDS, herpes, and gonorrhea
  • sexually abused children
  • women of childbearing age
  • prostitutes of either sex and their customers
  • prisoners
  • persons who abuse drugs or alcohol

The chances of contracting syphilis from an infected person in the early stages of the disease during unprotected sex range from 3050%.

Causes & symptoms

Syphilis is caused by a spirochete, Treponema pallidum. A spirochete is a thin spiral- or coil-shaped bacterium that enters the body through the mucous membranes or breaks in the skin. In 90% of cases, the spiro-chete is transmitted by sexual contact. Transmission by blood transfusion is possible but rare, not only because blood products are screened for the disease, but also because the spirochetes die within 24 hours in stored blood. Other methods of transmission are highly unlikely because T. pallidum is easily killed by heat and drying.

Primary syphilis

Primary syphilis is the stage of the organism's entry into the body. The first signs of infection are not always noticed. After an incubation period ranging from 1090 days, the patient develops a chancre, which is a small blister-like sore about 0.5 in (13 mm) in size. Most chancres are on the genitals, but may also develop in or on the mouth or on the breasts. Rectal chancres are common in male homosexuals. Chancres in women are sometimes overlooked if they develop in the vagina or on the cervix. The chancres are not painful and disappear in three to six weeks even without treatment. They resemble the ulcers of lymphogranuloma venereum, herpes simplex virus, or skin tumors.

About 70% of patients with primary syphilis also develop swollen lymph nodes near the chancre. The nodes may have a firm or rubbery feel when the doctor touches them but are not usually painful.

Secondary syphilis

Syphilis enters its secondary stage ranging from six to eight weeks to six months after the infection begins. Chancres may still be present but are usually healing. Secondary syphilis is a systemic infection marked by the eruption of skin rashes and ulcers in the mucous membranes. The skin rash may mimic a number of other skin disorders such as drug reactions, rubella ringworm, mononucleosis , and pityriasis rosea . Characteristics that point to syphilis include:

  • a coppery color
  • absence of pain or itching
  • occurrence on the palms of hands and soles of feet

The skin eruption may resolve in a few weeks or last as long as a year. The patient may also develop condylomata lata, which are weepy pinkish or gray areas of flattened skin in the moist areas of the body. The skin rashes, mouth and genital ulcers, and condylomata lata are all highly infectious.

About 50% of patients with secondary syphilis develop swollen lymph nodes in the armpits, groin, and neck areas; about 10% develop inflammations of the eyes, kidney, liver, spleen, bones, joints, or the meninges (membranes covering the brain and spinal cord). They may also have a flulike general illness with a low fever, chills , loss of appetite, headaches, runny nose, sore throat , and aching joints.

Latent syphilis

Latent syphilis is a phase of the disease characterized by relative absence of external symptoms. The term latent does not mean that the disease is not progressing or that the patient cannot infect others. For example, pregnant women can transmit syphilis to their unborn children during the latency period.

The latent phase is sometimes divided into early latency (less than two years after infection) and late latency. During early latency, patients are at risk for spontaneous relapses marked by recurrence of the ulcers and skin rashes of secondary syphilis. In late latency, these recurrences are much less likely. Late latency may either resolve spontaneously or continue for the rest of the patient's life.

Tertiary syphilis

Untreated syphilis progresses to a third or tertiary stage in about 3540% of patients (only those who go untreated). Patients with tertiary syphilis cannot infect others with the disease. It is thought that the symptoms of this stage are a delayed immune hypersensitivity reaction to the spirochetes. Some patients develop so-called benign late syphilis, which begins between three and 10 years after infection and is characterized by the development of gummas. Gummas are rubbery tumor-like growths that are most likely to involve the skin or long bones but may also develop in the eyes, mucous membranes, throat, liver, or stomach lining. Gummas are increasingly uncommon since the introduction of antibiotics for treating syphilis. Benign late syphilis is usually rapid in onset and responds well to treatment.

CARDIOVASCULAR SYPHILIS. Cardiovascular syphilis occurs in 1015% of patients who have progressed to tertiary syphilis. It develops between 10 and 25 years after infection and often occurs together with neurosyphilis. Cardiovascular syphilis usually begins as an inflammation of the arteries leading from the heart and heart attacks, scarring of the aortic valves, congestive heart failure, or the formation of an aortic aneurysm.

NEUROSYPHILIS. About 8% of patients with untreated syphilis will develop symptoms in the central nervous system that include both physical and psychiatric symptoms. Neurosyphilis can appear at any time from five to 35 years after the onset of primary syphilis. It affects men more frequently than women and Caucasians more frequently than African Americans.

Neurosyphilis is classified into four types:

  • Asymptomatic. In this form of neurosyphilis, the patient's spinal fluid gives abnormal test results but there are no symptoms affecting the central nervous system.
  • Meningovascular. This type of neurosyphilis is marked by changes in the blood vessels of the brain or inflammation of the meninges (the tissue layers covering the brain and spinal cord). The patient develops headaches, irritability, and visual problems. If the spinal cord is involved, the patient may experience weakness of the shoulder and upper arm muscles.
  • Tabes dorsalis. Tabes dorsalis is a progressive degeneration of the spinal cord and nerve roots. Patients lose their sense of perception of body position and orientation in space (proprioception), resulting in difficulties walking and loss of muscle reflexes. They may also have shooting pains in the legs and periodic episodes of pain in the abdomen, throat, bladder, or rectum. Tabes dorsalis is sometimes called locomotor ataxia.
  • General paresis. General paresis refers to the effects of neurosyphilis on the cortex of the brain. The patient has a slow but progressive loss of memory, decreased ability to concentrate, and less interest in self-care. Personality changes may include irresponsible behavior, depression , delusions of grandeur, or complete psychosis. General paresis is sometimes called dementia paralytica, and is most common in patients over 40.

Special populations

NEWBORNS. Congenital syphilis has increased at a rate of 400500% over the past decade, on the basis of criteria introduced by the Centers for Disease Control (CDC) in 1990. In 1994, more than 2,200 cases of congenital syphilis were reported in the United States. The prognosis for early congenital syphilis is poor: about 54% of infected fetuses die before or shortly after birth. Those who survive may look normal at birth but show signs of infection between three and eight weeks later.

Infants with early congenital syphilis have systemic symptoms that resemble those of adults with secondary syphilis. There is a 4060% chance that the child's central nervous system will be infected. These infants may have symptoms ranging from jaundice , enlargement of the spleen and liver, and anemia to skin rashes, condylomata lata, certain congenital bone abnormalities, inflammation of the lungs, "snuffles" (a persistent runny nose), and swollen lymph nodes.

CHILDREN. Children who develop symptoms after the age of two years are said to have late congenital syphilis. The characteristic symptoms include facial deformities (saddle nose), Hutchinson's teeth (abnormal upper incisors), saber shins, dislocated joints, deafness, mental retardation, paralysis, and seizure disorders.

PREGNANT WOMEN. Syphilis can be transmitted from the mother to the fetus through the placenta at any time during pregnancy , or through the child's contact with syphilitic ulcers during the birth process. The chances of infection are related to the stage of the mother's disease. Almost all infants of mothers with untreated primary or secondary syphilis will be infected, whereas the infection rate drops to 40% if the mother is in the early latent stage and 614% if she has late latent syphilis.

Pregnancy does not affect the progression of syphilis in the mother; however, pregnant women should not be treated with tetracyclines.

HIV PATIENTS. Syphilis has been closely associated with HIV infection since the late 1980s. Syphilis sometimes mimics the symptoms of AIDS. Conversely, AIDS appears to increase the severity of syphilis in patients suffering from both diseases, and to speed up the development or appearance of neurosyphilis. Patients with HIV are also more likely to develop lues maligna, a skin disease that sometimes occurs in secondary syphilis. Lues maligna is characterized by areas of ulcerated and dying tissue. In addition, HIV patients have a higher rate of treatment failure with penicillin than patients without HIV.

ADULT MALES. A recent study indicates that infection with syphilis increases a man's risk of developing prostate cancer in later life. It is thought that infection may represent one mechanism among several through which prostate cancer may develop.

Diagnosis

Patient history and physical diagnosis

The diagnosis of syphilis is often delayed because of the variety of early symptoms, the varying length of the incubation period, and the possibility of not noticing the initial chancre. Patients do not always connect their symptoms with recent sexual contact. They may go to a dermatologist when they develop the skin rash of secondary syphilis rather than to their primary care doctor. Women may be diagnosed in the course of a gynecological checkup. Because of the long-term risks of untreated syphilis, certain groups of people are now routinely screened for the disease:

  • pregnant women
  • sexual contacts or partners of patients diagnosed with syphilis
  • children born to mothers with syphilis
  • patients with HIV infection
  • persons applying for marriage licenses

When the doctor takes the patient's history, he or she will ask about recent sexual contacts in order to determine whether the patient falls into a high-risk group. Other symptoms, such as skin rashes or swollen lymph nodes, will be noted with respect to the dates of the patient's sexual contacts. Definite diagnosis, however, depends on the results of laboratory blood tests.

Blood tests

There are several types of blood tests for syphilis presently used in the United States. Some are used in follow-up monitoring of patients as well as diagnosis.

NONTREPONEMAL ANTIGEN TESTS. Nontreponemal antigen tests are used as screeners. They measure the presence of reagin, which is an antibody formed in reaction to syphilis. In the Venereal Disease Research Laboratory (VDRL) test, a sample of the patient's blood is mixed with cardiolipin and cholesterol . If the mixture forms clumps or masses of matter, the test is considered reactive or positive. The serum sample can be diluted several times to determine the concentration of reagin in the patient's blood.

The rapid plasma reagin (RPR) test works on the same principle as the VDRL. It is available as a kit. The patient's serum is mixed with cardiolipin on a plastic-coated card that can be examined with the naked eye.

Nontreponemal antigen tests require a doctor's interpretation and sometimes further testing. They can yield both false-negative and false-positive results. False-positive results (test shows a positive result when the patient does not have the disease) can be caused by other infectious diseases, including mononucleosis, malaria , leprosy, rheumatoid arthritis , and lupus. HIV patients have a particularly high rate (4%, compared to 0.8% of HIV-negative patients) of false-positive results on reagin tests. False negative results (patient does have the disease, but test comes back negative) can occur when patients are tested too soon after exposure to syphilis; it takes about 1421 days after infection for the blood to become reactive.

TREPONEMAL ANTIBODY TESTS. Treponemal anti-body tests are used to rule out false-positive results on reagin tests. They measure the presence of antibodies that are specific for T. pallidum. The most commonly used tests are the microhemagglutination-T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorption (FTA-ABS) tests. In the FTA-ABS, the patient's blood serum is mixed with a preparation that prevents interference from antibodies to other treponemal infections . The test serum is added to a slide containing T. pallidum. In a positive reaction, syphilitic antibodies in the blood coat the spirochetes on the slide. The slide is then stained with fluorescein, which causes the coated spirochetes to fluoresce when the slide is viewed under ultraviolet (UV) light. In the MHA-TP test, red blood cells from sheep are coated with T. pallidum antigen. The cells will clump if the patient's blood contains anti-bodies for syphilis.

A newer treponemal antibody test developed in Belgium, the INNO-LIA, uses recombinant and peptide antigens derived from T. pallidum proteins. Preliminary testing in Europe indicates that the INNO-LIA is the most accurate of the available treponemal antibody tests for syphilis.

Treponemal antibody tests are more expensive and more difficult to perform than nontreponemal tests. They are therefore used to confirm the diagnosis of syphilis rather than to screen large groups of people. These tests are, however, very specific and very sensitive; false-positive results are relatively unusual.

INVESTIGATIONAL BLOOD TESTS. As of 1998, ELISA, Western blot, and PCR testing are being studied as additional diagnostic tests, particularly for congenital syphilis and neurosyphilis.

Other laboratory tests

MICROSCOPE STUDIES. The diagnosis of syphilis can also be confirmed by identifying spirochetes in samples of tissue or lymphatic fluid. Fresh samples can be made into slides and studied under darkfield illumination. A newer method involves preparing slides from dried fluid smears and staining them with fluorescein for viewing under UV light. This method is replacing dark-field examination because the slides can be mailed to professional laboratories.

SPINAL FLUID TESTS. Testing of cerebrospinal fluid (CSF) is an important part of patient monitoring as well as a diagnostic test. The VDRL and FTA-ABS tests can be performed on CSF as well as on blood. An abnormally high white cell count and elevated protein levels in the CSF, together with positive VDRL results, suggest a possible diagnosis of neurosyphilis. CSF testing is not used for routine screening. It is used most frequently for infants with congenital syphilis, HIV-positive patients, and patients of any age who are not responding to penicillin treatment.

Treatment

It is difficult to obtain information about alternative treatments for syphilis. The disease has a high profile as a public health issue and few alternative practitioners want to risk accusations of minimizing its dangers. One respected resource for alternative therapies states bluntly, "Syphilis should not be treated only with natural therapies." Most naturopathic practitioners agree that antibiotics are essential for the treatment of syphilis. Others would add that recovery from the disease can be assisted by dietary changes, sleep, exercise , and stress reduction, and immune support measures.

Homeopathy

Homeopathic practitioners are forbidden by law in the United States to claim that homeopathic treatment can cure syphilis. Given the high rate of syphilis in HIV-positive patients, however, some alternative practitioners who are treating AIDS patients with homeopathic remedies maintain that they are beneficial for syphilis as well. The remedies suggested most frequently are Medorrhinum, Syphilinum, Mercurius vivus, and Aurum. The use of Mercurius vivus as a homeopathic remedy reflects the past use of mercury to treat syphilis prior to the discovery of penicillin. Syphilinum represents a class of homeopathic remedy called nosodes. A nosode is a homeopathic medicine made from diseased material, such as bacteria, viruses, or pus. Its effect is based on the homeopathic law of similars, in which a substance that causes a specific set of symptoms in a healthy person is determined curative when given to a sick person with the same symptoms. Syphilinum is a nosode made from a dilution of killed Treponema pallidum. The historical link between homeopathy and syphilis is Hahnemann's theory of miasms, which he defined as fundamental predispositions toward disease that were transmitted from one generation to the next. He thought that the syphilitic miasm was the second oldest cause of constitutional weakness in humans.

Other

Traditional Chinese medicine (TCM) and other alternative methods emphasize the mental aspects of conditions and diseases such as syphilis. Mind-body medicine, guided imagery and affirmations are often used to help support a person through such a disease. New thought holds that humans can control physical as well as mental or spiritual events through the power of thinking itself. Some alternative therapies reflect new thought beliefs by maintaining that humans make themselves ill through harmful thought patterns, and that they can heal themselves by affirming positive beliefs. The affirmation suggested for healing syphilis is "I decide to be me." Most alternative practitioners would recommend this or similar new thought affirmations only as adjuncts to conventional medical treatment for syphilis.

One interesting recent historical development is that outdated or discredited treatments for syphilis have resurfaced as alternative treatments for AIDS or cancer. One study of alternative treatments for HIV infection notes that hyperthermia , which involves treating a disease by giving the patient a fever, originated as a treatment for syphilis. Syphilis patients were given malaria in the belief that the resultant fever would kill the spiro-chetes that cause syphilis.

Another example is the so-called Hoxsey treatment for cancer, which was started in the 1920s by an Illinois practitioner named Harry Hoxsey. The treatment is no longer legally available in the United States but is offered through a clinic in Tijuana, Mexico. The treatment consists of several chemical mixtures applied externally and a formula of nine herbs taken internally. The Hoxsey herbal formula is almost identical to a remedy that was listed in the 1926 and 1936 editions of the United States National Formulary called "Compound Fluidextract of Trifolium." It was recommended as a treatment for secondary and tertiary syphilis. One of the external Hoxsey compounds contains both arsenic and antimony, which were used to treat syphilis before the use of antibiotics. The internal formula includes Phytolacca americana, or pokeweed, which was used by Native Americans to treat syphilitic chancres; and Stillingia sylvatica, or queens-root, which has also been used to treat syphilis. There is no demonstrated data to support the therapy's effectiveness for syphilis.

It should be noted that many alternative medicine therapies that claim to help such infectious diseases as syphilis have little data supporting their effectiveness.

Allopathic treatment

Medications

Syphilis is treated with antibiotics given either intramuscularly (benzathine penicillin G or ceftriaxone) or orally (doxycycline, minocycline, tetracycline, or azithromycin). Neurosyphilis is treated with a combination of aqueous crystalline penicillin G, benzathine penicillin G, or doxycycline. It is important to keep the levels of penicillin in the patient's tissues at sufficiently high levels over a period of days or weeks because the spiro-chetes have a relatively long reproduction time. Penicillin is more effective in treating the early stages of syphilis than the later stages.

In the fall of 2000, the CDC convened a group of medical advisors to discuss backup medications for treating syphilis. Although none of the newer drugs will displace penicillin as the primary drug, the doctors recommended azithromycin and ceftriaxone as medications that should have a larger role in the treatment of syphilis than they presently do.

Doctors do not usually prescribe separate medications for the skin rashes or ulcers of secondary syphilis. The patient is advised to keep them clean and dry, and to avoid exposing others to fluid or discharges from condylomata lata.

Pregnant women should be treated as early in pregnancy as possible. Infected fetuses can be cured if the mother is treated during the second and third trimesters of pregnancy. Infants with proven or suspected congenital syphilis are treated with either aqueous crystalline penicillin G or aqueous procaine penicillin G. Children who acquire syphilis after birth are treated with benzathine penicillin G.

Jarisch-Herxheimer reaction

The Jarisch-Herxheimer reaction, first described in 1895, is a reaction to penicillin treatment that may occur during the late primary, secondary, or early latent stages. The patient develops chills, fever, headache , and muscle pains within two to six hours after the penicillin is injected. The chancre or rash gets temporarily worse. The Jarisch-Herxheimer reaction, which lasts about a day, is thought to be an allergic reaction to toxins released when the penicillin kills massive numbers of spirochetes.

Expected results

The expected results of alternative therapies used as adjuncts to conventional antibiotic treatment, for stress reduction or similar purposes, would include improvements in the patient's emotional and spiritual quality of life. The effectiveness of homeopathic treatment for syphilis has not been evaluated in clinical trials, although there are anecdotal reports of successful treatment of syphilis by homeopathic methods.

Analysis of the Hoxsey formulae, however, indicate that they should not be used to treat syphilis or other venereal diseases. Two ingredients in the internal formula have toxic effects: queensroot contains an irritant that can cause inflammation or swelling of the skin and mucous membranes, while pokeweed can cause potentially fatal respiratory paralysis. In addition, the arsenic and antimony in the external formula could potentially cause heavy metal toxicity.

Prevention

Immunity

Patients with syphilis do not acquire lasting immunity against the disease. As of 2002, no effective vaccine for syphilis has been developed even though the genome of T. pallidum was completely sequenced in 1998. The sequencing may, however, speed up the process of developing an effective vaccine. Prevention depends on a combination of personal and public health measures.

Lifestyle choices

The only reliable methods for preventing transmission of syphilis are sexual abstinence or monogamous relationships between uninfected partners. Condoms offer some protection but protect only the covered parts of the body.

Public health measures

CONTACT TRACING. United States law requires reporting of syphilis cases to public health agencies. Sexual contacts of patients diagnosed with syphilis are traced and tested for the disease. Tracing includes all contacts for the past three months in cases of primary syphilis and for the past year in cases of secondary disease. Neither the patients nor their contacts should have sex with anyone until they have been tested and treated.

Because of the rising incidence of syphilis abroad, a growing number of public health physicians are recommending routine screening of immigrants, refugees, and international adoptees for syphilis as of late 2002.

All patients who test positive for syphilis should be tested for HIV infection at the time of diagnosis.

PRENATAL TESTING OF PREGNANT WOMEN. Pregnant women should be tested for syphilis at the time of their first visit for prenatal care, and again shortly before delivery. Proper treatment of secondary syphilis in the mother reduces the risk of congenital syphilis in the infant from 90% to less than 2%.

As of late 2002, many obstetricians and gynecologists are recommending routine screening of nonpregnant as well as pregnant women for syphilis. At present, only about half of obstetricians and gynecologists in the United States screen nonpregnant women for chlamydia and gonorrhea, while fewer than a third screen them for syphilis.

EDUCATION AND INFORMATION. Patients diagnosed with syphilis should be given information about the disease and counseling regarding sexual behavior and the importance of completing antibiotic treatment. It is also important to inform the general public about the transmission and early symptoms of syphilis, and provide adequate health facilities for testing and treatment.

Resources

BOOKS

Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, Inc., 1995.

Fiumara, Nicholas J. "Syphilis." In Conn's Current Therapy, edited by Robert E. Rakel. Philadelphia: W.B. Saunders Company, 1998.

Jacobs, Richard A. "Infectious Diseases: Spirochetal." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney Jr. et al. Stamford, CT: Appleton & Lange, 1998.

Ramin, Susan M., et al. "Sexually Transmitted Diseases and Pelvic Infections." In Current Obstetric & Gynecologic Diagnosis & Treatment, edited by Alan H. DeCherney and Martin L. Pernoll. Norwalk, CT: Appleton & Lange, 1994.

Sigel, Eric J. "Sexually Transmitted Diseases." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay Jr., et al. Stamford, CT: Appleton & Lange, 1997.

"Syphilis." Section 13, Chapter 164 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Wolf, Judith E. "Syphilis." In Current Diagnosis 9, edited by Rex B. Conn, et al. Philadelphia: W.B. Saunders Company, 1997.

PERIODICALS

Augenbraun, M. H. "Treatment of Syphilis 2001: Nonpregnant Adults." Clinical Infectious Diseases 35 (October 15, 2002) (Suppl. 2): S187S190.

Campos-Outcalt, D., and S. Hurwitz." Female-to-Female Transmission of Syphilis: A Case Report." Sexually Transmitted Diseases 29 (February 2002): 119120.

Centers for Disease Control. "Primary and Secondary SyphilisUnited States, 2000-2001." Morbidity and Mortality Weekly Report 51 (November 1, 2002): 971973.

Dennis, L. K., and D. V. Dawson. "Meta-Analysis of Measures of Sexual Activity and Prostate Cancer." Epidemiology 13 (January 2002): 7279.

Gibbs, R. S. "The Origins of Stillbirth: Infectious Diseases." Seminars in Perinatology 26 (February 2002): 7578.

Grgic-Vitek, M., I Klavs, M. Potocnik, and M. Rogl-Butina. "Syphilis Epidemic in Slovenia Influenced by Syphilis Epidemic in the Russian Federation and Other Newly Independent States." International Journal of STD and AIDS 13 (December 2002) (Suppl. 2): 24.

Hagedorn, H. J., A. Kraminer-Hagedorn, K. de Bosschere, et al. "Evaluation of INNO-LIA Syphilis Assay as a Confirmatory Test for Syphilis." Journal of Clinical Microbiology 40 (March 2002): 973978.

Hogben, M., J. S. Lawrence, D. Kasprzyk, et al. "Sexually Transmitted Disease Screening by United States Obstetricians and Gynecologists." Obstetrics and Gynecology 100 (October 2002): 801807.

Kolivras, A., J. de Maubeuge, M. Song, et al. "A Case of Early Congenital Syphilis." Dermatology 204 (2002): 338340.

Pao, D., B. T. Goh, and J. S. Bingham. "Management Issues in Syphilis." Drugs 62 (2002): 14471461.

Ross, M. W., L. Y. Hwang, C. Zack, et al. "Sexual Risk Behaviours and STIs in Drug Abuse Treatment Populations Whose Drug of Choice is Crack Cocaine." International Journal of STD and AIDS 13 (November 2002): 769774.

Stauffer, W. M., D. Kamat, and P. F. Walker. "Screening of International Immigrants, Refugees, and Adoptees." Primary Care 29 (December 2002): 879905.

Sutmoller, F., T. L. Penna, C. T. de Souza, et al. "Human Immunodeficiency Virus Incidence and Risk Behavior in the 'Projeto Rio': Results of the First 5 Years of the Rio de Janeiro Open Cohort of Homosexual and Bisexual Men, 199498." International Journal of Infectious Diseases 6 (December 2002): 259265.

Whittington, W. L., T. Collis, C. Dithmer-Schreck, et al. "Sexually Transmitted Diseases and Human Immunodeficiency Virus-Discordant Partnerships Among Men Who Have Sex With Men." Clinical Infectious Diseases 35 (October 15, 2002): 10101017.

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Road NE, Atlanta, GA, 30333. (404) 639-3534.

Rebecca J. Frey, PhD

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Syphilis

Syphilis

Definition

Syphilis is an infectious systemic disease that may be either congenital or acquired through sexual contact or contaminated needles.

Description

Syphilis has both acute and chronic forms that produce a wide variety of symptoms affecting most of the body's organ systems. The range of symptoms makes it easy to confuse syphilis with less serious diseases and ignore its early signs. Acquired syphilis has four stages (primary, secondary, latent, and tertiary) and can be spread by sexual contact during the first three of these four stages.

Syphilis, which is also called lues (from a Latin word meaning plague ), has been a major public health problem since the sixteenth century. The disease was treated with mercury or other ineffective remedies until World War I, when effective treatments based on arsenic or bismuth were introduced. These were succeeded by antibiotics after World War II. At that time, the number of cases in the general population decreased, partly because of aggressive public health measures. This temporary decrease, combined with the greater amount of attention given to AIDS in recent years, leads some people to think that syphilis is no longer a serious problem. In actual fact, the number of cases of syphilis in the United States has risen since 1980. This increase affects both sexes, all races, all parts of the nation, and all age groups, including adults over 60. The number of women of childbearing age with syphilis is the highest that has been recorded since the 1940s. About 25,000 cases of infectious syphilis in adults are reported annually in the United States. It is estimated, however, that 400,000 people in the United States need treatment for syphilis every year, and that the annual worldwide total is 50 million persons.

In 1999, the Centers for Disease Control and Prevention (CDC) joined several other federal agencies in announcing the "National Plan to Eliminate Syphilis in the United States." Eliminating the disease was defined as the absence of transmission of the disease; that is, no transmission after 90 days following the report of an imported index case. The national goals for eliminating syphilis include bringing the annual number of reported cases in the United States below 1000, and increasing the number of syphilis-free counties to 90% by 2005. In November 2002, the CDC released figures for 20002001, which indicate that the number of reported cases of primary and secondary syphilis rose slightly. This rise, however, occurred only among men who have sex with other men. The CDC also stated that the number of new cases of syphilis has actually declined among women as well as among non-Hispanic blacks.

The increased incidence of syphilis since the 1970s is associated with drug abuse as well as changes in sexual behavior. The connections between drug abuse and syphilis include needle sharing and exchanging sex for drugs. In addition, people using drugs are more likely to engage in risky sexual practices. As of 2002, the risk of contracting syphilis is particularly high among those who abuse crack cocaine.

With respect to changing patterns of conduct, a sharp increase in the number of people having sex with multiple partners makes it more difficult for public health doctors to trace the contacts of infected persons. Women are not necessarily protected by having sex only with other women; in the past few years, several cases have been reported of female-to-female transmission of syphilis through oral-genital contact. In addition, the incidence of syphilis among men who have sex with other men continues to rise. Several studies in Latin America as well as in the United States reported in late 2002 that unprotected sexual intercourse is on the increase among gay and bisexual men.

Changing patterns of sexual behavior have led to a striking increase in the number of cases of syphilis in eastern Europe since the collapse of the Soviet Union; Slovenia reported an 18-fold increase in reported cases of syphilis just between 1993 and 1994. Over half of the new cases were linked to a source of infection in another European country.

In general, high-risk groups for syphilis in the United States and Canada include:

  • sexually active teenagers
  • people infected with another sexually transmitted disease (STD), including AIDS
  • sexually abused children
  • women of childbearing age
  • prostitutes of either sex and their customers
  • prisoners
  • persons who abuse drugs or alcohol

The chances of contracting syphilis from an infected person in the early stages of the disease during unprotected sex are between 30-50%.

Causes and symptoms

Syphilis is caused by a spirochete, Treponema pallidum. A spirochete is a thin spiralor coil-shaped bacterium that enters the body through the mucous membranes or breaks in the skin. In 90% of cases, the spirochete is transmitted by sexual contact. Transmission by blood transfusion is possible but rare; not only because blood products are screened for the disease, but also because the spirochetes die within 24 hours in stored blood. Other methods of transmission are highly unlikely because T. pallidum is easily killed by heat and drying.

Primary syphilis

Primary syphilis is the stage of the organism's entry into the body. The first signs of infection are not always noticed. After an incubation period ranging between 10 and 90 days, the patient develops a chancre, which is a small blister-like sore about 0.5 in (13 mm) in size. Most chancres are on the genitals, but may also develop in or on the mouth or on the breasts. Rectal chancres are common in male homosexuals. Chancres in women are sometimes overlooked if they develop in the vagina or on the cervix. The chancres are not painful and disappear in three to six weeks even without treatment. They resemble the ulcers of lymphogranuloma venereum, herpes simplex virus, or skin tumors.

About 70% of patients with primary syphilis also develop swollen lymph nodes near the chancre. The nodes may have a firm or rubbery feel when the doctor touches them but are not usually painful.

Secondary syphilis

Syphilis enters its secondary stage between six to eight weeks and six months after the infection begins. Chancres may still be present but are usually healing. Secondary syphilis is a systemic infection marked by the eruption of skin rashes and ulcers in the mucous membranes. The skin rash may mimic a number of other skin disorders such as drug reactions, rubella, ringworm, mononucleosis, and pityriasis rosea. Characteristics that point to syphilis include:

  • a coppery color
  • absence of pain or itching
  • occurrence on the palms of hands and soles of feet

The skin eruption may resolve in a few weeks or last as long as a year. The patient may also develop condylomata lata, which are weepy pinkish or grey areas of flattened skin in the moist areas of the body. The skin rashes, mouth and genital ulcers, and condylomata lata are all highly infectious.

About 50% of patients with secondary syphilis develop swollen lymph nodes in the armpits, groin, and neck areas; about 10% develop inflammations of the eyes, kidney, liver, spleen, bones, joints, or the meninges (membranes covering the brain and spinal cord). They may also have a flulike general illness with a low fever, chills, loss of appetite, headaches, runny nose, sore throat, and aching joints.

Latent syphilis

Latent syphilis is a phase of the disease characterized by relative absence of external symptoms. The term latent does not mean that the disease is not progressing or that the patient cannot infect others. For example, pregnant women can transmit syphilis to their unborn children during the latency period.

The latent phase is sometimes divided into early latency (less than two years after infection) and late latency. During early latency, patients are at risk for spontaneous relapses marked by recurrence of the ulcers and skin rashes of secondary syphilis. In late latency, these recurrences are much less likely. Late latency may either resolve spontaneously or continue for the rest of the patient's life.

Tertiary syphilis

Untreated syphilis progresses to a third or tertiary stage in about 35-40% of patients. Patients with tertiary syphilis cannot infect others with the disease. It is thought that the symptoms of this stage are a delayed hypersensitivity reaction to the spirochetes. Some patients develop so-called benign late syphilis, which begins between three and 10 years after infection and is characterized by the development of gummas. Gummas are rubbery tumor-like growths that are most likely to involve the skin or long bones but may also develop in the eyes, mucous membranes, throat, liver, or stomach lining. Gummas are increasingly uncommon since the introduction of antibiotics for treating syphilis. Benign late syphilis is usually rapid in onset and responds well to treatment.

CARDIOVASCULAR SYPHILIS. Cardiovascular syphilis occurs in 10-15% of patients who have progressed to tertiary syphilis. It develops between 10 and 25 years after infection and often occurs together with neurosyphilis. Cardiovascular syphilis usually begins as an inflammation of the arteries leading from the heart and causes heart attacks, scarring of the aortic valves, congestive heart failure, or the formation of an aortic aneurysm.

NEUROSYPHILIS. About 8% of patients with untreated syphilis will develop symptoms in the central nervous system that include both physical and psychiatric symptoms. Neurosyphilis can appear at any time, from 5-35 years after the onset of primary syphilis. It affects men more frequently than women and Caucasians more frequently than African Americans.

Neurosyphilis is classified into four types:

  • Asymptomatic. In this form of neurosyphilis, the patient's spinal fluid gives abnormal test results but there are no symptoms affecting the central nervous system.
  • Meningovascular. This type of neurosyphilis is marked by changes in the blood vessels of the brain or inflammation of the meninges (the tissue layers covering the brain and spinal cord). The patient develops headaches, irritability, and visual problems. If the spinal cord is involved, the patient may experience weakness of the shoulder and upper arm muscles.
  • Tabes dorsalis. Tabes dorsalis is a progressive degeneration of the spinal cord and nerve roots. Patients lose their sense of perception of one's body position and orientation in space (proprioception), resulting in difficulties walking and loss of muscle reflexes. They may also have shooting pains in the legs and periodic episodes of pain in the abdomen, throat, bladder, or rectum. Tabes dorsalis is sometimes called locomotor ataxia.
  • General paresis. General paresis refers to the effects of neurosyphilis on the cortex of the brain. The patient has a slow but progressive loss of memory, ability to concentrate, and interest in self-care. Personality changes may include irresponsible behavior, depression, delusions of grandeur, or complete psychosis. General paresis is sometimes called dementia paralytica, and is most common in patients over 40.

Special populations

CONGENITAL SYPHILIS. Congenital syphilis has increased at a rate of 400-500% over the past decade, on the basis of criteria introduced by the Centers for Disease Control (CDC) in 1990. In 1994, over 2,200 cases of congenital syphilis were reported in the United States. The prognosis for early congenital syphilis is poor: about 54% of infected fetuses die before or shortly after birth. Those who survive may look normal at birth but show signs of infection between three and eight weeks later.

Infants with early congenital syphilis have systemic symptoms that resemble those of adults with secondary syphilis. There is a 40-60% chance that the child's central nervous system will be infected. These infants may have symptoms ranging from jaundice, enlargement of the spleen and liver, and anemia to skin rashes, condylomata lata, inflammation of the lungs, "snuffles" (a persistent runny nose), and swollen lymph nodes.

CHILDREN. Children who develop symptoms after the age of two years are said to have late congenital syphilis. The characteristic symptoms include facial deformities (saddle nose), Hutchinson's teeth (abnormal upper incisors), saber shins, dislocated joints, deafness, mental retardation, paralysis, and seizure disorders.

PREGNANT WOMEN. Syphilis can be transmitted from the mother to the fetus through the placenta at any time during pregnancy, or through the child's contact with syphilitic ulcers during the birth process. The chances of infection are related to the stage of the mother's disease. Almost all infants of mothers with untreated primary or secondary syphilis will be infected, whereas the infection rate drops to 40% if the mother is in the early latent stage and 6-14% if she has late latent syphilis.

Pregnancy does not affect the progression of syphilis in the mother; however, pregnant women should not be treated with tetracyclines.

HIV PATIENTS. Syphilis has been closely associated with HIV infection since the late 1980s. Syphilis sometimes mimics the symptoms of AIDS. Conversely, AIDS appears to increase the severity of syphilis in patients suffering from both diseases, and to speed up the development or appearance of neurosyphilis. Patients with HIV are also more likely to develop lues maligna, a skin disease that sometimes occurs in secondary syphilis. Lues maligna is characterized by areas of ulcerated and dying tissue. In addition, HIV patients have a higher rate of treatment failure with penicillin than patients without HIV.

Diagnosis

Patient history and physical diagnosis

The diagnosis of syphilis is often delayed because of the variety of early symptoms, the varying length of the incubation period, and the possibility of not noticing the initial chancre. Patients do not always connect their symptoms with recent sexual contact. They may go to a dermatologist when they develop the skin rash of secondary syphilis rather than to their primary care doctor. Women may be diagnosed in the course of a gynecological checkup. Because of the long-term risks of untreated syphilis, certain groups of people are now routinely screened for the disease:

  • pregnant women
  • sexual contacts or partners of patients diagnosed with syphilis
  • children born to mothers with syphilis
  • patients with HIV infection
  • persons applying for marriage licenses

When the doctor takes the patient's history, he or she will ask about recent sexual contacts in order to determine whether the patient falls into a high-risk group. Other symptoms, such as skin rashes or swollen lymph nodes, will be noted with respect to the dates of the patient's sexual contacts. Definite diagnosis, however, depends on the results of laboratory blood tests.

Blood tests

There are several types of blood tests for syphilis presently used in the United States. Some are used in follow-up monitoring of patients as well as diagnosis.

NONTREPONEMAL ANTIGEN TESTS. Nontreponemal antigen tests are used as screeners. They measure the presence of reagin, which is an antibody formed in reaction to syphilis. In the venereal disease research laboratory (VDRL) test, a sample of the patient's blood is mixed with cardiolipin and cholesterol. If the mixture forms clumps or masses of matter, the test is considered reactive or positive. The serum sample can be diluted several times to determine the concentration of reagin in the patient's blood.

The rapid plasma reagin (RPR) test works on the same principle as the VDRL. It is available as a kit. The patient's serum is mixed with cardiolipin on a plastic-coated card that can be examined with the naked eye.

Nontreponemal antigen tests require a doctor's interpretation and sometimes further testing. They can yield both false-negative and false-positive results. False-positive results can be caused by other infectious diseases, including mononucleosis, malaria, leprosy, rheumatoid arthritis, and lupus. HIV patients have a particularly high rate (4%, compared to 0.8% of HIV-negative patients) of false-positive results on reagin tests. False-negatives can occur when patients are tested too soon after exposure to syphilis; it takes about 14-21 days after infection for the blood to become reactive.

TREPONEMAL ANTIBODY TESTS. Treponemal antibody tests are used to rule out false-positive results on reagin tests. They measure the presence of antibodies that are specific for T. pallidum. The most commonly used tests are the microhemagglutination-T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorption (FTA-ABS) tests. In the FTA-ABS, the patient's blood serum is mixed with a preparation that prevents interference from antibodies to other treponemal infections. The test serum is added to a slide containing T. pallidum. In a positive reaction, syphilitic antibodies in the blood coat the spirochetes on the slide. The slide is then stained with fluorescein, which causes the coated spirochetes to fluoresce when the slide is viewed under ultraviolet (UV) light. In the MHA-TP test, red blood cells from sheep are coated with T. pallidum antigen. The cells will clump if the patient's blood contains antibodies for syphilis.

Treponemal antibody tests are more expensive and more difficult to perform than nontreponemal tests. They are therefore used to confirm the diagnosis of syphilis rather than to screen large groups of people. These tests are, however, very specific and very sensitive; false-positive results are relatively unusual.

INVESTIGATIONAL BLOOD TESTS. Currently, ELISA, Western blot, and PCR testing are being studied as additional diagnostic tests, particularly for congenital syphilis and neurosyphilis.

Other laboratory tests

MICROSCOPE STUDIES. The diagnosis of syphilis can also be confirmed by identifying spirochetes in samples of tissue or lymphatic fluid. Fresh samples can be made into slides and studied under darkfield illumination. A newer method involves preparing slides from dried fluid smears and staining them with fluorescein for viewing under UV light. This method is replacing darkfield examination because the slides can be mailed to professional laboratories.

SPINAL FLUID TESTS. Testing of cerebrospinal fluid (CSF) is an important part of patient monitoring as well as a diagnostic test. The VDRL and FTA-ABS tests can be performed on CSF as well as on blood. An abnormally high white cell count and elevated protein levels in the CSF, together with positive VDRL results, suggest a possible diagnosis of neurosyphilis. CSF testing is not used for routine screening. It is used most frequently for infants with congenital syphilis, HIV-positive patients, and patients of any age who are not responding to penicillin treatment.

Treatment

Medications

Syphilis is treated with antibiotics given either intramuscularly (benzathine penicillin G or ceftriaxone) or orally (doxycycline, minocycline, tetracycline, or azithromycin). Neurosyphilis is treated with a combination of aqueous crystalline penicillin G, benzathine penicillin G, or doxycycline. It is important to keep the levels of penicillin in the patient's tissues at sufficiently high levels over a period of days or weeks because the spirochetes have a relatively long reproduction time. Penicillin is more effective in treating the early stages of syphilis than the later stages.

In the fall of 2000, the CDC convened a group of medical advisors to discuss backup medications for treating syphilis. Although none of the newer drugs will displace penicillin as the primary drug, the doctors recommended azithromycin and ceftriaxone as medications that should have a larger role in the treatment of syphilis than they presently do.

Doctors do not usually prescribe separate medications for the skin rashes or ulcers of secondary syphilis. The patient is advised to keep them clean and dry, and to avoid exposing others to fluid or discharges from condylomata lata.

Pregnant women should be treated as early in pregnancy as possible. Infected fetuses can be cured if the mother is treated during the second and third trimesters of pregnancy. Infants with proven or suspected congenital syphilis are treated with either aqueous crystalline penicillin G or aqueous procaine penicillin G. Children who acquire syphilis after birth are treated with benzathine penicillin G.

Jarisch-Herxheimer reaction

The Jarisch-Herxheimer reaction, first described in 1895, is a reaction to penicillin treatment that may occur during the late primary, secondary, or early latent stages. The patient develops chills, fever, headache, and muscle pains within two to six hours after the penicillin is injected. The chancre or rash gets temporarily worse. The Jarisch-Herxheimer reaction, which lasts about a day, is thought to be an allergic reaction to toxins released when the penicillin kills massive numbers of spirochetes.

Alternative treatment

Antibiotics are essential for the treatment of syphilis. Recovery from the disease can be assisted by dietary changes, sleep, exercise, and stress reduction.

Homeopathy

Homeopathic practitioners are forbidden by law in the United States to claim that homeopathic treatment can cure syphilis. Given the high rate of syphilis in HIV-positive patients, however, some alternative practitioners who are treating AIDS patients with homeopathic remedies maintain that they are beneficial for syphilis as well. The remedies suggested most frequently are Medorrhinum, Syphilinum, Mercurius vivus, and Aurum. The historical link between homeopathy and syphilis is Hahnemann's theory of miasms. He thought that the syphilitic miasm was the second oldest cause of constitutional weakness in humans.

Prognosis

The prognosis is good for the early stages of syphilis if the patient is treated promptly and given sufficiently large doses of antibiotics. Treatment failures can occur and patients can be reinfected. There are no definite criteria for cure for patients with primary and secondary syphilis, although patients who are symptom-free and have had negative blood tests for two years after treatment are usually considered cured. Patients should be followed up with blood tests at one, three, six, and 12 months after treatment, or until the results are negative. CSF should be examined after one year. Patients with recurrences during the latency period should be tested for reinfection.

The prognosis for patients with untreated syphilis is spontaneous remission for about 30%; lifelong latency for another 30%; and potentially fatal tertiary forms of the disease in 40%.

Prevention

Immunity

Patients with syphilis do not acquire lasting immunity against the disease. Currently, no effective vaccine for syphilis has been developed. Prevention depends on a combination of personal and public health measures.

Lifestyle choices

The only reliable methods for preventing transmission of syphilis are sexual abstinence or monogamous relationships between uninfected partners. Condoms offer some protection but protect only the covered parts of the body.

Public health measures

CONTACT TRACING. The law requires reporting of syphilis cases to public health agencies. Sexual contacts of patients diagnosed with syphilis are traced and tested for the disease. This includes all contacts for the past three months in cases of primary syphilis and for the past year in cases of secondary disease. Neither the patients nor their contacts should have sex with anyone until they have been tested and treated.

Because of the rising incidence of syphilis abroad, a growing number of public health physicians are recommending routine screening of immigrants, refugees, and international adoptees for syphilis as of late 2002.

All patients who test positive for syphilis should be tested for HIV infection at the time of diagnosis.

PRENATAL TESTING OF PREGNANT WOMEN. Pregnant women should be tested for syphilis at the time of their first visit for prenatal care, and again shortly before delivery. Proper treatment of secondary syphilis in the mother reduces the risk of congenital syphilis in the infant from 90% to less than 2%.

As of late 2005, many obstetricians and gynecologists are recommending routine screening of nonpregnant as well as pregnant women for syphilis. At present, only about half of obstetricians and gynecologists in the United States screen nonpregnant women for chlamydia and gonorrhea, while fewer than a third screen them for syphilis.

EDUCATION AND INFORMATION. Patients diagnosed with syphilis should be given information about the disease and counseling regarding sexual behavior and the importance of completing antibiotic treatment. It is also important to inform the general public about the transmission and early symptoms of syphilis, and provide adequate health facilities for testing and treatment.

KEY TERMS

Chancre The initial skin ulcer of primary syphilis, consisting of an open sore with a firm or hard base.

Condylomata lata Highly infectious patches of weepy pink or gray skin that appear in the moist areas of the body during secondary syphilis.

Darkfield A technique of microscope examination in which light is directed at an oblique angle through the slide so that organisms look bright against a dark background.

General paresis A form of neurosyphilis in which the patient's personality, as well as his or her control of movement, is affected. The patient may develop convulsions or partial paralysis.

Gumma A symptom that is sometimes seen in tertiary syphilis, characterized by a rubbery swelling or tumor that heals slowly and leaves a scar.

Index case The first case of a contagious disease in a group or population that serves to call attention to the presence of the disease.

Jarisch-Herxheimer reaction A temporary reaction to penicillin treatment for syphilis that includes fever, chills, and worsening of the skin rash or chancre.

Lues maligna A skin disorder of secondary syphilis in which areas of ulcerated and dying tissue are formed. It occurs most frequently in HIV-positive patients.

Spirochete A type of bacterium with a long, slender, coiled shape. Syphilis is caused by a spirochete.

Tabes dorsalis A progressive deterioration of the spinal cord and spinal nerves associated with tertiary syphilis.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Syphilis." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Augenbraun, M. H. "Treatment of Syphilis 2001: Nonpregnant Adults." Clinical Infectious Diseases 35, Supplement 2 (October 15, 2002): S187-S190.

Campos-Outcalt, D., and S. Hurwitz. "Female-to-Female Transmission of Syphilis: A Case Report." Sexually Transmitted Diseases 29 (February 2002): 119-120.

Centers for Disease Control. "Primary and Secondary SyphilisUnited States, 20002001." Morbidity and Mortality Weekly Report 51 (November 1, 2002): 971-973.

Dennis, L. K., and D. V. Dawson. "Meta-Analysis of Measures of Sexual Activity and Prostate Cancer." Epidemiology 13 (January 2002): 72-79.

Gibbs, R. S. "The Origins of Stillbirth: Infectious Diseases." Seminars in Perinatology 26 (February 2002): 75-78.

Grgic-Vitek, M., I Klavs, M. Potocnik, and M. Rogl-Butina. "Syphilis Epidemic in Slovenia Influenced by Syphilis Epidemic in the Russian Federation and Other Newly Independent States." International Journal of STD and AIDS 13, Supplement 2 (December 2002): 2-4.

Hagedorn, H. J., A. Kraminer-Hagedorn, K. de Bosschere, et al. "Evaluation of INNO-LIA Syphilis Assay as a Confirmatory Test for Syphilis." Journal of Clinical Microbiology 40 (March 2002): 973-978.

Hogben, M., J. S. Lawrence, D. Kasprzyk, et al. "Sexually Transmitted Disease Screening by United States Obstetricians and Gynecologists." Obstetrics and Gynecology 100 (October 2002): 801-807.

Kolivras, A., J. de Maubeuge, M. Song, et al. "A Case of Early Congenital Syphilis." Dermatology 204 (2002): 338-340.

Pao, D., B. T. Goh, and J. S. Bingham. "Management Issues in Syphilis." Drugs 62 (2002): 1447-1461.

Ross, M. W., L. Y. Hwang, C. Zack, et al. "Sexual Risk Behaviours and STIs in Drug Abuse Treatment Populations Whose Drug of Choice is Crack Cocaine." International Journal of STD and AIDS 13 (November 2002): 769-774.

Stauffer, W. M., D. Kamat, and P. F. Walker. "Screening of International Immigrants, Refugees, and Adoptees." Primary Care 29 (December 2002): 879-905.

Sutmoller, F., T. L. Penna, C. T. de Souza, et al. "Human Immunodeficiency Virus Incidence and Risk Behavior in the 'Projeto Rio': Results of the First 5 Years of the Rio de Janeiro Open Cohort of Homosexual and Bisexual Men, 199498." International Journal of Infectious Diseases 6 (December 2002): 259-265.

Whittington, W. L., T. Collis, C. Dithmer-Schreck, et al. "Sexually Transmitted Diseases and Human Immunodeficiency Virus-Discordant Partnerships Among Men Who Have Sex With Men." Clinical Infectious Diseases 35 (October 15, 2002): 1010-1017.

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

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Syphilis

Syphilis

Syphilis is a chronic, degenerative, sexually transmitted disease caused by the bacterium Treponema pallidum. Although modern treatments now control the disease, its incidence remains high worldwide, making it a global public health concern. Spread by sexual contact, syphilis begins as a small, hard, painless swelling, called a primary (or Hunter's) chancre. The disease is very contagious in the early stages. The initial sore will usually pass away in about eight weeks, but the disease will then spread through the body and lodge in the lymph nodes, causing a skin rash to appear in two to four months along with fever and headaches. This second stage can last two to six weeks. After a latent period, which can extend for years, the disease can appear in various bodily organs and it can be spread to others.

The earliest records of syphilis are those of Spanish physician Rodrigo Ruiz de Isla, who wrote that he treated syphilis patients in Barcelona in 1493. He further claimed that the soldiers of explorer Christopher Columbus contracted the disease in the Caribbean and brought it back to Europe in 1492. However, others challenge this position. Some medical historians believe that syphilis has been present from ancient times but was often mislabeled or misdiagnosed. Italian physician and writer Girolamo Fracastoro gave the disease its name in his poem "Syphilis sive morbus Gallicus" (Syphilis or the French Disease), published in 1530, during the height of a European epidemic. However, for centuries, the disease was called pox or the great pox. At that time, the treatment was mercury, used in vapor baths, as an ointment, or taken orally. The mercury increased the flow of saliva and phlegm to wash out the poisons, but it also caused discomfort, such as loss of hair and teeth, abdominal pains, and mouth sores. Through the centuries, a milder form of the disease evolved and often became confused with gonorrhea . In 1767, physician John Hunter infected himself with fluid from a patient who had gonorrhea to prove these were two different diseases. Unknown to Hunter, the patient also had syphilis. Hunter developed the sore indicative of syphilis that now bears his name.

The distinction between the two diseases was made clear in 1879, when German bacteriologist Albert Neisser isolated the bacterium responsible for gonorrhea. In 1903, Russian biologist Elie Metchnikoff and French scientist Pierre-Paul-Emile Roux demonstrated that syphilis could be transmitted to monkeys and then studied in the laboratory. They also showed that mercury ointment was an effective treatment in the early stages. Two years later, German zoologist Fritz Schaudinn and his assistant Erich Hoffmann discovered the bacterium responsible for syphilis, the spiral-shaped spirochete Treponema pallidum. The following year, German physician August von Wassermann (18661925) developed the first diagnostic test for syphilis based on new findings in immunology . The test involved checking for the syphilis antibody in a sample of blood. One drawback was that the test would take two days to complete.

In 1904, German research physician Paul Ehrlich began focusing on a safe, effective treatment for syphilis. Ehrlich had spent many years studying the effect of dyes on biological tissues and treatments for tropical diseases. His work in the emerging field of immunology earned him a Nobel Prize in 1908. Ehrlich began working with the arsenic-based compound atoxyl as a possible treatment for syphilis. Japanese bacteriologist Sahachiro Hata came to study syphilis with Ehrlich. Hata tested hundreds of derivatives of atoxyl and finally found one that worked, number 606. Ehrlich called it Salvarsan. Following clinical trials, in 1911 Ehrlich and Hata announced the drug was an effective cure for syphilis. The drug attacked the disease germs but did not harm healthy cells; thus, Salvarsan ushered in the new field of chemotherapy . Ehrlich went on to develop two safer forms of the drug, including neosalvarsan in 1912 and sodium salvarsan in 1913.

Penicillin came into widespread use in treating bacterial diseases during World War II. It was first used to against syphilis in 1943 by New York physician John F. Mahoney, and it remains the treatment of choice today. Other antibiotics are also effective. Meanwhile, Russian-American researcher Reuben Leon Kahn (18871979) developed a modified test for syphilis in 1923 that took only a few minutes to complete. Another test was developed by researchers William A. Hinton (18831959) and J. A. V. Davies. Today fluorescent antibody tests are used for detection. Although there is no inoculation for syphilis, the disease can be controlled through education, safe sexual practices, and proper medical treatment.

See also Sexually transmitted diseases

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Syphilis Test

Syphilis test

Syphilis was once a disease of epidemic proportions. Today, it is effectively treated with penicillin and other antibiotics. Because there is no known immunization to protect against contracting syphilis, accurate testing has become a key determinant for quick and successful treatment.

Discovery of the Bacteria

In 1903 Russian biologist Elie Metchnikoff (1845-1916) and French scientist Pierre-Paul-Emile Roux demonstrated that syphilis could be transmitted to monkeys. With this capability, the disease could be studied in the laboratory. Two years later, German zoologist Fritz Schaudinn and his assistant Erich Hoffmann isolated the bacterium that causes syphilis. Schaudinn and Hoffmann showed it to be a spiral-shaped spirochete called Treponema pallidum.

Salvarsan

In 1904 German researcher Paul Ehrlich (1854-1915) and Japanese bacteriologist Sahachiro Hata began looking for a safe, effective treatment for syphilis. They tested hundreds of derivatives of atoxyl, eventually discovering one that worked. Ehrlich called the derivative "Salvarsan." Following trials of the substance on humans, Ehrlich and Hata announced in 1911 that the drug was an effective cure for syphilis. The drug attacked the bacteria without harming healthy cells.

Wassermann Test

The first effective test for syphilis was developed in 1906 by German physician and bacteriologist August von Wassermann (1866-1925). Wassermann was influenced by Ehrlich's work. Wassermann's exam consisted of testing a patient's blood sample for the syphilis bacterium antibody. If antibodies were present, the test was positive. If the antibodies disappeared after treatment, the test was negative. The Wassermann test proved successful in diagnosing syphilis in 95 percent of cases.

Kahn Test

Unfortunately, the Wassermann test required a two-day incubation period. Reuben Leon Kahn (1887-1979), a Russian-born American immunologist, developed a faster and simpler syphilis test in 1923. This modified test used an extract from beef heart to detect syphilis antibodies. More sensitive than the Wassermann test, the Kahn test could be completed in a matter of minutes. The Kahn tests, however, could also be inaccurate. It could show false positive or false negative reports.

Davies-Hinton Test

Another effective syphilis test was developed by William A. Hinton (1883-1959). Hinton was an African-American physician who became a leading expert on venereal disease. Hinton worked out of Harvard Medical School, collaborating with J. A. V. Davies on the Davies-Hinton test.

Syphilis

Syphilis is a serious disease transmitted through sexual activity. Although modern treatments can control the disease, the number of people suffering from syphilis remains high. It is a public health concern around the world.

Syphilis can be cured through doses of penicillin, yet many people remain untreated. The first stage appears between one and eight weeks after infection occurs. The symptom is a small, hard, painless swelling, called a primary chancre (pronounced "shanker"). The sore usually heals in one to five weeks. However, during this period, disease bacteria circulate throughout the body via the bloodstream.

The second stage appears about six weeks after the sore disappears. Symptoms include a general feeling of being ill, fever, headache, and a loss of appetite. Glands may swell in the groin or neck, and a skin rash may develop. This second stage can last two to six weeks.

The third stage is called latent or late syphilis. It can last for years. While no symptoms may be present for some time, a special blood test will show the presence of the disease. During this stage, the disease will eventually flare up without warning. Syphilis affects both the brain and heart. At this point, the disease is no longer treatable. Symptoms of third stage syphilis include blindness, sterility, and insanity.

VDRL Test

Several other syphilis tests have been developed. One of most widely used tests today is the VDRL test, designed by the Venereal Disease Research Laboratory. Other diagnostic tools include a fluorescent antibody test to reveal the syphilis bacterium.

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syphilis

syphilis (sĬf´əlĬs), contagious sexually transmitted disease caused by the spirochete Treponema pallidum (described by Fritz Schaudinn and Erich Hoffmann in 1905). Syphilis was not widely recognized until an epidemic in Europe at the end of the 15th cent. Some medical historians have proposed that syphilis first appeared in Spain among sailors who had returned from the New World in 1493, while others have concluded from archaeological evidence that it probably originated in the Old World but may have been confused with leprosy. A study (pub. 2008) that examined the evolutionary relationships among Treponema bacteria supported the idea that the spirochete originated in the New World, with some researchers suggesting it may have mutated into a sexually transmitted disease in Europe.

Transmission

The most prevalent mode of transmission is by sexual contact; infection by other means is possible, but its occurrence depends upon an open wound or lesion to permit invasion of the organisms. A person with syphilitic sores has an increased chance of contracting AIDS from an infected partner. An infected mother can transmit the disease to her fetus; 25% of such pregnancies end in stillbirth or death of the infant, and another 40% to 70% will result in a baby with congenital syphilis, which, if untreated, can progress to late-stage syphilis and cause serious damage to the brain and other organs.

Symptoms

The development of syphilis occurs in four stages. The primary stage is the appearance of a painless chancre at the site of infection (often internal) about 10 days to 3 months after contact. There are no other symptoms, and the chancre disappears with or without treatment.

The secondary stage usually begins 3 to 6 weeks after the chancre with a rash over all or part of the body. Active bacteria are present in the sores of the rash. Headache, fever, fatigue, sore throat, patchy hair loss, and enlarged lymph nodes may be present. The signs of the secondary stage will disappear with or without treatment, but may reappear over the next 1 to 2 years.

Untreated syphilis then goes into a noncontagious latent period. Some people will have no more symptoms, but about one third will progress to tertiary syphilis, with widespread damage to the heart, brain, eyes, nervous system, bones, and joints. Late syphilis can result in mental illness, blindness, severe damage to the heart and aorta, and death.

Neurosyphilis, infection of the nervous system, frequently occurs in the early stages in untreated patients. There may be no symptoms, mild headache, or severe consequences such as seizures and stroke. Its treatment and course are complicated by concomitant HIV infection.

Diagnosis and Treatment

Diagnosis is made by symptoms, blood tests (required by many states before issuing marriage licenses), and microscopic identification of the bacterium. Until the advent of penicillin in the 1940s, treatment for syphilis was with mercury, arsenic, and bismuth. Penicillin is the antibiotic of choice for all stages of syphilis treatment, but penicillin-resistant organisms have complicated treatment of the disease. Even late-stage syphilis can be cured, but damage that has already occurred cannot be reversed. Despite available treatment, the incidence of syphilis in the United States was on the rise until 1990, when it began declining significantly; since 2000, it has risen again.

See also Ehrlich, Paul.

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Syphilis

SYPHILIS

Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum, a spirochete that can be transmitted during vaginal, anal, or oral sex. An estimated 70,000 syphilis cases occur in the United States annually.

Without treatment, syphilis in adults progresses through four stages: primary, secondary, latent, and tertiary. Persons with syphilis are most infectious during the primary and secondary stages. Primary syphilis is marked by an infectious sore (chancre) that resolves on its own. Without treatment, syphilis bacteria spread through the bloodstream and lead to the secondary stage, which is characterized by a skin rash and systemic symptoms. These symptoms can come and go over one to two years, during which an infected person can infect others. If untreated, the infection progresses to a latent stage. Symptoms disappear, and the disease is no longer infectious, but the bacteria remain in the body and can damage vital organs. In about a third of untreated persons, the results of the internal damage show up years later in the tertiary stage. Symptoms include paralysis, blindness, dementia, impotence, joint damage, heart problems, tumors, and deep sores. The damage can be serious enough to cause death. An untreated pregnant woman in an infectious stage of syphilis can pass the infection to her developing fetus.

Syphilis bacteria can be detected by laboratory examination of material from infectious sores. A safe, accurate, and inexpensive blood screening test is also available. Syphilis is treatable with penicillin. Persons who engage in sexual behaviors that place them at risk of STDs should use latex or polyurethane condoms every time they have sex and limit the number of sex partners. Pregnant women should be screened for syphilis. Infected persons should notify all sex partners so they can receive treatment.

Allison L. Greenspan

Joel R. Greenspan

(see also: Sexually Transmitted Diseases )

Bibliography

Centers for Disease Control and Prevention (1998). "1998 Guidelines for Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report 47(RR-1):2841.

Sparling, P. F. (1999). "Natural History of Syphilis." In Sexually Transmitted Diseases, 3rd edition. eds. K. Holmes, P. Mardh, P. Sparling et al. New York: McGraw-Hill.

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syphilis

syphilis a chronic bacterial disease that is contracted chiefly by infection during sexual intercourse, but also congenitally by infection of a developing fetus. The word is recorded in English from the early 18th century, and is modern Latin, originally from the title of a poem, Syphilis, sive Morbus Gallicus, published 1530 by Girolamo Fracastoro or Hieronymus Fracastorius (1483–1553), a physician, astronomer, and poet of Verona; it was translated by Nahum Tate in 1686 with the title ‘Syphilis: or, a Poetical History of the French Disease’. The illness was known from the early 16th century as the great pox, to distinguish it from smallpox.

Syphilis was used as the name of the disease in the poem itself; the subject is the shepherd ‘Syphilus’, the first sufferer from the illness. (The ultimate origin of his name is disputed; it has been suggested that it is a corrupt medieval form of Sipylus, a son of Niobe.)

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syphilis

syphilis (sif-i-lis) n. a sexually transmitted disease caused by the bacterium Treponema pallidum. Bacteria usually enter the body during sexual intercourse; they may also pass from an infected pregnant woman across the placenta to the developing fetus, resulting in the disease being present at birth (congenital s.). The primary symptom is a hard painless ulcer (chancre) at the site of infection. Secondary stage symptoms include fever, malaise, general enlargement of lymph nodes, and a faint red rash on the chest. After months, or even years, the disease enters its tertiary stage with widespread formation of tumour-like masses (gummas). Tertiary syphilis may cause serious damage to the heart and blood vessels (cardiovascular s.) or to the brain and spinal cord (neurosyphilis), resulting in tabes dorsalis, blindness, and general paralysis of the insane. See also bejel.
syphilitic (sif-i-lit-ik) adj.

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syphilis

syphilis Sexually transmitted disease caused by the spiral-shaped bacterium (spirochete) Treponema pallidum. Untreated, it runs its course in three stages. The first symptom is often a hard, painless sore on the genitals, appearing usually within a month of infection. Months later, the second stage features a skin rash and fever. The third stage, often many years later, brings the formation of growths and serious involvement of the heart, brain and spinal cord, leading eventually to blindness, insanity and death. The disease is treated with antibiotics.

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Syphilis

Syphilis

What Is Syphilis?

How Common Is Syphilis?

Is Syphilis Contagious?

What Are the Signs and Symptoms of Infection?

How Is the Diagnosis of Syphilis Made?

How Is Syphilis Treated?

How Long Does Infection Last?

Does the Disease Have Complications?

Can Syphilis Be Prevented?

Resources

Syphilis (SIH-fih-lis) is a sexually transmitted disease that, if untreated, can lead to serious lifelong problems throughout the body, including blindness and paralysis*.

*paralysis
(pah-RAH-luh-sis) is the loss or impairment of the ability to move some part of the body.

KEYWORDS

for searching the Internet and other reference sources

Chancre

Congenital infections

Sexually transmitted disease (STD)

Treponema pallidum

What Is Syphilis?

Syphilis is a disease that is caused by the bacterium Treponema pallidum (treh-puh-NEE-muh PAL-ih-dum). The disease develops in three distinct phases. The first, or primary, stage is marked by a chancre*. In the secondary stage, a rash develops. By the third, or tertiary, stage the disease can cause widespread damage to the body, affecting the brain, nerves, bones, joints, eyes, and heart and other organs. Syphilis does not advance to this point in all infected people, and it does so only if it has not been treated adequately during either of the two earlier stages.

*chancre
(SHANG-ker) is a usually painless sore or ulcer that forms where a disease-causing germ enters the body, such as with syphilis.

Without treatment, syphilis can be fatal. It also can have serious consequences for babies who become infected in the womb, before birth. If a pregnant woman has syphilis, she can pass it to her fetus*, a condition known as congenital* syphilis. Because the immune system of a baby is not developed fully until the infant is well into the first year of life, infection with syphilis bacteria can lead to severe complications. If pregnant women who are infected are not treated, more than a third of their infants may die before or shortly after birth.

*fetus
(FEE-tus) is the term for an unborn human after it is an embryo, from 9 weeks after fertilization until childbirth.
*congenital
(kon-JEH-nih-tul) means present at birth.

How Common Is Syphilis?

Before the introduction of the antibiotic penicillin in the 1940s, syphilis was rampant in the United States. Although the disease is still relatively common, the number of cases today is far below the high rate of infection early in the twentieth century. According to the U.S. Centers for Disease Control and Prevention (CDC), 31,575 cases (or about 12 per 100,000 people) were reported in 2000 (although the number of actual infections is likely higher, because many cases go unnoticed at first). Of those, 529 were cases of congenital syphilis. Compare that with 485,560 cases overall (or 368 per 100,000 people) in 1941, the first year that the government began tracking syphilis rates.

Is Syphilis Contagious?

Syphilis is a sexually transmitted disease that spreads from person to person through vaginal*, oral*, or anal* intercourse. A pregnant female also can pass the disease to her fetus. People are most contagious during the second stage of the infection.

*vaginal
(VAH-jih-nul) refers to the vagina, the canal in a woman that leads from the uterus to the outside of the body.
*oral
means by mouth or referring to the mouth.
*anal
refers to the anus, the opening at the end of the digestive system through which waste leaves the body.

What Are the Signs and Symptoms of Infection?

Syphilis has been called the great imitator, because its symptoms can resemble those of many other diseases. Not all people have obvious symptoms, but in those who do, signs of disease appear 10 to 90 days after being infected. The first symptom is a small, usually painless sore known as

How Syphilis Changed The FAce Of Medical Research

Just a few decades ago syphilis was the subject of the most infamous public health study ever carried out in the United States. From 1932 to 1972 the U.S. Public Health Service conducted a study in Macon County, Alabama, to learn more about the long-term consequences of the disease. Six hundred poor African-American men, 399 infected with syphilis, participated in the study in exchange for free medical exams, free meals, and burial insurance.

The Tuskegee Syphilis Study became notorious because local doctors who participated in the study were instructed not to treat the mens infections, even after an easy cure with penicillin became widely available in 1947. Although the men had agreed to be part of the project, they were never told they would not be treated fully for their condition. They were simply told that they were part of a study of bad blood, a local term used for several illnesses.

Public outrage erupted in 1972 when it became known that men with syphilis in the study had been allowed to remain untreated so that doctors could investigate the progression of the disease, and the project was stopped. But that came too late for the men; many were disabled permanently or had died. In the wake of the study, the government moved quickly to adopt policies that protect people who take part in research programs. In 1974, a new law created a national commission to set basic ethical standards for research. New rules also required that participants in government-funded studies be made fully aware of how a study will proceed and voluntarily agree to take part in it. Any study that involves humans also is reviewed before it begins to ensure that it meets ethical standards.

Of course, these changes could not reverse the physical and emotional harm done to the men in the Tuskegee Syphilis Study and to their families. In recognition of that harm, in 1997, President Bill Clinton offered an apology to the survivors, families, and descendants of those men on behalf of the U.S. government.

a chancre that appears where the syphilis bacterium entered the body, such as on the penis or the lips of the vagina*. Without treatment, chancres will heal on their own within 6 weeks. A person who is infected may never even notice a chancre, especially if it is inside the vagina or the rectum*.

*vagina
(vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.
*rectum
is the final portion of the large intestine, connecting the colon to the anus.

When the chancre fades, the disease moves to its second stage 1 to 2 months later. In this phase, a rash of rough reddish or brownish spots appears on the body, including the soles of the feet and the palms of the hands. The rash may be so faint that it is barely noticeable. Second-stage symptoms of syphilis also may include fever, headache, extreme tiredness, sore throat, muscle aches, swollen lymph nodes*, weight loss, hair loss, and ulcers* on mucous membranes* in the mouth and on the genitals*. Wartlike lesions* may appear on the vagina or anus. This stage of the infection also disappears on its own, fooling many people into thinking that they have had a common viral illness.

*lymph
(LIMF) nodes are small, bean-shaped masses of tissue that contain immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections.
*ulcers
are open sores on the skin or the lining of a hollow body organ, such as the stomach or intestine. They may or may not be painful.
*mucous membranes
are the moist linings of the mouth, nose, eyes, and throat.
*genitals
(JEH-nih-tuls) are the external sexual organs.
*lesions
(LEE-zhuns) is a general term referring to sores or damaged or irregular areas of tissue.

After the second-stage symptoms clear up, the disease enters a latent, or hidden, period in which there are no signs of illness. The latent period can last for many years, and in some infected people the bacteria do no further damage. In about one-third of people who reach the latent period, the disease progresses to its final stage. This phase has no symptoms at first, but as the bacteria invade and damage nerves, bones, and the heart and other organs, the patient may experience dizziness, headaches, seizures*, dementia*, loss of coordination, numbness, increasing blindness, and paralysis. The disease also can eat away at tissue in the mouth and nose, disfiguring the face. This last stage of the disease can begin 2 to 40 years after a person is first infected.

*seizures
(SEE-zhurs) are sudden bursts of disorganized electrical activity that interrupt the normal functioning of the brain, often leading to uncontrolled movements in the body and sometimes a temporary change in consciousness.
*dementia
(dih-MEN-sha) is a loss of mental abilities, including memory, understanding, and judgment.

Babies who are born with syphilis may have symptoms right away or may show signs of the disease within a few weeks or months. Those symptoms include failure to thrive*, irritability, fever, rash, a nose without a bridge (known as saddle nose), bloody fluid from the nose, and a rash on the palms, soles, or face. As these children grow older, they may become blind and deaf and have notched teeth (called Hutchinson teeth). Bone lesions may arise, and lesions and scarring may appear around the mouth, genitals, and anus.

*failure to thrive
is a condition in which an infant fails to gain weight and grow at the expected rate.

How Is the Diagnosis of Syphilis Made?

If a patient has a chancre or other lesion, the doctor collects a sample of fluid from the sore to examine under a special microscope. Syphilis bacteria in the fluid are visible under magnification. The doctor also may take a blood sample to look for antibodies* to the bacterium. If neurosyphilis (nur-o-SIH-fih-lis, syphilis that has progressed to the point that it affects the brain, spinal cord, and nerves) is suspected, the spinal fluid also may be tested for antibodies. Pregnant women are screened for syphilis during routine prenatal care.

*antibodies
(AN-tih-bah-deez) are protein molecules produced by the bodys immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.

How Is Syphilis Treated?

Even though visible signs of the infection will clear up on their own, patients with syphilis are treated to prevent the disease from progressing to the late, potentially much more harmful stage, or to prevent a pregnant womans infant from being damaged by the infection. Early-stage syphilis is treated easily with antibiotics. People who are infected with syphilis are advised to notify all their recent sexual partners so that they, too, can be tested for the disease. Patients with advanced cases of the disease often need to be hospitalized. They also receive antibiotics, although medications cannot reverse damage already done to the body.

How Long Does Infection Last?

A single dose of antibiotics can clear up syphilis infections that are less than a year old. Longer-term cases require longer courses of treatment. Congenital syphilis also needs a longer course of treatment. Without treatment, the disease can last for years or even decades.

Does the Disease Have Complications?

Untreated cases of syphilis can lead to destructive tissue lesions known as gummas on the skin, bones, and organs; seizures; damage to the spine that can result in paralysis; heart problems; damage to blood vessels that can lead to stroke*; and death. According to the CDC, a person with syphilis has a two to five times greater risk of acquiring human immunodeficiency (ih-myoo-no-dih-FIH-shen-see) virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), an infection that weakens the immune system. The reason for this increased risk is that open sores make it easier for HIV to enter the body during sexual contact. Also, people infected with HIV are more likely to experience neurological* complications of syphilis. In infants, syphilis can lead to hearing loss, blindness, neurological problems, and death.

*stroke
is a brain-damaging event usually caused by interference with blood flow to the brain. A stroke may occur when a blood vessel supplying the brain becomes clogged or bursts, depriving brain tissue of oxygen. As a result, nerve cells in the affected area of the brain, and the specific body parts they control, do not properly function.
*neurological
refers to the nervous system, which includes the brain, spinal cord, and the nerves that control the senses, movement, and organ functions throughout the body.

Can Syphilis Be Prevented?

Using latex condoms or not having sex, especially with someone who is known to be infected, can prevent the spread of syphilis and other sexually transmitted diseases. To be effective, the condom has to cover all syphilis sores. Contact with sores in the mouth or on areas such as the rectum that may not be covered by a condom can spread the disease. Doctors advise pregnant women to be tested and, if needed, treated for syphilis to minimize the risk of passing it to the developing fetus.

See also

AIDS and HIV Infection

Congenital Infections

Sexually Transmitted Diseases

Resources

Organizations

American Social Health Association, P.O. Box 13827, Research Triangle Park, NC 27709. The American Social Health Association has information and fact sheets concerning sexually transmitted diseases, including syphilis, at its website.

Telephone 919-361-8400 http://www.ashastd.org

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC provides fact sheets and other information on syphilis at its website.

Telephone 800-311-3435 http://www.cdc.gov

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of childrens health. It contains articles on a variety of health topics, including syphilis.

http://www.KidsHealth.org

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syphilis

syph·i·lis / ˈsifəlis/ • n. a chronic bacterial disease caused by the spirochete Treponema pallidum. It is contracted chiefly by infection during sexual intercourse, but also congenitally by infection of a developing fetus. DERIVATIVES: syph·i·lit·ic / ˌsifəˈlitik/ adj. & n.

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"syphilis." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. 27 Jun. 2016 <http://www.encyclopedia.com>.

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syphilis

syphilis XVIII. — modL. Syphilis title of a poem, in full ‘Syphilis sive Morbus Gallicus’ (syphilis or the French disease), 1530, by Girolamo Fracastoro, physician, astronomer, and poet, of Verona; the poem is the story of a shepherd Syphilus, represented as the first sufferer.
Hence syphilitic XVIII.

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T. F. HOAD. "syphilis." The Concise Oxford Dictionary of English Etymology. 1996. Encyclopedia.com. 27 Jun. 2016 <http://www.encyclopedia.com>.

T. F. HOAD. "syphilis." The Concise Oxford Dictionary of English Etymology. 1996. Encyclopedia.com. (June 27, 2016). http://www.encyclopedia.com/doc/1O27-syphilis.html

T. F. HOAD. "syphilis." The Concise Oxford Dictionary of English Etymology. 1996. Retrieved June 27, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O27-syphilis.html

syphilis

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"syphilis." A Dictionary of Biology. 2004. Retrieved June 27, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O6-syphilis.html

syphilis

syphilisAlice, chalice, challis, malice, palace, Tallis •aurora australis •Ellis, trellis •necklace •aurora borealis, Baylis, digitalis, Fidelis, rayless •ageless • aimless • keyless •amaryllis, cilice, Dilys, fillis, Phyllis •ribless • lidless • rimless •kinless, sinless, winless •lipless • witless • annus mirabilis •annus horribilis • syphilis •eyeless, skyless, tieless •polis, solace, Wallace •joyless •Dulles, portcullis •accomplice •Annapolis, Indianapolis, Minneapolis •Persepolis •acropolis, cosmopolis, Heliopolis, megalopolis, metropolis, necropolis •chrysalis • surplice • amice • premise •airmiss • Amis • in extremis • Artemis •promise •pomace, pumice •Salamis •dermis, epidermis, kermis

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"syphilis." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. 27 Jun. 2016 <http://www.encyclopedia.com>.

"syphilis." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. (June 27, 2016). http://www.encyclopedia.com/doc/1O233-syphilis.html

"syphilis." Oxford Dictionary of Rhymes. 2007. Retrieved June 27, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-syphilis.html

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