Definition

     Syphilis is a sexually transmitted or congenital infection caused by the bacterium Treponema pallidum. The infection is usually transmitted person to person through minor cuts in the skin or mucous.

Causes

     Syphilis is an infectious disease caused by the spirochete Treponema pallidum, which penetrates broken skin or mucous membranes. Transmission occurs most frequently by sexual contact. Congenital syphilis can be transmitted to the fetus during any stage in pregnancy.

Symptoms

     The symptoms of syphilis depend on the stage of the disease. In addition, a significant proportion of individuals may remain without symptoms.

     Primary syphilis:

• chancres -- (usually single yet may be multiple) painless sores on genitals, rectum, or mouth

• enlarged lymph nodes in the area adjacent to the chancre

     Secondary syphilis:

• skin rash -- usually throughout the body with both flat and raised patches which may involve the palms and soles of the feet.

• extensive lymph node enlargement

• mucous patches (painless silvery ulcerations of mucous membranes -- seen mostly in the mouth and on the genitals)

• condyloma lata: coalescing papules which form a grey-white plaque frequently in folds such as groin, genital areas, axilla, and under the breasts

• hair loss (alopecia)

• general symptoms such as fever, fatigue, loss of appetite, and aches and pains in bones

     Tertiary syphilis:

• infiltrative, destructive lesions of skin, bones, or liver (gummatous syphilis)

• cardiovascular syphilis, which leads to inflammation of the aorta (aortitis) and can be associated with aortic aneurysms

• central nervous system disorders with involvement of the meninges, brain, spinal cord, eye, or auditory system.

Screening and Diagnostics

• VDRL or RPR are screening tests

• FTA-ABS (antibody test for syphilis) confirms the diagnosis

• Microscopic exam -- dark field microscopy techniques show Treponema pallidum from material that has been aspirated from lesions of the affected regional lymph nodes

Treatment

• Penicillin by injection is the treatment of choice

• Alternatives include Tetracycline, Doxycycline, or Azithromycin

• There is no need for local treatment of lesions

• Jarisch-Hersheimer reaction, the sudden killing of the Treponema pallidum bacteria that results in the release toxic products, may occur.  This causes fever and a worsening of the current symptoms.

• Treatment should not be stopped unless the symptoms are severe.  Antipyretics (fever reducing medications such as Tylenol or aspirin) and corticosteroids can be used to prevent or modify this reaction.

• The Jarisch-Hersheimer reaction generally resolves itself in 24 hours.

Prognosis

     Prompt treatment and monitoring for response to treatment for syphilis can cure the disease. Once late complications develop (tertiary syphilis), long-term health problems are likely despite therapy.

Complications

     The complications of syphilis are related to the development of the syndromes associated with tertiary syphilis:

• neurosyphilis

• cardiovascular complications (aortitis and aneurysms)

• destructive lesions of the skin and bones (gummas).

     In addition, untreated secondary syphilis during pregnancy may result in transmission to the fetus (congenital syphilis).

Prevention 

     Safer sexual practices and consistent condom use are important measures in the prevention of syphilis. In addition, early diagnosis and treatment is needed to prevent ongoing transmission of this disease, as is screening during any evaluation for a sexually transmitted disease.

     Screening of all pregnant women for syphilis is another measure to decrease the risk that the disease will be passed on to the fetus.