• Syphilis

    Definition

    Syphilis is a sexually transmitted disease (STD). If left untreated, syphilis can cause brain, nerve, tissue damage, and death. Fortunately, syphilis can be treated with antibiotics.

    Causes

    Syphilis is caused by specific bacteria. It is transmitted through direct contact with a syphilis lesion. This may occur when:
    • There is vaginal, anal, or oral sexual contact with an infected person
    • A pregnant woman passes the infection to her unborn baby—congenital syphilis

    Risk Factors

    Factors that may increase your chance of getting syphilis include:
    • Having sex with a person infected with syphilis
    • Having multiple sex partners
    • Not using a latex condom during vaginal, anal, or oral sex
    • Touching a syphilis lesion
    • Having other sexually transmitted diseases

    Symptoms

    Symptoms will depend on what stage the syphilis is in. There are 3 main stages as well as a resting phase.

    Primary (First) Stage within 10-90 days of exposure

    A single lesion will usually appear. It will occur in the area where the infection was originally passed. Common sites include the genitals, rectum, tongue, inside of the mouth, or lips.
    It will start as a raised and painless lesion called a chancre. It will gradually break down to form an ulcer. It usually lasts for 3-6 weeks. The ulcer will heal on its own.
    Without treatment, the infection may move to the secondary stage. This can happen even if the ulcers are no longer visible.
    Lymph Nodes
    Male Lymph nodes
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    Secondary Stage Several Weeks to Months after the Original Lesion

    This stage is marked by the appearance of a non-itchy rash. This rash may appear as rough, red, or reddish brown spots on the palms of the hands or soles of the feet. It is also possible for different rashes to appear in other places on the body. These rashes may appear as:
    • Small blotches, pustules, or scales
    • Moist warts in the groin area
    • Slimy white patches in the mouth
    The rash may be accompanied by flu-like symptoms, such as:
    • Sore throat
    • Swollen lymph nodes throughout the body
    • Fever
    • Headache
    • Fatigue
    • Muscle aches
    Untreated secondary symptoms will disappear within a few weeks, but there may be repeated episodes during the next few years.

    Latency (Resting) Stage May Last for Years

    The infection is still present but there are no symptoms. It may or may not progress to the third stage. Blood tests for syphilis will be positive during this stage.

    Tertiary (Third or Late) Stage

    This stage may begin years after the initial infection. This stage has become rare in developed countries. In this stage, the infection begins to damage:
    • Brain and nerves
    • Eyes
    • Heart and blood vessels
    • Liver
    • Bones and joints
    Damage can be serious enough to cause death. Symptoms include the following:
    • Small bumps called gummas on the skin, bones, or internal organs
    • Blindness
    • Central nervous system damage, including weakness, numbness, trouble walking, difficulty with balance, memory and psychiatric problems, and loss of bladder control

    Congenital Syphilis

    Babies born with this infection can have problems, such as deafness, cataracts, brain and nerve damage, and seizures. It can also cause premature births or stillbirths.
    Fetal Infection
    DW00030 96472 1
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    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.
    Your bodily fluids will be tested. This can be done with:
    • Samples taken from lesions
    • Blood tests
    • A spinal tap
    Syphilis testing is part of routine prenatal care. This is done to treat and prevent congenital syphilis.
    All people who have syphilis should also be tested for HIV.

    Treatment

    Syphilis can be treated with antibiotics. The type of antibiotic and length of treatment will depend on how long you have been infected. Half of those being treated for syphilis will have fever with headache, muscle aches, and other symptoms during the first 24 hours of treatment.
    If you have syphilis of any stage, avoid sexual contact until treatment is complete and the infection is gone. All sex partners should be notified. They will need to be treated as well.

    Prevention

    To reduce your chance of getting syphilis:
    • Abstain from vaginal, anal, and oral sex.
    • Have a mutually monogamous sexual relationship with an uninfected partner.
    • Use a latex condom during vaginal, anal, and oral sex. This is especially important if you are unsure of your partner's status.
    • Have regular testing for sexually transmitted diseases, especially if you are at increased risk.
    • Make sure your sexual partner is also treated if you have primary, secondary, or early latent syphilis.
    It may not be obvious that a sex partner has syphilis. Do not assume your partner is healthy just because you do not see lesions.

    RESOURCES

    American Social Health Association http://www.ashastd.org

    Centers for Disease Control and Prevention http://www.cdc.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Sex Information and Education Council of Canada http://www.sieccan.org

    References

    Latent syphilis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115040/Latent-syphilis. Updated January 26, 2016. Accessed June 7, 2016.

    Primary syphilis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115619/Primary-syphilis. Updated January 26, 2016. Accessed June 7, 2016.

    Secondary syphilis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113985/Secondary-syphilis. Updated January 26, 2016. Accessed June 7, 2016.

    Syphilis. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/syphilis/Pages/default.aspx. Updated October 27, 2014. Accessed June 7, 2016.

    Syphilis-CDC fact sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm. Updated May 20, 2016. Accessed June 7, 2016.

    Tertiary syphilis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113669/Tertiary-syphilis. Updated January 13, 2016 Accessed June 7, 2016.

    Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12):1-110.

    7/13/2016 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for syphilis infection in nonpregnant adults and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2016 Jun 7;315(21):2321-2327.

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