Syphilis

Definition
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as
a painless sore on your genitals, mouth or another part of your body. If untreated,
syphilis can damage your heart and brain.

Syphilis rates in the United States have been rising since 2000. Nearly two-thirds of
new infections occur in men who have sex with men, according to the Centers for
Disease Control and Prevention. Rates have also risen among young women. Syphilis
affects a higher percentage of African-Americans than whites.

Syphilis progresses in stages and can lead to serious complications or death. Having
syphilis also makes you more vulnerable to HIV. When caught early, syphilis can be
cured with antibiotics.

Symptoms

Primary syphilis

Syphilis develops in four stages, and symptoms vary with each stage. But the stages
may overlap, and symptoms don't always occur in the same order. You may be
infected with syphilis and not notice any symptoms for years. If you have HIV
infection at the same time, the symptoms of syphilis may be somewhat different than
without HIV infection.

Primary syphilis
These signs may occur from 10 days to three months after exposure:
  A small, firm, painless sore (chancre, pronounced "SHANG-ker") on the part of your body
where the bacteria entered, usually your genitals, rectum, tongue or lips. A single chancre
is typical, but you may have multiple sores.
 Enlarged lymph nodes in your groin.

The sore will heal without treatment, but the syphilis infection remains. In some
people, syphilis then moves to the secondary stage.

Secondary syphilis
The signs and symptoms of secondary syphilis begin two to 10 weeks after the
chancre appears and may include:

 Skin rash, often appearing as rough, red or reddish-brown, penny-sized sores, over any area
of your body, including your palms and soles
 Fever
 Fatigue and a vague feeling of discomfort
 Soreness and aching
 Swollen lymph glands
 Sore throat
 Wart-like sores in the mouth or genital area

These signs and symptoms may disappear within a few weeks or repeatedly come and
go for as long as a year.

Latent syphilis
If you aren't treated for syphilis, the disease moves from the secondary to the latent
(hidden) stage, when you have no symptoms. The latent stage can last for years. Signs
and symptoms may never return, or the disease may progress to the tertiary (third)
stage.

Tertiary or late syphilis

About 15 to 30 percent of people infected with syphilis who don't get treatment will
develop complications known as tertiary, or late, syphilis. In the late stages, the
disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and
joints. These problems may occur many years after the original infection.

Some of the signs and symptoms of late syphilis include:

 Jerky or uncoordinated muscle movements

 Paralysis
 Numbness
 Gradual blindness
 Dementia

Congenital syphilis
If you're pregnant, you may pass syphilis to your unborn baby. Blood containing the
bacteria reaches the fetus through the placenta, the organ that nourishes the
developing baby. This is known as congenital syphilis.

Most infants born with syphilis have no symptoms of the disease. Almost all develop
symptoms by 3 months of age, though some children with congenital syphilis show
no signs of the disease until after age 2.
Early signs and symptoms, which occur before the age of two, may include:

 "Snuffles" (runny nose)

 Skin sores
 Rashes
 Fever
 Jaundice — yellow skin
 Infection of the umbilical cord
 Anemia
 Swollen liver and spleen

If not treated right away, the baby may experience serious problems, including:

 Deformities
 Tooth abnormalities
 Deafness
 Developmental delays
 Seizures
 Death

When to see a doctor

Visit your doctor if:

 You have a sore in your genital area, enlarged lymph nodes in your groin area, a
widespread rash or any other symptoms that might indicate syphilis.
 Your sexual behaviors put you at risk for sexually transmitted diseases. You should be
tested periodically for syphilis.
 You've been treated for another sexually transmitted disease, such as gonorrhea or HIV
infection. You should be tested to make sure you don't also have syphilis.

Causes
The cause of syphilis is a bacterium called Treponema pallidum. The most common
route of transmission is through contact with an infected person's sore during sexual
activity. The bacteria enter your body through minor cuts or abrasions in your skin or
mucous membranes. Syphilis is contagious during its primary and secondary stages,
and sometimes in the early latent period.

Less commonly, syphilis may spread through transfusion of infected blood, through
direct unprotected close contact with an active lesion (such as during kissing), or
through an infected mother to her baby during pregnancy or childbirth (congenital
syphilis).

Treponema pallidum is sensitive to light, air and changes in temperature. Because of

this, you won't get syphilis from using the same toilet, bathtub, clothing or eating
utensils as an infected person, or from doorknobs, swimming pools or hot tubs.
Risk factors
You face an increased risk of acquiring syphilis if you:

 Engage in high-risk sexual activity, including unprotected sex, sex with

multiple partners, having sex with a new partner, or having sex under the
influence of drugs or alcohol
 Are a man who has sex with men
 Are infected with the human immunodeficiency virus (HIV)

The more sexual partners you have, the more likely you are to get syphilis or another
sexually transmitted disease (STD). Even if you've had syphilis and been treated for it
previously, you can get it again.

Complications
Without treatment, syphilis can lead to damage throughout your body. Syphilis also
increases the risk of HIV infection and, for women, can cause problems during
pregnancy. Treatment can help prevent future damage but can't repair or reverse
damage that's already occurred.

Small bumps or tumors

Called gummas, these bumps can develop on your skin, bones, liver or any other
organ in the late stage of syphilis. If you're treated during this stage, the gummas will
usually disappear.

Neurological problems
In the late stage, syphilis can cause a number of problems with your nervous system,
including:

 Stroke
 Infection and inflammation of the membranes and fluid surrounding the brain
and spinal cord (meningitis)
 Poor muscle coordination
 Numbness
 Paralysis
 Deafness or visual problems
 Personality changes
 Dementia

Cardiovascular problems
These may include bulging (aneurysm) and inflammation of the aorta — your body's
major artery — and of other blood vessels. Syphilis may also cause valvular heart
disease, such as aortic valve stenosis.

HIV infection
Adults with sexually transmitted syphilis or other genital ulcers have an estimated
two- to five-fold increased risk of contracting HIV. A syphilis sore can bleed easily,
providing an easy way for HIV to enter your bloodstream during sexual activity.
Pregnancy and childbirth complications
About 40 percent of babies who contract syphilis from their mothers will die — either
through miscarriage, stillbirth or within a few days of birth. The chance of premature
(preterm) birth also is higher.

Tests and diagnosis

Syphilis can be diagnosed by blood tests or by testing a sample of fluid from sores.

Blood tests
Blood tests can confirm the presence of antibodies that the body produces to fight
infection. The antibodies to the bacteria that cause syphilis remain in your body for
years, so the test can be used to determine a current or past infection.

Lab tests
Your doctor may scrape a small sample of cells from a sore to be analyzed by
microscope in a lab. This test can only be done during primary or secondary syphilis,
when sores are present. The scraping can reveal the presence of bacteria that cause
syphilis.

Cerebrospinal fluid test

If it's suspected that you have nervous system complications of syphilis, your doctor
may also suggest collecting a sample of cerebrospinal fluid through a procedure called
a lumbar puncture (spinal tap).

Screening for pregnant women

The U.S. Preventive Services Task Force and other major medical organizations
recommend that all pregnant women be screened for syphilis.

Treatments and drugs

When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred
treatment at all stages is penicillin, an antibiotic medication that can kill the organism
that causes syphilis. If you're allergic to penicillin, your doctor will suggest another
antibiotic.

A single injection of penicillin can stop the disease from progressing if you've been
infected for less than a year. If you've had syphilis for longer than a year, you may
need additional doses.

Penicillin is the only recommended treatment for pregnant women with syphilis.
Women who are allergic to penicillin can undergo a desensitization process that may
allow them to take penicillin. Even if you're treated for syphilis during your
pregnancy, your newborn child should receive antibiotic treatment. Penicillin is the
standard treatment for infants and children with congenital syphilis.

The first day you receive treatment you may experience what's known as the Jarisch-
Herxheimer reaction. Symptoms include fever, chills, nausea, achy pain and
headache. This reaction usually doesn't last more than one day.
Treatment follow-up
After you're treated for syphilis, your doctor will ask you to:

 Have periodic blood tests and exams to make sure you're responding to the
usual dosage of penicillin. Typically, these follow-up tests are done six
months and 12 months after treatment, but may be done more often. Follow-up
testing may continue for two years in some cases.
 Avoid sexual contact until the treatment is completed and blood tests indicate
the infection has been cured.
 Notify your sex partners so that they can be tested and get treatment if
necessary.
 Be tested for HIV infection.

Prevention
To reduce your risk of syphilis and other sexually transmitted diseases, practice safe
sex:

 Avoid sex, or have mutually monogamous sex with one partner who is
uninfected.
 Talk with your sex partners about your HIV status and history of other
sexually transmitted diseases (STDs).
 If you don't know the STD status of your partner, use a latex condom with
each sexual contact.
 Avoid excessive use of alcohol or other drugs, which can cloud your judgment
and lead to unsafe sexual practices.