What problems can occur in people with syphilis?

Syphilis is a curable sexually transmitted disease caused by theTreponema pallidum spirochete. The name "syphilis" was initiated by the Italian physician and poet Girolamo Fracastoro in his latin poem entitledSyphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. syphilis became known as the "French disease" in Italy and Germany, and the "Italian disease" in France. In addition, the Russians called it the "Polish disease", the Dutch called it the "Spanish disease", the Turks called it the "Christian disease" and the Tahitians called it the "British disease". These names are due to the disease often being present among invading armies or sea crews, due to the high instance of unprotected sexual contact with prostitutes. It was also called "Great pox" in the 16th century to distinguish it from smallpox. In its early stages, the Great pox produced a rash similar to smallpox. However, this name wass misleading, as smallpox was a far more deadly disease.

Transmission of syphilis is almost always by sexual contact, although it can be acquired congenitally by transmission from the mother to child across the placenta. The signs and symptoms of syphilis are numerous. The disease was known as the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Syphilis can be easily treated with antibiotics including penicillin. If not treated, syphilis can cause serious effects such as damage to the brain, eyes,heart, aorta, and bones. Sometimes these effects can be fatal.

History

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples.

In 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirocheteTreponema pallidum in the brain of a progressive paralysis patient, proving that Treponema pallidum was the cause of the disease.

Some famous historical personages, including King Henry VIII, Franz Schubert, Frederick Delius, Ivan the Terrible, Leo Tolstoy, Adolf Hitler, Al Capone, Mussolini and Idi Amin have been alleged to have had syphilis.

The insanity caused by late-stage syphilis was once one of the more common forms of dementia.

Karen Blixen, the authoress ofOut of Africa, contracted syphilis from her husband while living in Africa. He had contracted the disease from an African woman with whom he had been unfaithful. After having undergone treatment in Denmark, she returned to Africa but she was unable to have children.

Primary Syphilis

With the initial infection, the majority of the organisms are focused at the site where they enter the body. About four weeks after infection a painless hard sore can be seen. This is the characteristic sign of primary syphilis.

Approximately 10-90 days after the initial exposure (average 21 days), a skin lesion appears at the point of contact, which is usually the genitalia, but could be anywhere on the body. This lesion, called achancre, is a localized, firm, painless skin ulceration. It may persist for 4 to 6 weeks and usually heals spontaneously. Local lymph glands may enlarge. During the initial incubation period, individuals are otherwise symptom free. As a result, many patients do not seek immediate medical care.

Syphilis cannot be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.

Secondary Syphilis

The organisms subsequently reach all parts of the body. About ten weeks after infection there may be fever and generalised ill health. There is a typical dull red, raised rash all over the body including the palms and soles of the feet. This is secondary syphilis. In moist areas of the body, the rash becomes flat broad whitish lesions known as condylomata lata.

There are many different manifestations of secondary disease. A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include malaise, fever, sore throat, weight loss, headache, and enlarged lymph glands.

Photo. Rash Syphilis

Picture secondary syphilitic rash covering his back representing the systemic spread of the Treponema pallidum bacteria.

There is a typical rough, red, or reddish brown rash that usually forms on the palms of the hands, soles of the feet, the chest and back.

Photo. Rash Syphilis

Picture of secondary syphilis rash. These are lesions on the palms of a woman aged 60.

Syphilis has often been called "the great imitator" because many of the signs and symptoms are indistinguishable from those of other diseases.

Latent syphilis

Latent syphilis is defined as having serologic (blood test for antibodies) proof of infection without signs or symptoms of the disease. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk for transmission. In the real-world, the timing of infection is often not known and should be presumed to be late for the purpose of therapy. Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. Late latent syphilis is not considered as contagious as early latent syphilis.

Tertiary Syphilis

Following secondary syphilis, about one third of those affected never have any further problems. The others enter a latent phase before the tertiary phase, which may cause damage to the nervous system and the heart. Syphilis can be transmitted across the afterbirth to affect the unborn child in pregnancy.

Tertiary syphilis usually occurs 1-10 years after the initial infection, although in some cases it has taken almost 50 years. This stage is characterized by the formation of gummas which are soft, balls of inflammation known as granulomas. The granulomas are chronic and represent an inability of the immune system to completely clear the organism. Gummas may appear almost anywhere in the body including in the skeleton. Other characteristics of untreated tertiary syphilis include neuropathic joint disease, which is a degeneration of joint surfaces resulting from loss of sensation. The more severe manifestations include neurosyphilis and cardiovascular syphilis.

In some patients, neurological manifestations which results in personality changes, changes in emotional affect and hyperactive reflexes. Argyll-Robertson pupils are a diagnostic sign in which the small and irregular pupils constrict in response to focusing the eyes, but not to light. Locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait.

Cardiovascular complications include syphilitic aortitis, and aortic valve regurgitation. The course can be insidious, and heart failure may be the presenting sign after years of disease. The infection can also occur in the coronary arteries and cause narrowing of the vessels.

Diagnostic Tests

In 1906, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected.

It was only in the 20th century that effective tests and treatments for syphilis were developed. Microscopy of fluid from the primary or secondary lesion using darkfield illumination can diagnose treponemal disease with high accuracy. As there are other treponemes that may be confused withT. pallidum, care must be taken in evaluating with microscopy to correlate symptoms with the correct disease.

Present-day syphilis screening tests, such as Venereal Disease Research Laboratory (VDRL) tests are cheap and fast but not completely specific, as many other conditions can cause a positive result. False positives results can be seen in tuberculosis, malaria, hepatitis, varicella, measles, lymphoma, Chagas Disease, endocarditis, connective tissue disease, pregnancy, and intravenous drug abuse. As a result, these two screening tests should always be followed up by a more specific treponemal test. Tests based on monoclonal antibodies and immunofluorescence, such as the Treponema pallidum hemagglutination assay (TPHA) are more specific but more expensive. Unfortunately, false positives can still occur in related treponomal infections such as yaws.

Treatment

Prevention

While abstinence from any sexual activity is very effective at helping prevent all sexually transmitted diseases such as syphilis, it should be noted thatT. pallidum readily crosses intact cut skin, including areas not covered by a condom. Proper and consistent use of a latex condom is effective against the spread of syphilis through sexual contact.

Individuals sexually exposed to a person with primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be assumed to be infected and treated for syphilis, even if they are currently seronegative. If the exposure was more than 90 days before the diagnosis, presumptive treatment is recommended if serologic testing is not immediately available or if follow-up is uncertain.

There were originally no effective treatments for syphilis. Mercury was administered multiple ways including orally and by rubbing it on the skin.

Early treatment

As the disease became better understood, more effective treatments were found. The first antibiotic to be used for treating disease was the arsenic-containing drug Salvarsan. This was later modified into Neosalvarsan. Unfortunately, these drugs were not 100% effective, especially in late disease. It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers. Malaria as a treatment for syphilis was usually reserved for late disease and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after the second world war allowed syphilis to be effectively and reliably cured.

Current treatment

The first-choice treatment for all manifestations of syphilis remains penicillin G. For early syphilis, one dose of penicillin is sufficient.

Non-pregnant individuals who have severe allergic reactions to penicillin may be effectively treated with oral tetracycline or doxycycline. Azithromycin was suggested as an alternative. However, there have been reports of treatment failure due to resistance in some patients.

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Women's Health

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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Syphilis, a sexually transmitted disease - History, Diagnosis and Treatment