What is it?
Syphilis is an infection with the bacterium Treponema pallidum from the spirochete family. Symptoms for syphilis come in stages and vary a lot from person to person. It is also known as the great imitator since it appears to be like many other diseases and is difficult to diagnose.
How do you get it?
Syphilis is most commonly transmitted through sexual activity, including penis to vagina, penis to mouth, penis to rectum and mouth to vagina. The disease can also be transmitted during pregnancy, when a mother who has an active, untreated infection may pass the disease to her baby. Finally, in rare cases syphilis could be transmitted during blood transfusion. Blood is tested for syphilis, but on rare occasions, blood could be taken from a person incubating it (during the window period). The blood could test negative for syphilis even though it has live organisms. After 48 hours, blood generally is noninfectious, making it extremely unlikely that syphilis is passed this way.
Symptoms
Acquired syphilis - transmitted by sex.
Primary stage
About 9-90 days after the bacteria enters the blood, some people will develop a sore at the place where the bacteria entered the body (e.g. on the penis or vagina, etc). The sore is usually the size of a 10 cent coin, is often painless and the edges may feel firm to the touch. This lesion oozes clear fluid that has many spirochetes in it and is very infectious. The sore will last about a month and then will go away by itself. Some people may not go through this stage, or the lesion will be so small they do not notice it. If it is a lesion in the anus or in the vagina, it probably will go unnoticed as the lesions are usually painless.
The person may also develop swollen lymph nodes or glands in the area where the lymph from the affected body part drains (e.g. penis drains to lymph nodes at the tops of the legs).
Secondary stage
About 6 weeks after the syphilis bacteria enters the body (the primary lesion may still be present), a person may enter the secondary stage. The most common symptom is a rash all over the body, and sometimes on the palms of the hands and the soles of the feet. The rash is not usually itchy. It is commonly dry and noninfectious. Some people with secondary syphilis develop small lesions or ulcers around or in the mouth, on the penis, around the anus, inside the vagina or on its lips. These are painless and ooze clear fluid that is infectious.
People with secondary syphilis often show lymph node enlargement in the neck, underarm and groin area. Some may develop symptoms such as fever, chills, weight loss, vision loss, and others. The secondary stage disappears by itself in about a month.
Latent syphilis
In its latent or 'hidden' stage there are no signs or symptoms, and the syphilis is only discovered through a positive blood test. This stage may occur between the primary and secondary stages, but most commonly it occurs after the secondary stage. Some who don't recognize any primary or secondary symptoms may go directly into the latent stage. It is divided into early latent - which is up to 1 year after the person is infected - and late latent which is beyond 1 year after infection. Often it is difficult to know when a person was infected and they are put in the category of 'latent syphilis of unknown duration'.
Tertiary or Late syphilis
About 3-30 years after the initial infection some people who have not had treatment for syphilis, and often who have not had antibiotics for other infections, will go on to develop late stage disease. This is the bad stuff often associated with syphilis: a form of insanity and a type of paralysis in neurosyphilis. In cardiovascular syphilis, the aorta, or large blood vessel coming out of the heart, can be infected and it can dilate. People may also get gummas, which are lesions in any part of the body except for the heart. These lesions can be ulcers, sores, masses or lumps.
As you can see, syphilis can mimic many diseases.
Congenital - syphilis caught by the baby while it is inside the mother.
If the baby is stillborn, it usually happens when the mother is in the mid 3 months of pregnancy. If this does not happen and a live baby is born, it can have congenital syphilis if the mother has not been treated.
Congenital syphilis is divided into early congenital syphilis, or syphilis under 2 years of age, and late congenital syphilis showing up after 2 years of age.
There are many symptoms of early congenital syphilis: a body rash, clear discharge from the nose, pain in the arms and/or legs, enlargement of the spleen, anemia, and others.
Late congenital syphilis - Beethoven was said to have this. There may be deformed teeth, inflammation of the eyes causing scarring of the corneas, deafness, etc.
Tests for syphilis
Lesion Tests:
Tests on the lesions are the Darkfield test, the DFA-TP test, biopsy, and sometimes PCR (a research test). With the PCR test, the syphilis bacteria can be fingerprinted and it may be possible to tell if an epidemic has been imported from a specific country or geographical area. Tests on lesions may be useful at times.
Blood Tests:
These are the most common tests for syphilis. The blood is screened with a nonspecific test called the RPR. This test detects antibodies to lipid present in people with syphilis. If this test is positive, other tests that are more specific, such as the MHA-TPPA and FTA-ABS are done.
If the screening test and the confirmatory tests are positive, this confirms that a person has syphilis. At least one of the blood tests usually start to react when a lesion first appears. If a lesion does appear, the average incubation period of primary syphilis is about 3 weeks, so most people will show antibodies by that time. However, the blood can be negative for syphilis for as long as 3 months (known as the window period). We therefore recommend that recent contacts to syphilis be examined, tested and treated for syphilis without waiting for test results.
Treatment
The best treatment is injectible long-acting penicillin, if the person is not allergic. If the person has primary syphilis, secondary syphilis, or latent syphilis of under a year in duration, one set of penicillin injections in each buttock is enough. If the syphilis is of over a year in duration, or is of unknown duration, the person receives the injectable penicillin weekly x 3 (6 injections altogether). Alternate treatment if a person is allergic to penicillin, is doxycycline.
Doxycycline cannot be used in pregnancy. If a woman is pregnant and has a history of being allergic to penicillin, alternative testing and treatment is recommended.
Jarish Herxheimer Reaction
Seventy percent of people treated for early syphilis (primary, secondary and early latent syphilis) will have fever or chills on the night of the treatment lasting up to 6 hours. Anti-fever medications like Tylenol or Aspirin can be taken. It stops by itself and does not mean that the person is allergic to penicillin. If a person does not have this reaction after treatment, it does not mean that the treatment is ineffective.
Follow-up after treatment
The syphilis specific blood tests remain reactive for a lifetime, so are not used in assessing the response to treatment. The general syphilis screening test (RPR) is the test that is followed. It is reported as a level, which can be seen to decrease with successful treatment.
After treatment the level of the RPR blood test is followed regularly every 3 months in HIV infected people and every 6 months in non-HIV infected people. If the RPR level does not decrease as quickly as desired, retreatment may be recommended. Sometimes, a test of the spinal fluid is needed to see if the syphilis has infected the nervous system.
Pregnancy
If a woman is treated with an acceptable antibiotic regimen for syphilis either before pregnancy or during pregnancy (the treatment has to be completed before the last month of pregnancy), the likelihood of the baby being involved is extremely low. If the baby appears healthy at birth, it only needs to have a blood test at the time of birth and every 3 months until the baby=s syphilis antibody test becomes negative. The baby gets passively transferred antibodies from the mother through the placenta and those fade within the first year of life. If the mother is not treated, or not treated before the last month of pregnancy, the baby needs a blood test, a spinal fluid test, long bone x-rays, and treatment with injectable penicillin.
Who is at risk?
Anybody who has sex with different partners or has a partner who has sex with different partners is at risk for catching syphilis. Syphilis is spread easily by vaginal, rectal and oral sex. Many people are surprised that a person can catch syphilis just by oral sex, but we see this quite frequently. At present there is an outbreak in Vancouver in the Downtown Eastside, especially in commercial sex workers and their partners, many of whom are HIV positive. There is also a smaller outbreak in men who have sex with men, and many of those with syphilis are HIV positive as well.
If you are having sex with different partners, it is recommended that you use a condom for all types of sex, including mouth/penis sex, and a barrier such as a dental dam for mouth vagina sex. This will reduce your risk of catching syphilis. As well, you should have a blood test for syphilis (RPR) every few months, especially if you are not using protection, or if you are using protection for vaginal and/or anal sex but not for oral sex.
As long as syphilis is treated properly and monitored after treatment by blood tests, it is extremely unlikely that a person would develop the symptoms linked to late syphilis. Treatment makes a person noninfectious from the standpoint of sex with others and transmission from mother to unborn baby.
Reportable
Syphilis is a reportable STD
Links
| 
