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Syphilis is a Sexually Transmitted Infection (STI) that is caused by the bacterium Treponema pallidum.

It may also be transmitted from mother to fetus during pregnancy or at Childbirth.

If a infant gets Syphilis – it is called Congenital Syphilis. Syphilis affects more than 12 million people worldwide. 90%+ cases are found in the Developing World.

Symptoms are worse if patient also has Human Immunodeficiency Virus (HIV)

The number of cases dropped significantly when Penicillin was introduced.

Recently the number has again increased due to unsafe sexual practices among men who have sex with men, men and women with multiple sexual partners, prostitution and decreased use of Condoms.

Can be passed by oral, vaginal, and anal sex.

Can be passed by kissing near a lesion.

30-60 % of patients that come into contact with a lesion will get the disease

Cannot be passed by contact with toilet seats, hot tubs, swimming pools, sharing clothing or eating utensils.

Symptoms

–  Chancre  (Occurs during Primary Stage)
–  Rash  (Occurs during Secondary Stage)
–  Neurlogical Symptoms  (Occurs during Tertiary Stage)
–  Cardiovascular Symptoms  (Occurs during Tertiary Stage)
–  Fever
–  Chills
–  Nausea
–  Vomiting
–  Abdominal pain (Occasional)
–  Headache
–  Sore throat
–  Weight loss

Chancre is a major symptom.

–  A Skin ulceration
–  Usually Painless
–  Firm
–  Non Itchy

Rash is another symptom

–  Diffuse Rash
–  Can involve palms of hands
–  Can involve soles of feet

Four Major Stages

1.)  Primary

–  Acquired by direct sexual contact with another person
–  The lesions are what is directly contacted with
–  Average onset of symptoms after exposure is 21 days.
–  But can occur between 3 and 100 days after exposure
–  Chancre occurs in 50% or so of the time.
–  Chancre appears to be an ulcer.
–  Less than 40% of those with a Chancre will have more than one ulcer
–  Multiple lesions are more common in those with HIV
–  They are occasionally painful.
–  Lymph node enlargement is seen.
–  The Chancre usually lasts for 3-6 weeks without treatment.

2.)  Secondary

–  Begins 4 to 12 weeks after the Primary Stage.
–  Reddish-pink rash on skin starts.
–  Typically non-itchy
–  Can be seen on trunk, chest, legs, palms, and soles.
–  Most likely spots are palms and soles.
–  Rash is Maculopapular or pustular
–  Occasionally white – wart like – lesions are seen.
–  Inside the rash is the bacteria and are infectious.
–  Rarely it can affect the liver, kidney, joints, eyes, and other organs or locations.
–  Rash last usually three to six weeks
–  Rash can be seen without experiencing a Chancre initially

3.)  Latent

–  Can be early latent or late latent
–  Usually a year after exposure for early
–  Usually two or more years after exposure for late
–  During early – relapse of symptoms can occur.
–  During early – patient is contagious
–  During late – no symptoms are seen
–  During late – patient is not contagious

4.)  Tertiary

–  Three main types of symptoms during this stage

1.)  Gummatous Syphilis –  (Less than 20% of cases)

.  Late benign syphilis begins 1 – 50 years after initial infection
.  Average is 15 years
.  Gummas are Soft tumor like balls of Inflammation.
.  Affects the bone, skin, liver, and most anywhere

2.)  Cardiovascular  –  (Less than 10% of cases)

.  Occurs 10 – 30 years after exposure
.  Affects the Heart
.  Can cause Syphilitic Aortitis
.  Can cause Aneuryms to form

3.)  Neurosyphilis  –  (Less than 10% of Cases)

.  Infection of the Central Nervous System
.  Can be Syphilitic Meningitis
.  Can be Meningovascular Syphilis
.  Can be General Paresis
.  Can be Tabes Dorsalis  (Poor balance and lightening pains in legs.)
.  Can occur 4 – 25 years after exposure

–  Without initial treatment – 30-40% of patients will get Tertiary symptoms

Diagnosis

–  Physical Exam of Chancre or Rash

–  Confirm or Diagnosis with blood test

Two types of blood tests

1.)  Nontreponemal
2.)  Treponemal

Nontreponemal are used initially.

  –  VDRL –  Venereal Disease Research Laboratory
  –  RPR  –  Rapid Plasma Reagin

*** – occasionally false positives can occur

Confirmation is Required through Treponemal Tests

  –  TPHA  –  Treponemal Pallidum Particle Agglutination
  –  FTA-Abs  –  Fluorescent Treponemal Antibody Absorption Test

Dark Field Microscopy

Treatment

Early Infections

Antibiotics

.  Penicillin G  –  Given Intramuscular
.  Ceftriaxone
.  Tetracycline
.  Doxycycline
.  Azithromycin  –  Given Oral

*** Tetracycline and Doxycycline should not be given during pregnancy

Late Infections

.  Penicillin G x 10 days –  Given IV in cases of Neurosyphilis
.  Ceftriaxone can be used if allergy to Penicillin
.  If allergy to Penicillin and Ceftriaxone – Tetracycline and Doxycyline can be used – but for much longer treatment periods.