Syphilis

How is syphilis transmitted?

The syphilis bacterium is very fragile, and the infection is almost always transmitted by sexual contact with an infected person. The bacterium spreads from the initial ulcer (sore) of an infected person to the skin or mucous membranes (linings) of the genital area, mouth, or anus of an uninfected sexual partner. It also can pass through broken skin on other parts of the body.

In addition, a pregnant woman with syphilis can pass T. pallidum to her unborn child, who may be born with serious mental and physical problems as a result of this infection.

What are the symptoms of syphilis?

The initial infection causes an ulcer at the site of infection. The bacteria, however, move throughout the body, damaging many organs over time. Medical experts describe the course of the disease by dividing it into four stages-primary, secondary, latent, and tertiary (late). An infected person who has not been treated may infect others during the first two stages, which usually last 1 to 2 years. In its late stages, untreated syphilis, although not contagious, can cause serious heart abnormalities, mental disorders, blindness, other neurologic problems, and death.

Primary syphilis

The first symptom of primary syphilis is an ulcer called a chancre .The chancre can appear within 10 days to 3 months after exposure, but it generally appears within 2 to 6 weeks. Because the chancre may be painless and may occur inside the body, the infected person might not notice it. It usually is found on the part of the body exposed to the infected partner's ulcer, such as the penis, vulva, or vagina. A chancre also can develop on the cervix, tongue, lips, or other parts of the body. The chancre disappears within a few weeks whether or not a person is treated. If not treated during the primary stage, about one-third of people will go on to the chronic stages.

Secondary syphilis

A skin rash, with brown sores about the size of a penny, often marks this chronic stage of syphilis. The rash appears anywhere from 3 to 6 weeks after the chancre appears. While the rash may cover the whole body or appear only in a few areas, it is almost always on the palms of the hands and soles of the feet.

Because active bacteria are present in the sores, any physical contact-sexual or nonsexual-with the broken skin of an infected person may spread the infection at this stage. The rash usually heals within several weeks or months.

Other symptoms also may occur, such as mild fever, fatigue, headache, sore throat, patchy hair loss, and swollen lymph glands throughout the body. These symptoms may be very mild and, like the chancre of primary syphilis, will disappear without treatment. The signs of secondary syphilis may come and go over the next 1 to 2 years of the disease.

Latent syphilis

If untreated, syphilis may lapse into a latent stage during which the disease is no longer contagious and no symptoms are present. Many people who are not treated will suffer from no further signs and symptoms of the disease.

Tertiary syphilis

Approximately one-third of people who have had secondary syphilis go on to develop the complications of late, or tertiary, syphilis, in which the bacteria damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. This stage can last for years, or even for decades. Late syphilis can result in mental illness, blindness, other neurologic problems, heart disease, and death.

How is syphilis treated?

Unfortunately, the early symptoms of syphilis can be very mild, and many people do not seek treatment when they first become infected.

Doctors usually treat patients with syphilis with penicillin, given by injection. They use other antibiotics for patients allergic to penicillin. A person usually can no longer transmit syphilis 24 hours after starting treatment. Some people, however, do not respond to the usual doses of penicillin. Therefore, it is important that people being treated for syphilis have periodic blood tests to check that the infectious agent has been completely destroyed.

People with neurosyphilis may need to be retested for up to 2 years after treatment. In all stages of syphilis, proper treatment will cure the disease. But in late syphilis, damage already done to body organs cannot be reversed.

Can syphiIis cause other complications?

Syphilis bacteria frequently invade the nervous system during the early stages of infection. Approximately 3 to 7 percent of persons with untreated syphilis develop neurosyphilis, a sometimes serious disorder of the nervous system. In some instances, the time from infection to developing neurosyphilis may be up to 20 years.

Some people with neurosyphilis never develop any symptoms. Others may have headache, stiff neck, and fever that result from an inflammation of the lining of the brain. Some people develop seizures. People whose blood vessels are affected may develop symptoms of stroke with numbness, weakness, or visual problems. Neurosyphilis may be more difficult to treat, and its course may be different, in people with HIV infection or AIDS.