Syphilis: Treatment, symptoms, advice and help
Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum.
Syphilis: Incidence, age and sex
There are 12 million worldwide cases and approximately 0.03% of the world population has had syphilis at some point in time. Acquired syphilis is most common in young adults.
Signs & symptoms of syphilis: Diagnosis
Primary syphilis: A chancre develops at the site of infection, usually in the genital area. The draining inguinal lymph nodes may become moderately enlarged. Without treatment, the chancre will heal in 2-6 weeks to leave a thin atrophic scar. Secondary syphilis occurs 6-8 weeks after the development of the chancre. There is mild fever, malaise and headache. Over 75% of patients present with a rash. Condylomata lata (papules coalescing to plaques) may develop in warm, moist sites such as the vulva or perianal area. Rarely, confluence produces characteristic snail track ulcers in the mouth.
Other features such as meningitis, cranial nerve palsies, anterior or posterior uveitis, hepatitis, gastritis, glomerulonephritis or periostitis are sometimes seen.
Latent syphilis: This phase is characterized by the presence of positive syphilis serology or the diagnostic cerebrospinal fluid (CSF) abnormalities of neurosyphilis are an untreated patient with no evidence of clinical disease.
Late syphilis: The characteristic features are a chronic granulomatous lesion called a gumma, which may be single or multiple. The nervous system and heart may get involved during this phase.
T.Pallidum may be identified in serum collected from chancres, or from moist or eroded lesions in secondary syphilis using a dark-field microscope, direct fluorescent antibody test or PCR.
Blood tests can be done to detect substances produced by the bacteria that cause syphilis. The older test is the VDRL test. Other blood tests may include T.pallidum haemagglutination assay (TPHA), T.pallidum particle agglutination assay (TPPA), Fluroescent treponemal antibody – absorbed (FTA – ABS) test.
Causes and prevention of syphilis
Syphilis is caused by infection, through abrasions in the skin or mucous membranes, with the spirochaete Treponema pallidum. In adults, the infection is usually sexually acquired. Transplacental infection of the fetus may also occur.
Proper and consistent use of a latex condom substantially reduces, but does not completely eliminate, the spread of syphilis through sexual contact.
Cardiovascular syphilis: Clinical features include aortic incompetence, angina and aortic aneurysm.
Neurosyphilis: Meningovascular disease, tabes dorsalis and general paralysis of the insane constitute the symptomatic forms.
Pregnant mothers infected with the disease may pass it to the baby developing in their womb.
Congenital syphilis: This is called congenital syphilis. About 40 percent of babies who contract syphilis from their mothers will die -either through miscarriage, stillbirth or within a few days of birth. The chance of premature (pre-term) birth also is higher.
Penicillin is the drug of choice.Specific regimens depend on the stage of infection. Longer courses are required in late syphilis. Doxycycline is indicated for patients allergic to penicillin. All patients must be followed up to ensure cure and partner notification is of particular importance.