Syphilis
Syphilis is a sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum. Syphilis can also be passed from mother to infant during pregnancy causing a disease called congenital syphilis. Rarely, syphilis is transmitted by means other than from a sexual partner or mother to child. Syphilis is a disease of ancient times that is still of major importance in modern times.
TRANSMISSION
The most common way to get syphilis is by having sexual contact with an infected person. If you get infected, you can pass the bacteria from infected skin or mucous membranes (linings), usually your genital area, lips, mouth, or anus, to the mucous membranes or skin of your sexual partner. The bacteria are fragile, and you can't get them from eating utensils or through using tubs, pools, or toilets.
SYMPTOMS
Syphilis is sometimes called "the great imitator" because it has so many possible symptoms, and its symptoms are similar to those of many other diseases. Having HIV infection at the same time can change the symptoms and course of syphilis. Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.
Primary Syphilis
The first symptom of primary syphilis is often a small, round, firm ulcer called a chancre ("shanker") at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres can also develop on the cervix, tongue, lips, or other parts of your body. Usually there is only one chancre, but sometimes they are many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout the body.) The chancre usually appears about 3 weeks after you're infected with the bacteria, but it can occur any time from 9 to 90 days after exposure. Because chancres are usually painless and because a chancre can occur inside your body, you might not notice it. The chancre disappears in about 3 to 6 weeks whether or not you are treated. Thus, you can go through primary syphilis without symptoms or with only brief symptoms that you overlook. If, however, primary syphilis is not treated, the infection moves to the secondary stage.
Secondary syphilis
Most people with secondary syphilis have a non-itchy skin rash. Although the rash is usually on the palms of your hands and soles of your feet, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include sore throat, fatigue, headache, and swollen lymph glands. Less frequent symptoms include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area. Your symptoms may be mild. The lesions of secondary syphilis contain many syphilis bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will disappear even without treatment. Without treatment, however, the infection will move to the next stages. You may have recurrences of secondary syphilis.
Latent syphilis
The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over. In early latent syphilis, you may not have symptoms but the infection remains in your body. When you are in this stage, you can infect a sexual partner. In late latent syphilis, the infection is quiet and the risk infecting a sexual partner is low or absent. If you don't get treated for latent syphilis, you will progress to tertiary syphilis, the most serious stage of the disease.
Tertiary syphilis
Even without treatment, only a minority of infected people develops the dreaded complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage. Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurological problems, heart disease, and death. Late neurosyphilis (brain or spinal cord damage) is one of the most severe signs of this stage.
TREATMENT
Syphilis is easy to cure in its early stages. Penicillin, an antibiotic, injected into the muscle is the best treatment for syphilis. If you are allergic to penicillin, your health care provider may give you another antibiotic to take by mouth. You are more likely to need repeat treatment if you get an antibiotic other than penicillin. If you have neurosyphilis, you may need to receive daily doses of penicillin intravenously (in the vein) and may need to be treated in the hospital. If you have late syphilis, damage done to your body organs cannot be reversed. While you are being treated, you should abstain from sex until your sores are completely healed. You should also notify your sex partners so they can be tested for syphilis and treated if necessary.
PREVENTION
To prevent getting syphilis, you must avoid contact with infected tissues and body fluids of an infected person. Most transmission of syphilis, however, is from people who have no visible sores or rashes and who do not know they are infected. If you are uninfected and sexually active, having mutually monogamous sex with only one uninfected partner is the best way to prevent syphilis. Using condoms properly and consistently during sexual intercourse reduces the risk of getting syphilis. Washing or douching after sex will not prevent syphilis. Even if you have been treated for syphilis and cured, you can be re-infected by having sex with an infected partner. The risk of a mother transmitting syphilis to her unborn baby during pregnancy declines with time but continues during latent syphilis. To prevent congenital syphilis, all pregnant women should be tested for syphilis.
Credit: National Institute of Health.