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Syphilis is a serious, chronic infectious disease caused by the bacterium Treponema pallidum. It is a sexually-transmissible disease that passes through characteristic stages of signs and symptoms in its natural untreated course. Untreated syphilis is characterized by a lengthy course with periodic remission and exacerbation accompanied by formation of specific local inflammations in all organs and tissues.
A distinction is made between the following syphilis stages:
Incubation period lasts from the moment of infection till appearnce of a hard chancre. Length of the period is 3-4 weeks (may vary from 10 to 80 days). The latent period may be longer during admission of antibiotics.
Primary syphilis is characterized by appearance of a hard chancre or primary syphiloma at the location of Treponema pallidum entrance.
The secondary stage starts 9-10 weeks after exposure and lasts from 3 to 5 years. It is characterized by changes in skin, mucous membranes, internal organs and the central nervous system.
Up to 50% of individuals with untreated syphilis may develop tertiary syphilis with lesions many years after the initial infection. The lesions in the tertiary stage may involve the skin, mucous membranes, bones, joints, and irreversibly affected internal organs.
Incidence
Syphilis occurs most commonly amongst those aged 20 to 24.
Signs & Symptoms
The development of syphilis occurs in four stages: primary, secondary, latent and late stage (tertiary).
Primary syphilis is characterized by a chancre, which is a single, painless ulceration with a firm border, that appears at the site of infection. As a rule no inflammation signs can be observed around the chancre. The central part of the hard chancre may look covered with a dense grey-yellowish tarnish. The chancre diameter is 10-20mm.
The chancre usually appears on the external genitalia (glans penis, inner and outer lobes of the foreskin, seldom on the skin of the scrotum and pubis, on the major and minor lips), but can also appear in the anal canal or mouth, on the tongue, lips, nipples or throat (tonils). It can in fact appear anywhere on the body. It occurs approximately 21 days after contact (although this can range from 10 days to 3 months) and usually heals within six weeks, even without medication. Enlargement of lymph nodes located in the groin, arm pits and neck occurs within one week of appearance of the chancre.
Signs of secondary syphilis begin to appear within six weeks to six months after contact with a rash over all or part of the body. Active bacteria are present in the sores of the rash; these sores are lesions of the skin or mucous membranes. The skin rash that occurs ranges from flat to raised to pustular or blister-like lesions. These lesions characteristically occur on the palms of the hands, soles of the feet, face, and scalp. The raised lesions may break down in moist areas of skin folds to form broad gray-white or pink lesions. The breaking down of mucous membranes, known as mucous patches, appears on lips, inside the mouth, vulva, and vagina. With secondary syphilis there may also be headaches, fever, fatigue, weight loss, sore throat, patchy hair loss, enlarged lymph nodes and loss of appetite.This stage of symptoms will also pass without medication, but may reappear over the next 1 to 2 years. This does not mean the disease is gone - just the symptoms.
Untreated syphilis then goes into a noncontagious latent period - latent syphilis. It occurs when the laboratory tests for syphilis are positive, but there are no outward signs of infection. This stage may last for many years.
Some people will then have no more symptoms, but some 30-50% of untreated patients will progress to tertiary syphilis ("late syphilis"). This involves a slow destruction or breakdown of organic functioning in the central nervous system and blood vessels. The result can be widespread damage to the heart, brain, eyes, nervous system, bones, and joints, as well as mental illness, blindness, severe damage to the heart and aorta, and death.
The tertiary stage is characterized by appearance of infectious granulomas - cell clusters in various tissues. A skin granuloma is reffered to as gumma. Such formations disintegrate causing irreversible lesions. For example disintegration of a gumma located in the soft or hard palate results in perforation of the tissues.
Diagnosis & Tests
Laboratory diagnosis includes a special examination of material from infectious lesions, called a darkfield examination. Blood tests are more commonly used, but syphilis cannot be detected this way until 4 to 6 weeks after the appearance of a chancre.
Complications
Congenital syphilis occurs when the fetus is infected in the uterus, and occurs in some 80-85% of cases of early untreated maternal syphilis.
During the primary (hard chancre) stage syphilis in men may be complicated by balanitis, balanoposthitis, inflammatory phimosis, paraphimosis, gangrenization and phagedenas.
The secondary stage may bring such manifestations as syphilitic balding (during the 3d - 5th month of the disease), lesions of bones, joints and periosteum.
During the tertiary (late) syphilis irreversible destructive lesions occur (lesions of hard and soft palate, palatine arches, tongue, pharynx with formation of punctures, bone and periosteal inflammations, osteomielitis, hydroarthrosis and osteoarthrosis, lesions of nervous system, heart and other organs).
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Signs, symptoms & indicators of STD Syphilis:
Conditions that suggest STD Syphilis:
Risk factors for STD Syphilis:
STD Syphilis can lead to:
STD Syphilis could instead be: | | | | | Aging |  Alzheimer's Disease |
Mental |
Schizophrenia | Dementia paralytica, or paresis, is a form of syphilis which generally affects patients in their 40s or 50s. Increased behavioral deterioration occurs and the person may be believed to have a "psychiatric illness" or Alzheimer's disease. Symptoms can include convulsions, irritability, difficulty in concentrating, deterioration of memory, defective judgment, headaches, insomnia, fatigue, lethargy, deteriorated hygiene emotional instability, depression, and delusions of grandeur with lack of insight. The patient gradually progresses toward dementia and paralysis. |
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Recommendations and treatments for STD Syphilis: | | | | | Drug |  Antibiotics| | The gold standard for treatment of syphilis is consecutive daily intramuscular injections with procaine penicillin. The dosage and duration of treatment are determined by the clinical presentation, e.g. chancre, secondary mucocutaneous manifestations, neurosyphilis, etc. If no clinical staging is possible (as is usually the case), serological staging determines the treatment regime. There are a number of treatment options for patients who are allergic to penicillin, who are needle-phobic or who may not comply with a course of daily injections. These treatment options have not been as well studied as the procaine penicillin regimes but are totally acceptable alternatives.
Benzathine penicillin as a single injection will adequately treat primary and secondary syphilis, or sero-positive syphilis with a VDRL or RPR titre of 1:16 or higher. This regime is much more user-friendly than a 10-day use of intramuscular procaine penicillin and compliance is not an issue. This same dose can be given to sexual contacts of the above groups as epidemiological treatment. Because benzathine penicillin does not cross the blood-brain barrier it is only suitable for treating latent syphilis (VDRL or RPR titre< 8) if the C.S.F. is normal. Benzathine penicillin does cross the placenta and is therefore suitable for treating pregnant women with early syphilis.
Non-pregnant patients allergic to penicillin may be treated with doxycycline 300mg daily for 21 days. This regime is considered adequate for treatment of early and late disease, whether symptomatic or latent. This regime would also be appropriate for needle-phobic patients, as would oral amoxycillin 3gm twice daily with 1gm of probenecid for 2 weeks. |
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Preventive measures against STD Syphilis:
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Weakly counter-indicative | | | Highly recommended |
GLOSSARY
Alzheimer's Disease (Alzheimer's)
A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bursitis
The bursa is a fluid-filled pad that allows your muscles to easily slide over other muscles and bones. Bursitis occurs when this pad becomes inflamed. It usually occurs when you overuse or injure a specific joint, but it can also be caused by a bacterial infection. Symptoms include pain and inflammation around joints such as the elbow, hip, shoulder, big toe, ankle or knee.
Central Nervous System (CNS)
A collective term for the brain, spinal cord, their nerves, and the sensory end organs. More broadly, this can even include the
neurotransmitting hormones instigated by the CNS that control the chemical nervous system, the endocrine glands.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Dementia (Senile Dementia)
An acquired progressive impairment of intellectual function. Marked compromise exists in at least three of the following mental activity spheres: memory, language, personality, visuospatial skills, and cognition (i.e. abstraction and calculation).
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Mucous Membranes (Mucosa, Mucous Membrane, Mucus Membranes)
The membranes, such as the mouth, nose, anus, and vagina, that line the cavities and canals of the body which communicate with the air.
Mucus (Mucous)
The viscous, slippery substance that consists chiefly of mucin, water, cells, and inorganic salts and is secreted as a protective lubricant coating by cells and glands of the mucous membranes.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Nipple (Areola, Nipples, Subareolar)
The small projection near the center of the breast containing the outlets of the milk ducts, OR the corresponding projection of the male breast. The areola is the darker tissue that encircles the nipple. Subareolar describes the location beneath the surface of the areola.
Pharynx (Pharyngeal)
A hollow tube about five inches long that starts behind the nose and goes down to the neck to become part of the esophagus (the tube that goes to the stomach).
Schizophrenia
Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.
Staging
Although grading and the identification of cancer cell types help determine a patient's prognosis, most doctors believe that the cancer's stage is a better indicator of a patient's survivability. The grade of a cancer cell is an assessment of its appearance compared to that of a normal, healthy cell. Grading is done on a scale (such as 1 to 4) with grade 1 cells differing little from normal cells, typically spreading slowly, and having a good prognosis for treatment. The highest grade cells look extremely different and indicate an aggressive cancer with poor prognosis. Staging allows a physician to gauge the size and location of tumors by using information gathered from imaging studies such as CT scans and MRIs, and from pathology tests and physical examinations. Staging factors that influence a patient's prognosis are:- Spread to tissues surrounding the kidney
- Spread to contiguous organs
- Spread to nearby lymph nodes
- Distant metastasis.
Syphilis
A sexually-transmitted disease, with symptoms in the early contagious stages being a sore on the genitalia, a rash, patches of flaking tissue, fever, a sore throat, and sores in the mouth or anus.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Last updated: May 18, 2008
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