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Syphilis

Other Names

Syph, dirty blood, bad blood, the pox

Cause

Bacteria - Treponema pallidum, also known as the spriochaete because of its corkscrew appearance

Distribution

Worldwide

Transmission

  • Sexual - by direct contact with infectious sores or rashes.
  • Mother to child - this mau occur during pregnancy, causing congenital syphilis

Incubation

9 - 90 days (average 21 days)

Symptoms

Syphilis is described as having 4 stages:

 

Primary syphilis: An oval shaped ulcer (sore) known as the chancre (pronounced shanker) appears at the site of entry of the bacteria and nearby lymph glands become swollen but not tender. The ulcer is typically  painless and feels hard. In heterosexual males, chancres usually appear on the head or foreskin of the penis but in homosexual males, they may occur at or near the anus or actually inside the anal canal or the  rectum. In women, they may appear on the labia, the skin around the vaginal opening. Internal chancres (that is, those on the cervix or in the anal canal often go unnoticed. The chancre heals spontaneously after 2 -  6 weeks but infection continues to spread throughout the body, culminating in secondary syphilis.

 

Secondary syphilis: The symptoms of secondary syphilis appear 4 - 8 weeks after the appearance of the chancre. They include non-itchy scalp rashes all over the body, particularly on the palms and soles, patchy hair  loss, sore throat, fleshy wart-like growths known as  condylomata lata on, in or around the genitals and anus and generalised swelling of the lymph glands. There may be associated fever, malaise (feeling of  illness), weight loss and loss of appetite. The symptoms of secondary syphilis may also disappear spontaneously after 2 - 4 weeks. When this happens, syphilis is described as having entered the latent or hidden  stage.

 

Latent syphilis: Latent syphilis does not show any symptoms but infection can be detected through blood tests. It is divided into early and late latent syphilis. Early means that the infection is less than 2 years  and late when it is more.Latent syphilis may go on for 5 - 20 years. Despite the absence of symptoms, damage still occurs, culminating eventually in the final stage - tertiary syphilis.

 

Tertiary syphilis: Tertiary syphilis is not infectious because the bacteria are deep within tissues rather than on the surface where they can be easily transmitted. However, they are very destructive and can damage  important organs such as the brain and nervous system (neurosyphilis) and the heart and its great vessels (cardiovascular syphilis) or it may severely deform bones, joints and the skin. Neurosyphilis may result in  insanity, dementia (mental deterioration), paralysis and incontinence and cardiovascular syphilis may cause chest pain and heart failure. Both neurosyphilis and cardiovascular syphilis may be fatal.

Diagnosis

  • Physical examination.
  • Darkground microscopic examination of secretions from sores or condylomata lata.
  • Blood tests for example the Venereal Disease Reference Laboratory (VDRL), Treponema pallidum haemagglutination (TPHA) and the Fluorescent antibody absorption (FTA-ABs) tests.

Treatment

Penicillin injections are the best treatment but alternative antibiotics may be used if the person is allergic to penicillin.

Complications:

  • Syphilis may progress, causing severe damage to important organs such as the brain and the heart and may cause death.
  • A pregnant woman can transmit infection to the unborn causing congenital syphilis. Severely affected babies may die and survivors may develop rashes, blindness, deafness and bone deformities.

Comments

  • Treatment during the early stages of syphilis, that is primary, secondary and latent syphilis will result in complete cure and no long-term disability. However, tretment of tertiary syphilis will prevent further  progression or deterioration but will not reverse the damage that has been done. This is why early treatment is vital.
  • Syphilis may skin stages. A person may develop secondary syphilis without developing chancre or latent syphilis may develop without a preceding primary or secondary stage.
  • Congenital syphilis may be prevented by screening during pregnancy.
  • The VDRL test may be positive during pregnancy and does not necessarily indicate syphilis infection. Other blood tests are necessary to confirm the diagnosis of syphilis during pregnancy.