Syphilis

Symptoms Of Syphilis

The symptoms of syphilis are common for both men and women. It is usually unrecognizable for some time and can be passed to others without knowing it. The symptoms of syphilis change with time and stage. 

Generally, syphilis can be categorised in three stages namely: 

• Primary syphilis 

• Secondary syphilis 

• Tertiary syphilis 

1. Primary syphilis 

The first symptoms of syphilis usually develop 2 to 6 weeks after one has been exposed to the bacterium. The most common symptom is the appearance of a small, painless sore called a primary chancre. The sores are painless therefore one can overlook them without realizing they have an infection. The sore is typically seen on the penis, vagina, or around the anus or sometimes appears on the mouth and the lips.

Usually a single painless lesion (primary chancre) occurs, but multiple lesions can be seen in a minority of patients.

Regional lymph node swelling accompanies the primary syphilitic lesions. The nodes are firm, painless and appear within 1 week of the onset of lesion. Inguinal lymphadenopathy (swollen lymph nodes in the groin or lower extremities) is bilateral and may occur with anal as well as with genital chancres.

These sores disappear after two to six weeks, but lymphadenopathy may persist for months. If the condition is not treated, it moves on to the second stage.

2. Secondary syphilis 

These symptoms develop a few weeks after the initial symptoms have passed. The secondary stage usually includes lesions involving the skin and mucous membranes along with generalized non-tender lymphadenopathy. The healing primary chancre may still persist in some of the cases, more frequently in people with concurrent HIV infection.

The symptom of secondary syphilis are:

• A blotchy red rash develops anywhere on the body but usually develops on the palms of the hands and soles of the feet

• White patches in the mouth

• Severe necrotic lesions may appear, more commonly in HIV infected individuals

• Swollen glands

• Headache, tiredness, and joint pain

• Involvement of hair follicles may result in patchy alopecia (hair loss) of scalp hair, eye brows, or beard.

Signs and symptoms that may accompany or precede secondary syphilis include sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus (symptoms similar to meningitis without inflammation of the membranes lining the brain). Eye symptoms include pupillary abnormalities, optic neuritis, & uveitis.These symptoms may disappear within a few weeks, and can again come and go after some time. 

Secondary syphilis is often mistaken for other conditions such as:

• Pityriasis rosea

• Lichen planus

• Psoriasis

Note: Because the symptoms of syphilis can be so nonspecific, people experiencing these may ignore them. For this reason, syphilis has been known as the “great imitator.” 

Latent phase: During the latent phase, a person experiences no symptoms, even though the person is infected. Early latent syphilis is limited to the first year after infection, whereas late latent syphilis is defined as that of >1 year’s duration or of unknown duration. During the first year, the infection can be passed on to the other partner through physical close contact. However, after a couple of years, one cannot pass the infection. Without treating the disease, it can be passed to the most dangerous stage called the tertiary stage.

Tertiary stage

The symptoms of tertiary syphilis appear after years of initial infection. 

• The symptoms are manifested based on the part of the body affected such as the brain, nerves, eyes, and heart. 

• People with tertiary syphilis may experience vision problems or blindness, meningitis, stroke, dementia, heart problems, and co-ordination problems. 

• Syphilis is still treatable at this stage but the damage caused cannot be reversed.

Congenital syphilis

Babies born to women who have syphilis can become infected during pregnancy or birth. Most newborns with congenital syphilis have no symptoms, although some show a rash on the palms of their hands and the soles of their feet.

Later signs and symptoms may include deafness, teeth deformities, and saddle nose, where the bridge of the nose collapses.

Neurosyphilis

At any stage of infection, syphilis can invade the nervous system and it is called neurosyphilis. Signs and symptoms of neurosyphilis can include:

• Severe headache

• Trouble with muscle movements

• Muscle weakness or paralysis (not able to move certain parts of the body)

• Numbness

• Changes in mental status (trouble focusing, confusion, and personality change) 

• Dementia (problems with memory, thinking, and/or making decisions)

Causes Of Syphilis

Syphilis is caused by a bacterium called Treponema pallidum. The only known natural hosts for T. pallidum are humans. Routes of transmission of syphilis are:

• The most common route of transmission is through sexual contact with the infected person.

• It can also enter the body through minor cuts in the skin or mucous membrane or direct unprotected contact with an active lesion.

• Infected mothers can pass it to their babies during pregnancy or birthing.

• Less common modes of transmission include blood transfusion and organ transplantation.

Risk Factors For Syphilis

The risk of acquiring the infection is high, if you:

• Engage in unprotected sex.

• Have sex with multiple partners.

• Have human immunodeficiency virus (HIV) infection.

• Have sexual contact with someone having syphilis.

• Engage in sexual activity with someone from a region of the high prevalence of syphilis.

Note: The chances of getting an infection increase if a man has unprotected sexual contact with other men.

Diagnosis Of Syphilis

The doctor will ask about your symptoms and health history. A physical examination is done to confirm certain risks that make your chances of infection higher.

1. Physical examination

The doctor will examine the genitals. For men, it involves examining the penis, foreskin, and urethra and for women, it involves the internal examination of the vagina. The other parts of the body are also examined for the appearance of any rashes.

2. Blood tests

If someone is detected with syphilis, then his/her body produces antibodies against the syphilis bacteria. Serological tests for syphilis can be classified into two types: treponemal and nontreponemal. 

The treponemal test is useful in detecting an antigen or antibody of the T. palladium bacterium and includes the fluorescent treponemal antibody absorbed test (FTA-ABS) and the T. pallidum particle agglutination test (TPPA), both of which are more sensitive for primary syphilis than the non-treponemal tests.

A positive result can be indicative that the person can have the infection or used to have it before. A negative result does not always prove that the person is free of infection as the antibodies are not detectable after three months of infection. 

The non-Treponemal test or lipoidal tests looks for indirect indications of the infection like the cardiolipin (released when treponema damages the cells). When cardiolipin is found in the sample, it is indicative of an active infection. 

3. Venereal Disease Research Laboratory (VDRL) test 

This is a screening test for syphilis. It measures antibodies that the body has produced at the time of infection. This test in combination with specific antibody testing also checks whether the person is having an active infection or not. This minimizes the risk of complications and the spreading of disease. 

4. Direct testing of chancre

The following tests can be done directly from a chancre:

• Dark field microscopy

• Direct fluorescent antibody (DFA) 

• Polymerase chain reaction (PCR) 

DFA uses antibodies tagged with fluorescein, which attach to specific syphilis proteins, while PCR uses techniques to detect the presence of specific syphilis genes. These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis.

5. Cerebrospinal fluid (CSF) evaluation

Diagnosis of neurosyphilis depends on a combination of CSF tests like CSF cell count, protein, or reactive CSF-VDRL in the presence of reactive serologic test (nontreponemal and treponemal). 

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Prevention Of Syphilis

There is no vaccine for syphilis. However, to prevent the spread of syphilis following measures can be adopted such as:

• Having protected physical contact by using condoms. Condoms can reduce the risk of contracting syphilis only if it covers the sores.

• Promoting sex education among the population. Mainly among the teenagers and high-risk population like laborers, truck drivers, and migrants.

• Avoiding recreational drugs and alcohol, which can inhibit safe sexual practices. 

• Abstaining from sexual contact or being in a mutually monogamous relationship with a person who is tested and does not have any infection.

Specialist To Visit 

In most cases, the best place to visit is a sexual health clinic also called a genitourinary medicine clinic (GUM). They tend to have easier access to tests and treatments for syphilis. 

If a person develops symptoms like rashes, sores on the moist areas like genitals, mouth, throat, or anus then that person should visit a doctor and confirm the presence of syphilis or any other infection. The doctors to visit are:

• General physician

• Dermatologist

• Gynecologist

• Infectious disease specialist

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Treatment Of Syphilis

The treatment of syphilis depends on the stage of the disease.

Early syphilis

• Penicillin G  benzathine is the most widely used agent for the treatment of early syphilis. Preventive treatment is also recommended for individuals who have been exposed to infectious syphilis within the previous three months.

• Penicillin G benzathine cures >95% of the cases of early syphilis, although clinical relapse can occur especially in HIV infected patients.

Secondary or tertiary syphilis

If the CSF examination is normal or not examined, the recommended treatment is Penicillin G benzathine. If the CSF abnormalities are found, then they should be treated as a case of neurosyphilis. The same is the treatment option for late syphilis or syphilis of unknown duration.

Neurosyphilis

• Penicillin G benzathine, even at high doses does not kill the treponema concentrations in CSF and should not be used for the treatment of neurosyphilis.

• Both symptomatic and asymptomatic neurosyphilis should be treated with aqueous penicillin. 

Pregnancy

Parenteral penicillin G is the recommended therapy for syphilis during pregnancy. Pregnant women with syphilis at any stage who report penicillin allergy should be desensitized and treated with penicillin.

Syphilis in penicillin-allergic patients

A 2 week (for early syphilis) or 4 weeks (for late syphilis) course of therapy may be considered with doxycycline or tetracycline. Ceftriaxone has also been found to be effective for early syphilis.

Jarisch-Herxheimer reaction

• The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgia, and fever that can occur within the first 24 hours after the initiation of any syphilis therapy.

• It is a reaction to treatment and not an allergic reaction to penicillin. 

• Patients should be informed about this possible adverse reaction and how to manage it if it occurs.

• The Jarisch-Herxheimer reaction occurs most frequently among persons who have early syphilis, presumably because bacterial loads are higher during these stages.

• Antipyretics can be used to manage symptoms; however, they have not been proven to prevent this reaction. 

• The Jarisch-Herxheimer reaction might induce early labor or cause fetal distress in pregnant women; however, this should not prevent or delay therapy.

Management of sex partners

• Person who has had sexual contact with someone who receives a diagnosis of primary, secondary, or early latent syphilis <90 days before the diagnosis should be treated presumptively for early syphilis, even if serologic test results are negative.

• Person who has had sexual contact with someone who receives a diagnosis of primary, secondary, or early latent syphilis >90 days before the diagnosis should be treated presumptively for early syphilis if serologic test results are not immediately available and the opportunity for follow-up is uncertain. If serologic tests are negative, no treatment is needed. If serologic tests are positive, treatment is based on evaluation and stage of syphilis.

• Long-term sexual partners of people who have late latent syphilis should be evaluated for syphilis and treated on the basis of the findings.

Home-care For Syphilis

1. Talk and understand the situation

Understanding the condition of the person is the first step in managing the disease. Caring can involve several skills such as emotional support, dealing with medical equipment, and recognizing the warning signs if the disease worsens. Caring for someone with syphilis involves different things depending upon the infection.

2. Take medication 

When syphilis is treated in the early stages it is easy to cure. Help the patient in making routines and following the treatment.

3. Encourage treatment 

If an individual is diagnosed with syphilis, have periodic blood tests and follow-ups. Make sure that the person is responding to the penicillin treatment. 

4. Support the patient

Finding out you have syphilis can be upsetting. Listen to your loved ones and reassure them that it is a manageable health condition. 

5. Eat a balanced diet 

To recover from the condition and side effects related to the medications a healthy diet is beneficial and rest to cope with the stress. 

Complications Of Syphilis

Syphilis causes damage to internal organs during the latent and tertiary stages. Tertiary syphilis causes various complications like:

• Mental disorders

• Loss of vision 

• Bone damage 

• Liver damage 

• Nervous system breakdown 

• Sores on the skin 

• Syphilis has a greater risk of contracting HIV infection because of the existence of open sores

• Birth defects like mental retardation, stillbirths, and premature death, if the infection spreads from mother to the unborn child during pregnancy

• Late-stage syphilis, if left untreated, can be life threatening