| Syphilis: symptoms and treatments
Syphilis is caused by the spiral-shaped bacterium, Treponema pallidum. Syphilis is usually passed on sexually, although the causative bacteria can also enter through a cut or breaks in the skin and may be passed on orally during kissing. Syphilis can also be passed from mother to baby during pregnancy. What symptoms will I notice? Primary syphilis: Within hours of infection, the motile bacteria have entered the blood stream and spread all over the body. Nine to ninety days later (an average of 21 days) a painless, shallow ulcer develops at the initial site of infection, which is typically on the genitals, finger or tongue. Local lymph nodes (glands) may also become painlessly enlarged and feel rubbery. The primary sore, known as a chancre, is teeming with bacteria and is highly infectious. If left untreated, it heals naturally within one or two months to leave a scar. The disease will then progress to secondary syphilis within six to twelve weeks. Secondary syphilis: Although secondary syphilis may pass unnoticed, many people develop a mild flu-like illness with headache, fever, loss of appetite and fatigue. A dusky-pink skin rash usually appears, which may involve the palms and soles although it's sometimes fleeting and overlooked. This rash varies in appearance and often mimics other conditions, especially non-specific viral illnesses. Widespread swollen lymph nodes usually appear, too. Other telltale signs include silvery, 'snail track' ulcers on mucous membranes such as those in the mouth and around the genitals and anus. Hair may fall out in clumps and large, flat wart-like growths (condylomata lata) may appear on the genitals. This secondary stage of the disease can persist for a year or more and those affected are highly infectious, even if they don't develop obvious symptoms. If left untreated, the clinical features improve and the disease then enters a quiet phase in which the infected person seems to be well, with no obvious symptoms and is no longer infectious. Between three and 40 years later, however, one in three people with untreated, latent syphilis enter a third stage of the disease known as tertiary syphilis. Tertiary or late syphilis: Characterised by tissue destruction, with the production of tumour-like lesions, known as gummas, which invade skin, bones and soft tissues. The bones, nose, tongue and other parts of the body are 'eaten away as if riddled with worms', but thanks to the discovery of antibiotics and diagnostic blood tests, this is now extremely rare in developed countries. Tertiary syphilis can also weaken the heart and aorta (the largest artery in the body, which may literally burst from a swelling (known as an aneurysm), or attack the nervous system to produce progressive brain damage (formerly known as general paralysis of the insane). There may also be difficulty walking. Untreated, advanced tertiary syphilis will eventually prove fatal.
How is syphilis diagnosed? Blood tests: Syphilis is also diagnosed by detecting specific antibodies in the circulation. These blood tests give positive results in secondary, latent and tertiary syphilis. False-negative results can occur during primary syphilis, however, as it can take up to three months for the antibodies to be produced after infection. False-positive tests can also occur, so repeat tests are usually made to confirm diagnosis. Blood tests cannot distinguish between syphilis and other treponemal diseases such as yaws (which can occur in the tropics), or between treated and untreated syphilis infections. Someone with suspected advanced syphilis might be investigated with a lumbar puncture test to examine cerebro-spinal fluid and look for evidence of neurological involvement. Testing for syphilis during pregnancy: This is routinely performed, as syphilis can be passed from mother to baby through the placenta after the tenth week of gestation. One in four affected pregnancies will, sadly, end in stillbirth or neonatal death. Those born with congenital syphilis may have various deformities such as a flattened face, saddleback nose, notched peg-shaped teeth plus infectious skin sores, rashes, fever, swollen organs, jaundice and anaemia. If left untreated, late-stage syphilis may develop in late childhood or early adulthood. How is syphilis treated? There is no evidence of resistance to treatment but if someone is allergic to penicillin, other antibiotics (for example, doxycycline, erythromycin) may be given by mouth. Unfortunately, any tissue destruction that has already occurred cannot be reversed by treatment. As many as one in two people treated with penicillin suffer a reaction within six to twelve hours of the first penicillin injection. This is due to the large number of Treponema bacteria killed and is known as the Jarisch-Herxheimer reaction. Symptoms include fever, headache, and worsening of any current syphilis symptoms. This is usually treated with paracetamol and resolves within 24 to 48 hours. Those with advanced syphilis affecting the nervous system are usually given penicillin plus steroids (started three days beforehand) to help reduce the severity of this reaction. Anyone with syphilis should refrain from sex until they and any infected partners are treated. Follow-up blood tests are recommended at three months, six monthly for two years, and then annually to detect any reactivation or re-infection. If you're worried you have an STI or want to find out more, check out the symptoms, diagnosis and treatments for: Join the discussions live on the Sexual Health message board: |