SyphilisOverview

Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. It is almost always transmitted through sexual contact with infectious lesions, but it also can be transmitted in utero and via blood transfusion. Syphilis is also called "the great imitator" because many of its symptoms are almost indistinguishable from those of other diseases. Other names are: "syph", "the pox" (or "great pox"), "lues", and the "French disease".

The word "syphilis" comes from Greek and it means "lover of swine" (sus-philos) or "one who makes love" (sym-philos). It was the name of the main character in a Latin epic poem written in 1530 by the Italian physician and poet, Girolamo Fracastoro, called Syphilis sive morbus gallicus (the Latin for "Syphilis or The French Disease"). Syphilis was a shepherd who contracted the disease as a punishment from the god Apollo for the defiance Syphilis and his followers showed him.

The incidence of syphilis had been declining in recent years, with 53,000 reported cases (11,387 primary and secondary cases) in 1996, compared with 113,000 cases (33,962 primary and secondary cases) reported in 1992. However, the number of cases of primary and secondary syphilis increased yearly from 2000-2003. In 2003, 7177 cases were reported to the US Centers for Disease Control and Prevention. Most of this increase has been noted in men, particularly in men who have sex with other men. The overall cases reported in women decreased. More than 80% of cases were reported in the southern United States. Trends for congenital syphilis cases closely parallel those for acquired syphilis cases in women, namely, a decreased incidence over the past decade.

Internationally, Syphilis remains prevalent in many developing countries and in some areas of North America, Asia, and Europe, especially Eastern Europe. In some regions of Siberia, as of 1999, prevalence was 1300 cases per 100,000 population.

TESTING

It is very important to get tested if you think you have syphilis or if you have had intimate contact with someone who does.

Syphilis can be easily diagnosed, at any stage, by running several types of tests. These are Rapid Plasma Reagin (RPR), Venereal Disease Research Laboratory (VDRL), Treponema pallidum haemagglutination assay (TPHA) or Fluorescent Treponemal Antibody Absorption (FTA-ABS). There is also another quick and effective test consisting of a Simple microscopy of chancre fluid using dark ground illumination.

TREATMENT

The current treatment for primary, secondary and early latent syphilis is penicillin, in the form of Benzathine penicillin G, 2.4 MU IM in a single dose. For penicillin-allergic persons the treatment consists of a 2-week course of Doxycycline 100 mg PO bid, Tetracycline 500 mg PO qid, or Erythromycin base 500 mg PO qid.

For late latent syphilis (>1 y duration), syphilis of undetermined duration, and late syphilis, the treatment consists of Benzathine penicillin G, 2.4 million U IM once weekly for 3 consecutive weeks or Doxycycline 100 mg PO bid or tetracycline 500 mg PO qid daily for 4 weeks for penicillin-allergic persons.

For neurosyphilis the treatment is aqueous Crystalline Penicillin G, 2-4 million U IV q4h for 10-14 days or Procaine Penicillin, 2.4 million U IM qd, plus Probenecid 500 mg PO qid for 10-14 days.

Syphilis treatment may develop side-effects which are known as the Jarisch-Herxheimer reaction and include transient fever and symptoms such as malaise, chills, headache, and myalgias (muscular pain or tenderness, especially when diffuse and nonspecific), intensification of existing lesions. The reaction is quite common, develops within several hours after beginning antibiotic treatment, and usually clears within 24 hours.

Patients treated for primary and secondary syphilis should have follow-up VDRL at 3, 6, and 12 months after treatment. Those with HIV should be monitored closely as they are known to have more rapid progression of disease. Patients with neurosyphilis should have follow-up at 6-month intervals for at least 3 years with physical examinations and CSF (cerebrospinal fluid) and serologic testing. Pregnant women treated for syphilis should have monthly VDRL testing for the duration of their pregnancy.

COMPLICATIONS

Left untreated, syphilis eventually leads to blindness, loss of motor control skills, dementia and death.

Most of the complications appear during the third stage of the disease. During this stage, syphilis can spread to other parts of the body and affect the nerves, heart, brain, eyes, internal organs, joints, liver and bones. Death may result in approximately 20% of untreated patients.

During pregnancy, syphilis can have devastating consequences in the child if left untreated so it is very important to recognize the symptoms and seek medical care.

PREVENTION

In order to prevent contracting syphilis you must never have unprotected sex. But if you happen to experience symptoms similar to those of syphilis you should seek medical care as soon as possible because early stages of syphilis can be easily treated.