Syphilis is a sexually transmitted disease (STD) that is caused by the bacterium Treponema pallidum. It is transmitted through sexual contact with an infected person, and can cause severe health problems if left untreated. According to the Centers for Disease Control and Prevention (CDC), the number of syphilis cases in the United States has been on the rise in recent years. In 2017, there were nearly 30,000 cases of syphilis reported in the U.S.
Syphilis: symptoms, causes and treatments of sexually transmitted disease
Syphilis is a sexually transmitted (but not limited to) infectious disease caused by a bacterium of the order of spirochetes, Treponema pallidum. A widespread disease since ancient times, the symptoms are divided into three phases: typically these phases occur in sequence, but are separated from each other by periods of latent asymptomatic infection. So let’s find out what the symptoms of these phases are, how they are transmitted, how to diagnose it, what tests to do and what is the cure.
Syphilis: causes and modes of transmission
The cause of syphilis is infection with a bacterium, more precisely a spirochete known as Treponema pallidum. Microscopically speaking, T. pallidum looks like a small, spiral-shaped, mobile filament. For this reason it is able to penetrate both through intact mucous membranes and through the skin.
As a mode of transmission of syphilis we have:
sexual transmission: through unprotected genital, oral or anal sexual intercourse
transplacental route: responsible for the congenital form due to transmission from infected mother to child
indirect contact: contact with infected objects or clothing
However, it is good to remember that T. pallidum does not last long in the external environment: outside the body it survives very little time.
A bit of history
It is not known exactly where syphilis originated. According to many sources, it arrived in Europe from the Americas via the sailors of Christopher Columbus. Throughout history, syphilis triggered real epidemics. The first known is that of 1495 in Naples: syphilis arrived in Italy following the army of the French king Charles VIII, which is why the disease was called mal French (except in France where it was called mal napolitan ).
As for the name of syphilis, however, this etymology was introduced by Girolamo Fracastoro, a doctor and scientist from Verona: in 1530 he wrote the Syphilis sive morbus gallicus, while in 1546 he wrote the treatise De contagione et contagiosis morbis.
After spreading throughout Europe, the incidence of syphilis decreased in the late 1800s, also thanks to industrialization. Another peak occurred after the First World War, while it was not recorded after the Second World War as the diagnosis was improved and, above all, more effective therapies with antibiotics were implemented.
In Europe, syphilis is considered to be the third most widespread sexually transmitted infection, preceded only by Chlamydia and gonorrhea. Also according to the above report, 33,189 cases of syphilis were confirmed in the EU in 2017, with an incidence of 7.1 cases per 100,000 inhabitants. The countries most affected are:
Iceland (15.4 cases per 100,000)
Malta (13.5 cases per 100,000)
United Kingdom (11.8 cases per 100,000)
Spain (10.3 cases per 100,000)
Furthermore, cases of syphilis in Europe have increased by 70% in ten years.
In the world, however, the data published by the WHO speak of 6.3 million new cases of syphilis in 2016: the infection is the third most widespread IS after chlamydia and gonorrhea. The Americas and Africa are the continents where the greatest incidence has been recorded.
Symptoms of syphilis
T. pallidum penetrates the body through the skin or mucous membranes. It then reaches the peripheral lymph nodes within a few hours and then rapidly spreads throughout the body. Syphilis typically occurs in 3 stages:
These phases occur sequentially and are interspersed with long periods of latency. Patients are contagious during the first two stages. Another peculiarity is that the infection does not guarantee immunity in case of subsequent reinfections.
Another fact: syphilis often simulates other pathologies as a manifestation. HIV co-infection is frequently present, which accelerates the progression of the disease and causes ocular symptoms, meningitis or neurological complications to appear more frequently.
Primary syphilis – stage of syphilis
Primary or primitive syphilis or lue is the first stage of the disease. The incubation period varies from 1 to 13 weeks, but on average it is 3-4 weeks. Syphiloma develops, considered the primary lesion, at the site of inoculation or entry.
Syphiloma initially appears as a red papule that quickly transforms into a painless and solid ulcer. When touched, a clear liquid comes out of the ulcer (attention: it is full of spirochetes) and the neighboring lymph nodes may be enlarged, even if they are not painful.
Syphilomas can form anywhere, symptoms may include:
Women: on the vulva, vagina and perineum
Men: on the penis, anus and rectum
Both: on the lips or mouth
Being painless lesions, very often people infected with syphilis do not initially realize the problem. This syphiloma heals in 3-12 weeks.
Secondary syphilis – skin rash
Symptoms of secondary syphilis, spirochetes spread in the blood: this causes the development of mucocutaneous lesions all over the body (syphiloma of syphilis can also occur on the nose) and lymphadenomegaly (increase in the volume of the lymph nodes). These symptoms tend to appear 6-12 weeks after the onset of syphiloma. In addition to syphiloma can be noted as symptoms:
headache (caused by meningitis)
hearing loss (due to otitis)
balance disorders (due to labyrinthitis)
vision changes (caused by retinitis or uveitis)
bone tenderness (for periostitis)
The number of mucocutaneous lesions and eruptions varies from patient to patient, but can be spread all over the body. Without therapy, the lesions can either disappear within days or remain for months or disappear and then return. In general, all injuries undergo some form of remission, leaving no scars.
Particular forms and affected organs
Symmetrical, most evident on the palms of the hands and soles of the feet. It presents with round, large, fused lesions, without pain or itching. Once healed, areas of discoloration or darker areas may remain. If the lesions had occurred on the head, alopecic areas may remain
sided warts: flat, grayish-pink hypertrophic papules. They form on the mucocutaneous junctions, in the perianal area and in the inframammary sulcus and are very contagious
diffuse lymphadenomegaly and hepatosplenomegaly (enlargement of the liver and spleen)
meningitis (headache, neck stiffness, deafness, papilledema due to retinitis or optic neuritis and cranial nerve deficit)
Tertiary or late syphilis occurs decades after the primary infection and is typically found in untreated patients. There are also several forms here:
Benign tertiary syphilis: occurs in two forms.
The first is
benign rubbery tertiary syphilis: occurs 3-10 years after infection and causes the formation of inflamed, soft, infiltrating masses on the skin, bones and viscera. They tend to grow and heal slowly leaving scars. Then there is benign tertiary syphilis of the bones, with inflammation and bone pain that worsens during the night
Cardiovascular syphilis: occurs 10-25 years after primary infection. It can manifest itself with an aneurysm of the ascending aorta, aortic valve insufficiency and coronary artery disease. Symptoms include cough, dyspnoea, hoarseness due to paralysis of the vocal cords from compression of the left laryngeal nerve and very painful erosions of the sternum, ribs and spine
Syphilis can cause Chancre
A chancre is a small, firm, raised lesion that appears at the site of syphilis bacteria. The lesion is typically round or oval, and may be pink, red, or purple in color. It is usually painless, but can be associated with itching or burning. Chancres typically appear 3-4 weeks after exposure to the bacteria that causes syphilis. If left untreated, chancres will eventually disappear. However, syphilis can progress to more serious stages if it goes without treatment.
Neurosyphilis: manifests itself in various forms
Asymptomatic neurosyphilis presents meningitis which may or may not develop into a symptomatic form of neurosyphilis. Meningovascular neurosyphilis occurs 5-10 years after infection and includes: headache, neck stiffness and sore, dizziness, concentration deficit, amnesia, apathy, insomnia, visual impairment and behavior modification. If the spinal cord is involved, muscle weakness, urinary and / or faecal incontinence and paralysis occur.
Then there is parenchymatous neurosyphilis, also known as generalized paresis or paralytic dementia. It is caused by a form of chronic meningoencephalitis that occurs 15-20 years after primary infection, especially after the age of 50-60. Symptoms include dementia, nervousness, concentration deficit, amnesia, headache, insomnia, fatigue, lethargy, convulsions, aphasia, hemiparesis, depression, tremors, hyperextension phenomena and anisocoria.
Dorsal tabe: we speak of a form of locomotor ataxia that occurs 20-30 years after the primary infection. There is back and leg pain with proprioceptive and reflex deficits in the legs. Possible presence of ataxia, hyperesthesia, paraesthesia, urinary incontinence, urinary retention and erectile dysfunction.
Typically, patients affected by this form are thin, with sad facies and Argyll-Robertson phenomenon, ie pupils that do not react to light while functioning in near vision. A variant presents episodic visceral pain or paroxysmal pain with vomiting.
Between the various stages of syphilis, periods of latency alternate. These periods can also occur less than a year after infection. In these phases there are no symptoms, but the antibodies detected by the serological tests remain. Very often the diagnosis is made during these phases since in the primary and secondary phase the symptoms are often mild.
In some cases, people with syphilis remains in latent form. However, during early latency (less than 1 year after infection), mucocutaneous lesions can recur.
Other signs and symptoms
There are also ocular or auditory forms that can occur during any of the phases described above:
eyes: ocular syndrome can cause keratitis, uveitis, chorioretinitis, retinitis, retinal vasculitis and neuropathies of both the cranial and optic nerves and blindness. Patients who experience ocular syndrome are more likely to develop a form of neurosyphilis
ear: otosyphilis can cause deafness, tinnitus, dizziness and nystagmus
ulcers of the soles of the feet
neurogenic arthropathy or Charcot’s arthropathy
Particular mention goes to the form of congenital syphilis. The one transmitted from the infected mother to the fetus through the placenta. As early symptoms we have:
skin lesions with papules, vesicles, blisters on the palms and pains of the feet. Lesions also appear around the nose, mouth and in the area below the diaper
increase in the volume of the lymph nodes
rhinorrhea with blood
fissures in the perioral area
pseudoparalysis or Parrot’s atrophy
atrophy in the optic nerve
Furthermore, an untreated form of syphilis in pregnancy can result in miscarriage or stillbirth. Forms of congenital syphilis that occur within two years are considered early, while after two years we speak of late forms.
How is it diagnosed? The test for syphilis to do
If a patient presents with the typical mucocutaneous lesions or neurological symptoms of an unclear nature, a serological test for syphilis may also be required.
There are reaginic serological tests (especially indicated for neurological forms) or treponemal serological tests. In general, a reaginic screening test is performed first, then a treponemal confirmation test and finally the highlighting of the spirochetes under the microscope. However, the diagnostic protocol varies according to the facilities.
Serological treponemal tests, types
As regards serological treponemal tests, there are different types: immunofluorescence, microhemagglutination, hemagglutination, immunoenzymatic assay and immunological chemoluminescence. It will be up to your doctor to decide which diagnostic protocol to perform, also based on previous syphilis infections, possible exposure and results of the first tests.
Depending on the test results and the danger of exposure, your doctor may prescribe multiple tests to be repeated over time.
Syphilis therapy and treatment
Syphilis treatment will be established by your doctor. In general, penicillin-based antibiotic therapy is used. All sexual partners will be treated (this even when the serological tests are negative if the contact took place within 90 days before) and this therapy will also be performed in pregnant women.
Patients allergic to penicillins will be treated with either doxycycline or azithromycin (the latter, however, cannot be used in pregnancy or in patients with old latent form).
It may happen that patients undergoing therapy, especially with the secondary form, after 6-12 hours from the start of therapy experience the Jarisch-Herxheimer reaction with:
flare-up of lesions
This reaction disappears after 24 hours. However, people with paresis may experience seizures or strokes.
Syphilis and pregnancy
Syphilis during pregnancy can have serious consequences for a pregnant woman and her developing baby. If syphilis is not treated during pregnancy, it can lead to miscarriage, stillbirth, or preterm delivery. Syphilis can also cause newborns to develop the infection, which can be deadly.
Is caused by the bacterium Treponema pallidum and is typically spread through sexual contact with someone who has the infection. Syphilis can also be passed from a mother to her unborn child during pregnancy.
Prevent syphilis infection
Since there is no effective vaccine against syphilis, it is good to focus on prevention, especially by reducing risky sexual behaviors:
always use a condom during sexual intercourse
avoid sexual intercourse with people at risk or with infected people, even if only in case of suspicion
if you have had sexual intercourse with people who are at risk or suspect or if you have frequent sexual intercourse with several people, have periodic blood tests to check
if it is positive, contact all sexual partners (if primary form in the previous three months, if secondary form in the preceding six months or if latent form a year earlier).
Syphilis: how to cure French sickness
Syphilis is a sexually transmitted disease found all over the world. Caused by Treponema pallidum, the symptoms of the disease vary according to the stage of the disease and can manifest themselves over the course of years, with phases of latency between one phase and another.
Together with typhus, AIDS or HIV, hand-foot-mouth disease, smallpox, viral hepatitis, infectious mononucleosis, Kawasaki syndrome and other pathologies it is one of the least common and least known exanthematous diseases, since this term is usually referred to typical childhood diseases such as measles, rubella, chicken pox, scarlet fever, fourth disease, fifth disease, sixth disease.
Treatment is based on antibiotic treatment, but the earlier it is diagnosed and the sooner one intervenes, the better, also to reduce the risk of serious forms and complications. Prevention is fundamental: since there is no vaccine, the use of condoms during sexual intercourse is the basis of the prophylaxis of this disease.
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Vogue Health Team