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What Is Syphilis, And How Is It Treated?

Syphilis is a common sexually transmitted infection (STI) caused by the spirochete, Treponema pallidum. Being a venereal disease, the condition is most often acquired during sexual intercourse when skin or mucous membranes come into contact with sores present on an infected person's genitals, rectum, or mouth. 


After the initial inoculation of the bacteria into the body, they may lie dormant for several years before becoming active again. So, it is a chronic infection that may progress through various stages. The early stages of the condition are easily curable and require only a single shot of penicillin in the muscle as treatment. However, this seemingly easy-to-treat infection can affect multiple organs such as the heart and brain and even turn life-threatening if allowed to progress, thus, prompting the need for early treatment.


Syphilis, while dangerous, has effective treatment available. But before jumping on to the treatment, it is worth taking the time to learn more about the symptoms of this disease.


WHAT ARE THE SYMPTOMS OF SYPHILIS?

The symptoms that a person with Syphilis experiences vary depending on the stage of the infection.  


Primary syphilis, also known as early syphilis, is characterized by the appearance of one or more small painless ulcers, called chancres. Chancres are the hallmark lesion for primary syphilis and usually appear at the site where the bacteria entered the body, around 10-90 days after exposure. As they are generally painless, they often go unnoticed. Without treatment, they heal within a few weeks, without scarring. Treatment at this stage will stop the disease from progressing further.


The stage of secondary syphilis, which follows primary syphilis, usually manifests six weeks to six months after the first exposure. Like primary syphilis, the symptoms of secondary syphilis do resolve on their own in a few months, without any treatment. A rash that first appears on the trunk and later spreads to other parts of the body is a commonly reported symptom. In up to 50% of cases, a rash is present on the palms of the hands and soles of the feet and usually has what is described as a copper-penny appearance. Other symptoms may include the presence of sores that resemble oral, anal, or genital warts –Condylomata lata-, a fever, a sore throat, swollen lymph nodes, fatigue, and unexplained weight loss. Syphilis is also known as the great imitator as the manifestations of secondary syphilis closely resemble other disease processes. Although the symptoms of secondary syphilis will resolve without any treatment, treatment at this stage is quite important to stop the disease from progressing to the tertiary stage.  


In some people, primary and secondary syphilis stages follow a period of asymptomatic infection in which the infected person experiences no symptoms. This is described as latent syphilis. Although the person does not have any symptoms of syphilis at this stage, it can last for several years, and the infection, although not apparent, can damage the heart, brain, and other organs.


For many people, the infection does not progress past the latent phase and resolves completely; however, about third progress to the tertiary stage. This is also known as late syphilis and can pose a risk of severe health problems. The stage is characterized by ulcerating granulomatous lesions on the skin, called Gummas. These may also involve the bones and other internal organs. Cardiovascular complications of late syphilis include the formation of aortic aneurysms and coronary arteritis, and the person can have symptoms that indicate heart problems. Involvement of the nervous system can lead to gait impairments, vision problems, deafness, dementia, paralysis, and tabes dorsalis – a syndrome of pain and sensory deficits similar to those seen in Vitamin B12 deficiency. Treatment before reaching this stage is critical as the amount of organ damage can be life-threatening. 


Neuro-syphilis is a condition that involves the spread of bacteria to the nervous system. It is often associated with latent syphilis and the tertiary stage but can happen at any time after the primary stage.  


Pregnant women with syphilis are at risk of transferring the infection to the newborn either through the placenta or during childbirth. If the newborn acquires such an infection, it is known as congenital syphilis. Symptoms of congenital syphilis in a newborn include a saddle nose –in which the bridge of the nose is missing-, a fever, rashes on the genitals, anus, or mouth, and difficulty gaining weight. Infected older infants and young children can have peg-shaped teeth – Hutchinson’s teeth- and bone problems such as saber shins. The condition is often severe and life-threatening.  


HOW IS SYPHILIS DIAGNOSED?

Pregnant women are normally screened for syphilis to eliminate the mother’s risk of having syphilis and not knowing it. This is important as a maternal infection with syphilis is associated with several adverse pregnancy outcomes, and Congenital syphilis can be a life-threatening condition for a newborn.


Steps to the diagnosis of syphilis will include a history, physical examination, and investigations that will help confirm the diagnosis by the health care practitioner. 


Your health care provider will start by asking you to provide a detailed history, including your sexual history, that will include questions such as your number of sexual partners, whether safe sex is practiced to assess the risk of STIs, and whether testing is warranted. It is important to remain honest during this discussion. 


A physical examination will follow that will include an examination of genitalia to look for signs of an STI (Sexually Transmitted Infection), the presence of the chancres and eroded lesions, in the case of syphilis. Serum can be collected from chancres and eroded lesions in secondary syphilis and sent for laboratory testing to confirm the diagnosis. 


The health care provider may also draw some blood and order serological tests to check for antibodies against syphilis-causing bacteria, helping to establish a current or past infection. If your doctor suspects you might have tertiary syphilis, a lumbar puncture will also be performed. 


If a diagnosis of syphilis is confirmed, your sexual partners will also have to be contacted and tested to limit the spread.


Many home testing kits are also available now that use a small blood sample and give fairly accurate results in a few minutes. 


HOW IS SYPHILIS TREATED?

Treatment for syphilis is quite successful, particularly if treatment is started in the early course of the infection. Primary, secondary, and tertiary stages of syphilis are all treated with intramuscular injections of benzathine benzylpenicillin. Still, the treatment strategy employed depends heavily on the symptoms present and the duration of the person harboring bacteria. The current recommendations are administering 2.4 mega units of intramuscular benzathine benzylpenicillin to treat early syphilis and three doses administered weekly for late syphilis. 


In people that are allergic to penicillin, alternative drugs such as doxycycline, azithromycin, and erythromycin stearate can be used. Azithromycin, however, is less favored due to the potential for resistance. Doxycycline, being a tetracycline, is avoided during pregnancy. Since erythromycin stearate crosses the placenta poorly, both are not suitable treatment options in pregnant women with a concomitant penicillin allergy. 


Penicillin desensitization is the recommended treatment strategy in pregnant women and those with tertiary syphilis, that also have a penicillin allergy. 


Headaches, fever, and muscle pain may occur on the first day of treatment. The doctors refer to this as a Jarisch-Herxheimer reaction. It is not an indication for stopping treatment, and the symptoms usually go away in 24 hours. 


WHAT CAN BE DONE TO PREVENT SYPHILIS?

Practicing safe sex and knowing your STI status are important ways to help stop the spread of sexually transmitted infections like syphilis. If you are concerned that you may have contracted an STI, it is wise to get tested, and if you are diagnosed with syphilis following a test, your sexual partners should be tested to limit the spread.


Sexually active people are at risk of catching syphilis. However, practices such as: refraining from unprotected intercourse, not engaging in homosexual intercourse, avoiding having multiple sexual partners, and refraining from drugs that could potentially lead to unsafe sexual practices, can drastically reduce the risk of contracting syphilis and other STIs as well.


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