The Spirochetes (4)

Syphilis

Tertiary Stage of Syphilis

It is a multistage infection caused by spirochete Treponema pallidum. It is a sexually transmitted disease (STD). The primary route of transmission is through sexual contact; it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis.

The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary). The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration), secondary syphilis with a diffuse rash which frequently involves the palms of the hands and soles of the feet, latent syphilis with little to no symptoms, and tertiary syphilis with gummas, neurological, or cardiac symptoms. It has, however, been known as "the great imitator" due to its frequent atypical presentations. Diagnosis is usually via blood tests; however, the bacteria can also be visualized under a microscope.

A patient with syphilis

Symptoms

Primary Stage: One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:

1. On the vulva (outside the vagina) or on the cervix (neck of the womb) in women
2. On the penis in men



Primary Stage

3. Around the anus and mouth (both sexes)

Secondary Stage: If the infection has not been treated, the secondary stage of syphilis will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:

1. A flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months).
2. A non-itchy rash covering the whole body or appearing in patches.
3. Flat, warty-looking growths on the vulva in women and around the anus in both sexes.
4. White patches on the tongue or roof of the mouth.
5. Patchy hair loss.

Secondary Stage

Tertiary and Latent Stage: If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test.

If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system.

If treatment for syphilis is given during the latent stage the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.

See: http://www.avert.org/syphilis.htm, http://www.nhs.uk/Conditions/Syphilis/Pages/Symptomspg.aspx, http://en.wikipedia.org/wiki/Syphilis

Causes

1. Syphilis is caused by bacteria called Treponema pallidum. The bacteria can enter your body if you have close contact with an infected sore, normally during intercourse.
2. It may also be possible to catch syphilis if you are an injecting drug user and you share a needle with somebody who is infected.
3. Pregnant women can pass the condition on to their unborn babies, which can cause stillbirth or death of the baby shortly after labor.
4. It is extremely rare for syphilis to be spread through blood transfusions as all blood transfusions in the UK are routinely tested for syphilis.

Diagnosis

The doctor or nurse will examine your genitals. For men, this involves looking at the penis, foreskin and urethra (the hole at the end of the penis where urine comes out). For women, it involves an internal examination of the vagina. Both men and women may also have their anus examined.

Treatment

The spirochetes are extremely sensitive to penicillin, plasma concentration as low as 0.03 unit per ml being spirocheticidal.

Syphilis can be effectively treated with the preferred intramuscular penicillin G (given intravenously for neurosyphilis), as or else ceftriaxone, and in those who have a severe pencillin allergy, oral doxycycline or azithromycin.

Complications

It is estimated that people with syphilis are three to five times more likely to catch HIV. This is because the genital sores caused by syphilis can bleed easily, making it easier for the HIV virus to enter the blood during sexual activity.

Treponema pallidum, the causative microorganism of syphilis