Syphilis

What is Syphilis?
How does one get Syphilis?
What are the signs and symptoms of Syphilis?
How is Syphilis diagnosed?
How is Syphilis treated?
Is there any aftercare required following Syphilis treatment?
How is Syphilis prevented?

What is Syphilis?

Syphilis is an STD caused by the bacterium Treponema Pallidum.

First identified in 1913, the infection is believed to have been around for centuries. It has been called ‘the great imitator’ because so many of the clinical signs and symptoms of syphilis are indistinguishable from other diseases. By the end of September 2011 there had been 489 cases reported in Ireland for that year alone.

How does one get Syphilis?

Syphilis is usually passed on through sexual contact with the infectious lesions of a person with syphilis.

Pregnant women with the disease can also pass it to their babies. Many people infected with syphilis may not have symptoms for years, and are at risk of late complications of the disease if not diagnosed and treated.

What are the signs and symptoms of Syphilis?

The signs and symptoms are similar for both men and women.

The disease has primary, secondary and tertiary stages. Primary syphilis is marked by the appearance of a chancre. The chancre is typically a painless, firm skin ulceration, which is usually solitary, but there may be multiple lesions. It occurs on the penis, vagina, anus or rectum, but may also occur on the mouth and lips. The time from infection to the appearance of the chancre is from 10-90 days, about 3 weeks on average. It appears at the point of initial exposure to the bacterium, and heals spontaneously in about 3 to 6 weeks even without treatment. Local lymph node (gland) swelling may occur. Many have no symptoms, and may not seek medical advice. Without treatment the person will develop secondary syphilis.

The secondary stage begins on average 6 weeks after the untreated primary stage, and is characterised by a skin rash and mucous membrane lesions. The rash can appear as the chancre is healing, or several weeks after the chancre has healed. It is symmetrical, reddish-pink on the trunk and limbs and is not itchy. It can also involve the palms of the hands and soles of the feet, where it appears as rough reddish-brown spots, and in moist areas of the body can appear as whitish and flat lesions. Mucous patches appear in the genitals or in the mouth. Secondary syphilis is the most contagious stage of the disease, and all of these lesions are very infectious. Other symptoms associated with secondary syphilis include fever, sore throat, fatigue, weight loss, headache, meningitis-like symptoms. Rarely patients develop inflammation of the liver, eyes, kidneys, joints, stomach and colon. The signs and symptoms will resolve with or without treatment, but without treatment the infection may progress to the latent and late stage disease.

Latent (hidden) syphilis is defined as proof of infection from blood-testing without signs or symptoms of the disease. The latent stage can last for years and may progress to tertiary syphilis. This is characterised by damage to the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. Signs and symptoms of tertiary syphilis can include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, heart failure and dementia.

Neurosyphilis refers to a site of infection involving the central nervous system, the brain and spinal cord. Patients may complain of numbness, weakness, headache, vertigo or psychiatric abnormality, such as personality disorder. It can occur at any stage of syphilis. Advanced forms of neursyphilis include a chronic dementia. Neurosyphilis is now most common in patients with HIV infection.

How is Syphilis diagnosed?

Laboratory diagnosis of syphilis is by microscopy of fluid from the primary or secondary lesion (dark ground microscopy) and by blood tests.

Lumbar puncture to analyse cerebrospinal fluid may be indicated if neurosyphilis is suspected.

How is Syphilis treated?

Syphilis is very treatable in its early stages with antibiotics.

Persons who receive treatment should abstain from sexual contact until the lesions have completely healed. They must also notify their sex partners so that they too can be tested and receive treatment if required.

Is there any aftercare required following Syphilis treatment?

Regular clinical follow up is recommended with blood testing at 3, 6 and 12 months.

Past infection does not mean that one cannot be reinfected. A response to treatment or reinfection can be monitored by measuring certain syphilis blood tests.

How is Syphilis prevented?

The risk of syphilis is best reduced by correct and consistent condom use. It is important to use condoms for oral sex too as there may be infectious lesions in the mouth.

Avoiding alcohol and drug use may prevent risky sexual behaviour. Syphilitic lesions make the transmission of HIV easier. There is a 2-5 fold increased risk of HIV infection if exposed to HIV, if already infected with syphilis.

Between March 2000 and October 2001 there was a syphilis outbreak in Dublin, mostly among men who have sex with men (MSM). The outbreak was contained through raising awareness with an extensive publicity campaign, targeting MSM. Information leaflets and posters were distributed in the gay community, and extra syphilis clinics were set up for those who felt they were at risk, or contacted through partner notification. The numbers decreased between 2003 and 2006. Since 2007 however, there has been an increase in new cases of syphilis mainly affecting MSM countrywide.

Remember…

  • Syphilis has not gone away
  • It is very treatable if diagnosed early
  • One can be reinfected at any time following treatment
  • Sexual contacts need to be tested
  • Full STI screening is important as HIV and other STIs are more easily acquired if already infected with Syphilis
  • Condom should be worn for oral sex too
  • Alcohol and drug use should be avoided during sex

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