Syphilis

What is syphilis?

Syphilis is a sexually transmitted disease caused by Treponema pallidum. It is spread from one person to another through vaginal, anal or oral sex. The syphilis bacterium is passed through direct contact with a syphilis sore. Sores mainly occur on the external genitals, vagina, and anus or in the rectum. Sores also occur on the lips and in the mouth. An infected woman can also pass the disease on to her baby during pregnancy or childbirth. This kind of disease is called congenital syphilis.

What are the causes?

Treponema pallidum is the bacterium that cause syphilis. This organism penetrates broken skin or mucous membranes. Unprotected sexual intercourse increases the chance of acquiring syphilis.

Syphilis cannot be spread by toilet seats, doorknobs, swimming pools, bathtubs, shared clothing, or utensils.

What are the signs and symptoms?

The time between contacting the infection and the occurence of the first symptom can range from 10 to 90 days (average 21 days). If untreated, syphilis passes through three stages: primary, secondary, and latent or tertiary. The symptoms vary in the three stages:

Primary symptoms:

• Painless ulcers or open sores on the genitals, rectum, mouth, or fingers
  
• Enlarged lymph nodes in the area near the sores
  
• Sores that heal in 4 to 8 weeks

Secondary symptoms:

• Skin rash
  
• Enlargement of the lymph nodes
  
• Painless silvery ulcerations of the mucous membranes
  
• Headache
  
• Pain in the bones
  
• Loss of appetite
  
• Fever
  
• Fatigue
  
• Sore throat
  
• Weight loss

The secondary stage may persist for a year. Sometimes people can develop meningitis, which is inflammation of the membrane that surrounds the brain and spinal cord.

Tertiary symptoms: Tertiary stage syphilis can involve any organ of the body. When the brain is involved it is called neurosyphilis. This can cause many problems, including:

• Weakness or paralysis
  
• Loss of speech
  
• Deafness
  
• Blindness
  
• Mental disturbances

• Tumours of the skin, bones, or liver
  
• Cardiovascular syphilis, which affects the aorta causing valve disease
  
• Central nervous system disorders

Other symptoms that may be associated with syphilis are:

• Vaginal bleeding between periods
  
• Swallowing difficulty
  
• Nose bleed
  
• Mouth sores
  
• Groin lump
  
• Genital lesions in females

In congenital syphilis, there may be no symptoms at all or very severe symptoms may be present. The usual symptoms of syphilis include:

• Enlarged lymph nodes
  
• Rash
  
• Enlarged liver and spleen
  
• Bone abnormalities
  
• Low blood cell count

If left untreated, the late signs of congenital syphilis include bone malformations, malformed teeth, and eye and brain problems. It can even cause death.

How is it diagnosed?

Syphilis can be diagnosed by testing the blood sample for the presence of antibodies (proteins produced by the body to fight germs and other foreign substances) to Treponema pallidum. The doctor can also detect the presence of this organism in a sample of genital secretion. Various tests used to diagnose syphilis are:

• VDRL (veneral diseases research laboratory test)
  
• FTA-ABS fluorescent treponemal antibody test
  
• Dark field examination of primary lesion
  
• Donath-Landsteiner test
  
• T. pallidum hemagglutination assay (TPHA)

What is the treatment?

The objective of the treatment is to eliminate the infection with antibiotic therapy. Penicillin is the best choice for all types of syphilis. A test dose should be given to check the hypersensitivity for penicillin. Oral tetracycline can be given to those sensitive to penicillin. A baby born with the disease needs daily penicillin treatment for 10 days. This treatment will kill the bacteria causing syphilis and prevent further damage, but it will not repair any damage already done. Persons who are under treatment for syphilis must abstain from sexual contact with new partners until the syphilis sores are completely healed.

How can it be prevented?

To prevent syphilis, one should use a barrier method such as latex or plastic condom or a female condom when having sex. Some male condoms are made with the spermicidal nonoxynol-9, which helps kill some organisms that cause sexually transmitted diseases.

Anyone diagnosed as having syphilis should encourage his or her sex partner to be screened and treated. Also, people infected with the AIDS virus, as well as certain another STDs, should be tested for syphilis. To prevent congenital syphilis, all women should be screened for the disease and treated if detected positive.