Syphilis

Causes and Risks:
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, which penetrates broken skin or mucous membranes. Transmission occurs most frequently by sexual contact. Syphilis can also be transferred to the fetus via the placenta after the 10th week of pregnancy. Syphilis has 3 stages. In the primary stage, painless sores, called chancres , appear 10 days to 6 weeks after exposure which can disappear on their own. The secondary stage can begin a week to 6 months after the primary stage. A skin rash is the hallmark of this stage, and lesions may appear again. The lesions are very infectious in this stage. A latent or tertiary phase follows during which no symptoms are present, but syphilis can be diagnosed by blood tests. If the disease has not been effectively treated, bacteria continue to invade the body, and there will be a relapse. The tertiary phase is a widespread infection that infects the internal organs, bones, the heart, and the brain. Approximately 30,000 cases of syphilis in adults are reported each year in the U.S. Congenital syphilis occurs in 1:10,000 live births. Transplacental transmission of syphilis can result in stillbirth. The risk of transmission to the fetus in untreated primary or secondary syphilis is approximately 100%.

Prevention:
Avoidance of sexual contact is the only completely reliable method of prevention. Standard condoms offer some protection, but they are not fail-safe. Multiple sexual partners increase the risk of acquiring sexually transmitted diseases. Safer sexual practices are beneficial. Serologic tests for syphilis should be done on high risk, pregnant women.

Symptoms:
Untreated syphilis passes through three stages: primary, secondary, and latent or tertiary.

Primary symptoms:
  • painless sores on genitals, rectum, mouth, or fingers
  • enlarged lymph nodes in the area containing the sores
  • sore heals in 4 to 8 weeks

Secondary symptoms:

Latent symptoms (tertiary stage):

Additional symptoms that may be associated with this disease:



Signs and Tests:

This disease may also alter the results of the following tests:



Treatment:
The objective of treatment is to eliminate the infection with antibiotic therapy. Contact and treatment of all sexual partners is essential. Penicillin (see Penicillin V) is the best choice for all forms of syphilis (or oral tetracycline for those sensitive to penicillin).

The infection must be reported to public health authorities for assistance in identifying and treating contacts. 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 disease is extremely contagious in the primary and secondary stages.

Prognosis:
Lesions associated with syphilis are self-limiting and disappear with little residual damage. Late syphilis may be permanently disabling and lead to death. In untreated persons, about one-third will develop serious late lesions.

Complications:

  • tissue destruction of almost any body organ in tertiary infection



Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms worsen or do not improve with treatment, or if new symptoms develop.


Syphilis has been called the "great imitator" because the rash of secondary syphilis may mimic many other diseases. This is a common appearance of the rash of secondary syphilis. (Courtesy of the Centers for Disease Control.)



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.



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.



Secondary syphilis produces a variety of generalized rashes. This is a fairly typical rash on the chest.



Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles, as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person should always be evaluated for syphilis.



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.



The is how the rash associated with the second stage of syphilis typically appears. Individuals are very infectious during this stage.



Syphilis, secondary - lesions on the soles: A generalized rash is the hallmark of the second stage of syphilis. It is one of the few rashes that also appears on the soles and palms. This picture depicts the typical appearing rash on the soles.