About Syphilis

About Syphilis


Incidence and Transmission: Syphilis is a complex sexually transmitted infection caused by the bacterium Treponema pallidum. It spreads through direct contact with syphilis sores, which occur mainly on the external genitals, vagina, anus, or in the rectum. Sores can also occur on the lips and in the mouth. Transmission occurs during vaginal, anal, or oral sex; a pregnant woman can pass the infection to her unborn child. Infection occurs when the organism penetrates a mucous membrane or through broken skin on any part of the body. It cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Symptoms: There are four stages of syphilis infection.

1. Primary Stage:
The time between syphilis and the start of the first symptom can range from 10-90 days (average 21 days). The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre; pronounced “shanker”), but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. Even after the chancre disappears the person continues to be contagious, and will progress to the secondary stage if treatment is not administered.

2. Secondary Stage:
The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary signs or symptoms are present.

3. Latent:
After the secondary symptoms disappear the person enters a phase with no outward symptoms that may last 10-20 years. The organisms may now be invading inner organs including the heart, brain, and liver. After the first few years of the latent stage, syphilis is no longer infectious.

4. Late or Tertiary:
In this stage the effects of the latent stage appear. These depend on which organs the organism has attacked. Blindness, deafness, liver damage, skin ulcers, heart disease, paralysis and/or brain damage are all possible symptoms. Syphilis may also cause premature labor, or deformed or diseased tissues in a newborn child. It may also kill a fetus whose mother is infected, if the mother is not treated early in the pregnancy.

Diagnosis:
A health care provider can diagnose syphilis by using dark field microscopy to examine material from infectious sores. Syphilis bacteria show up with a characteristic appearance. A blood test for syphilis antibodies can detect the infection. The blood test is accurate, safe, and inexpensive. Every pregnant woman should have a blood test for syphilis, and it is required by law in California. It is also required to obtain a marriage license in California.

Treatment:
Syphilis can be treated and cured with a single dose of penicillin or comparable antibiotic if the person has been infected less than a year. Larger doses are needed for more established infections. Treatment cures the infection and prevents further damage, but will not repair any damage already done. Persons who receive treatment must abstain from sexual contact until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they can also be tested, and, if necessary, receive treatment. Syphilis can reoccur if the person is exposed to infection again.

Syphilis and HIV:
The genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5- fold increased risk of acquiring HIV infection when syphilis is present.

Prevalence:
In the United States 35,600 cases reported in 1999 though more cases occur each year than come to the attention of health officials. Of the nine states with the highest rates (2-5 times higher than the national rate of 2.5 cases per 100,000), eight were in the South. Some fundamental societal problems, such as poverty, inadequate access to health care, and lack of education are associated with disproportionately high levels of syphilis in certain populations. Cases of primary and secondary syphilis in 1999 had the following race or ethnicity distribution: African American 75%, whites 16%, Hispanics 8%, and others 1%. Syphilis reflects one of the most glaring examples of racial disparity in health status, with the rate for African Americans nearly 30 times the rate for whites.

Prevention:
Practice safer choices to reduce your risk of contracting syphilis. Safer choices are:

• Always use barrier methods (male condoms, female condoms, dental dams) during sex (oral, anal, vaginal) and limit your number of sexual partners.
• Get tested with your partner and have sex only with each other.
• Do not engage in sexual activities with anyone but yourself.

Even when barrier methods are used syphilis can still be passed through contact with uncovered areas. Always see a health care practitioner for any sores or lesions on the genitals. Avoid sex with people with undiagnosed rashes or legions. Know and be able to recognize the symptoms, and get tested when appropriate.