Syphilis - primary

Causes and Risks:
Syphilis is a multisystem infectious disease caused by the corkscrew-shaped bacterium (spirochete) Treponema pallidum. This organism causes infection when it penetrates broken or abraded skin or mucous membranes, usually of the genitals. Transmission occurs most frequently through sexual contact, although other means of transmission are possible. The likelihood of contracting syphilis from an infected sex partner following one episode of unprotected intercourse is 30% or about 1 in 3.

Syphilis occurs worldwide. In the United States, more than 100,000 cases occur annually. It is the third most commonly reported infectious disease ( gonorrhea is the first). The rate of syphilis is higher in urban areas (as compared to rural) and the incidence is highest in the southern states. Young adults, ages 15 to 25 are the highest risk population. There is no natural resistance to syphilis.

Because people may be unaware that they are infected with syphilis, many states require tests for syphilis prior to marriage. All pregnant women who receive prenatal care are screened for syphilis to prevent congenital syphilis, which appears in the newborn infant of infected mothers.

Syphilis has three commonly recognized stages: primary syphilis, secondary syphilis , and tertiary syphilis From a medical standpoint the actual stages are primary, secondary, latent (hidden), benign late, and tertiary. Syphilis can also affect the unborn child of an affected mother (congenital syphilis).

Primary syphilis first presents as a small painless open sore or ulcer that is called a chancre. This ulcer typically appears 10 days to 6 weeks after exposure. The often solitary ulcer that appears on the penis is easily visible; however, ulcers that occur on the labia, cervix , anal area, or in the mouth, may go unnoticed because they are painless and not easily visible.

The classical-appearing ulcer or chancre is shallow with sharply defined borders and slightly raised edges. The base of the ulcer is clean and free of debris. It is typically painless and is firm to the touch (indurated). However, many syphilitic ulcers are not "classical" or typical-appearing and any ulcer appearing on the genitalia should be suspect.

If left untreated, the chancre typically heals spontaneously within 6 to 8 weeks. It may leave behind a thin, slightly depressed (atrophic) scar. This is the end of the primary stage. The organism continues to multiply in the body but there is little outward evidence of disease until the appearance of the second stage.

Secondary syphilis, tertiary syphilis, and congenital syphilis are not seen as frequently as they were 20 or 30 years ago because of the availability of free, government- run Sexually Transmitted Disease Clinics, screening tests for syphilis, public education concerning STDs, and prenatal screening.

Prevention:
People with multiple sex partners, unknown partners, or sex partners involved in any high-risk sexual practices are at risk for acquiring sexually-transmitted diseases. A person who recognizes that he or she is at risk has taken the first step toward prevention.

Ideally, monogamous sex with a healthy partner remains, short of total abstinence, the safest type of sexual relation. Protected sex (that in which condoms are used) is the next most reliable method of preventing STDs. Condoms act as a barrier to the transmission of infectious organisms (pathogens) and should be used in any and all situations which would be considered risky or high risk. (See Condoms for Prevention of Sexually Transmitted Disease.)

Syphilis is a reportable disease as required by law. The infection must be reported to public health authorities. Information acquired from reporting helps the Public Health investigators identify, locate and treat infected sexual contacts. This function helps prevent the continued spread of infection.

Symptoms:



Signs and Tests:



Treatment:
The treatment of syphilis is determined by the length of time the person has been infected. Primary, secondary, and latent syphilis of less than one year duration are treated as follows:

  • penicillin G benzathine, 2.4 million units injected into a muscle (IM), as a single dose
  • doxycycline, 100 mg (milligrams) by mouth, twice per day for 15 days
  • tetracycline, 500 mg by mouth, four times per day for 15 days
  • erythromycin, 500 mg by mouth, four times per day for 2 weeks
  • ceftriaxone, 250 mg IM, daily for 10 days

For treatment of syphilis of greater than one year duration:

  • penicillin G benzathine, 2.4 million units IM, weekly for 3 weeks
  • doxycycline, 100 mg by mouth, twice per day for 30 days
  • tetracycline, 500 mg by mouth, twice per day for 30 days

Neurosyphilis :

  • aqueous penicillin G ,12 to 24 million units injected into a vein (IV), daily for 10 days; followed by benzathine penicillin 2.4 million units IM, once a week for 3 weeks
  • procaine penicillin, 2.4 million units IM, daily for 10 days; given with probenecid, 500 mg by mouth, four times per day for 10 days. This is followed by benzathine penicillin, 2.4 million units IM, once a week for 3 weeks.

Syphilis during pregnancy :
Penicillin is recommended as the only real drug of choice. Tetracycline cannot be used because of toxicity to the fetus, and erythromycin may fail to prevent congenital syphilis in the fetus. Penicillin-allergic individuals should ideally be desensitized and then treated with penicillin.

Several hours following treatment of early stages of syphilis individuals may undergo a reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include:

These symptoms usually disappear within 24 hours.

Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure the infection has been eliminated. There must be abstinence from sexual conduct until 2 follow-up tests have indicated that the infection has been cured. The sexual partner should also be treated. Syphilis is extremely contagious in the primary and secondary stages.

Prognosis:
Syphilis can be completely cured if diagnosed early and treated thoroughly.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if you have symptoms suggestive of syphilis . If you have had intimate contact with a person who has syphilis or any other STD, or have engaged in any high risk sexual practices including multiple partners, unknown partners, or IV drug usage you should contact your physician or be screened in a STD clinic.


This is the initial lesion seen with syphilis. There may be single or multiple ulcers. The ulcers are usually painless unless there is also a bacterial infection. The lesion may be hidden from view in women, and subsequently go unnoticed until the rash of secondary syphilis appears.



This is a chancroid erosion on the shaft of the penis. Chancroid is a sexually transmitted disease (STD) that produces a painful ulcer at the site of initial infection. The ulcer can be mistaken for the primary ulcer of syphilis. Specific lab studies should be done to differentiate between the two.



Syphilis is the third most commonly reported infectious disease in the United States. The multiple chancres on this penis are associated with primary syphilis. There may be single or multiple ulcers and they are generally painless. The lesions may be hidden from view in women and subsequently go unnoticed until the rash of secondary syphilis appears.



Syphilis is the third most commonly reported infectious disease in the United States. This is the initial lesion seen with syphilis (a chancre). There may be single or multiple ulcers that are generally painless. The lesion may be hidden from view in women, and subsequently go unnoticed until the rash of secondary syphilis appears. This lesion is on the scrotum.



This large ulcer on the penis is called a chancre and is typical of the lesions associated with primary syphilis.



A chancre on the penis caused by primary syphilis. The "chancre", a painless ulceration at the site of infection, is the classical presenting skin finding of syphilis. Chancres are highly visible in males but may go undetected in females.



Chancroid is a highly infectious sexually transmitted disease that produces ulceration of the skin, seen here on the head of the penis. Multiple ulcers may be present. Following contact, the incubation period is approximately 3 to 5 days.



Chancroid erosion on the glans of the penis: Chancroid is a highly infectious sexually transmitted disease that produces ulceration of the skin. Multiple ulcers may be present. Following contact the incubation period is approximately 3-5 days. The ulcers often have sharp edges and a yellowish base. They may ooze purulent (pus) material.