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Syphilis is a sexually transmitted disease that can be acute or chronic. Symptoms occur in three stages, characterized by a sore in the mouth or genital area, followed by a rash, and, if untreated, can progress to more serious issues such as blindness, paralysis, dementia, deafness, and death.
What is syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the spread of the bacteria Treponema pallidum. Syphilis is spread through sexual contact or from mother to baby as the fetus develops in the womb or the baby passes through the vaginal canal. If spread through sexual contact, it can be through oral, anal, or vaginal sex. Syphilis can present in multiple stages, each of which is defined by different symptoms. People who have symptoms or have had sexual relations with someone who may have syphilis should get tested for the condition. This test is performed on a blood draw or, if you have an active sore, it can be swabbed and examined under the microscope. Syphilis can be effectively treated with antibiotics. People known to have syphilis should undergo treatment as this condition can have dangerous long-term effects.
You should visit your primary care physician within the next 24 hours, where he/she will look for any skin changes and use screening tests to try to rule it out. If the diagnosis is confirmed (typically by a blood test), treatment would start immediately with antibiotics.
Symptoms of syphilis
The symptoms of syphilis generally depend on what stage the condition is in. There are three stages of syphilis infection:
- Primary stage: The first stage of syphilis infection is characterized by the presence of a sore in the genital, oral, or anal regions, also known as a chancre. This chancre is characteristically painless to touch, which is important as this feature often distinguishes it from other sexually transmitted infections (STIs) that present with painful sores. It is also usually small and round. The time between infection and appearance of the chancre usually ranges from 10 to 90 days.
- Secondary stage: As the chancre begins to heal or weeks after its resolution, the second stage of the infection ensues. This stage is characterized by the development of a diffuse rash on one or multiple areas of the body. This rash is generally rough and reddish-brown. During this stage, you may also experience flu-like symptoms, swollen glands, wart-like growths, and hair loss. These symptoms will generally resolve on their own, even if you go untreated, prompting the progression to the latent stage of the infection.
- Latent stage: Once the symptoms of the first and second stages resolve, and if you remain untreated, syphilis will enter the latent stage of the infection. The latent stage can progress for many years without any symptoms. If the infection goes untreated, it can progress to the tertiary stage.
- Tertiary (late) stage: If the infection progresses and remains untreated for many years, the late stage can occur. The symptoms that can occur in the late stage of syphilis include blindness, paralysis, aortic aneurysms, dementia, deafness, and death.
It is important to make an early diagnosis of syphilis as this condition can be easily treated and early treatment prevents progression to later stages of the infection. Screening tests for syphilis include the rapid plasma reagin (RPR) and the venereal disease research laboratory test (VDRL). While usually only one of these tests is performed, you will need an additional test to confirm the diagnosis if the screening test comes back positive. Rarely, a chancre will be swabbed and examined under the microscope to look for the presence of the bacteria. Screening for syphilis is recommended in pregnant women, as this condition can spread to a fetus.
If you are found to have syphilis, you are responsible for informing your sexual partner(s).
If you are suspected of having involvement of the brain with the infection due to a late-stage presentation (also known as neurosyphilis), a physician may need to take a sample of your cerebrospinal fluid (CSF) through a lumbar puncture procedure. If you are not suspected of having brain involvement, this test is not performed.
Causes of syphilis
Syphilis is caused by infection with the bacteria Treponema pallidum. This bacterium is in the spirochete family or organisms. The chancre that forms in the first stage of syphilis is the result of bacterial erosion into the tissues below the surface of the skin. Those infected with syphilis can get flu-like symptoms as the body mounts an immune response to the bacteria. The immune system is helpful in that it works to contain the bacteria but can produce symptoms due to widespread inflammation throughout the body.
Treatment options and prevention for syphilis
Syphilis is an acute infection with the potential to become chronic if not treated with antibiotics. After undergoing proper testing, anyone diagnosed with syphilis should be treated with antibiotics. The preferred treatment is a shot of penicillin G benzathine. People who are allergic to penicillin should undergo allergic de-sensitization as this antibiotic is considered superior to other drugs in treating this condition.
The best method for preventing syphilis or any STI is through abstinence from vaginal, oral, or anal sex. However, abiding by safe sex practices through the use of condoms, limiting your number of sexual partners, as well as getting regularly tested for STIs are all effective strategies.
When to seek further consultation for syphilis
Anyone who detects a chancre in their mouth, anus, or genital region should seek further consultation from a healthcare provider. In addition, anyone experiencing flu-like symptoms, rash, swollen glands, and unexplained hair loss should consult their doctor.
Dr. Henry is a first-year resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania. She received her medical degree from the University of Pennsylvania and her BA in political economy from Williams College. As a medical student, she was the editorial manager of an otolaryngology publication and has extensive experience with medical writing. She is currently working on research projects for publication in the sub-specialty fields of otology, head and neck cancer, and facial plastics. Outside the hospital she enjoys fly fishing, squash, hiking, and watching pro tennis.
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