Syphilis

Syphilis is a bacterial infection transmitted primarily by sexual intercourse. It is caused by the spirochete treopnema pallidum. The infection can start as an ulcerated lesion (chancre) and if untreated or undetected can develop into a generalized red rash or shallow ulcers of the mouth or genitals a few weeks later. Subsequently the infection can resolve and remain dormant till years later when it can manifest with involvement of the skin, bone, central nervous system and the cardiovascular system.

Where does it occur?

It occurs worldwide.

How is it transmitted?

It is transmitted primarily through unprotected sexual intercourse.  It can also be transmitted across the placenta from mother to her fetus, rarely through blood transfusions or contact with infected lesion by a healthcare worker.

Is it contagious from person to person?

It is contagious from person to person.

What is the risk for travelers?

The risk is generally low unless engaged in unprotected sexual intercourse.

How soon after exposure will one develop symptoms?

Symptoms usually develop in 3 weeks but can be seen anywhere from 1 week to 3 months after exposure.

What are the signs and symptoms?

The primary lesion starts as a painless small lump that erodes into a painless ulcer with raised borders.

If untreated the lesion heals, but in 2-8 weeks one can see a generalized red rash that is flat, 2-6 mm in size and can be seen all over the body especially the palms and soles. Simultaneously one may see shallow ulcers with a red border in the mouth and genitals.

These lesions fade and one enters a period when there are no external symptoms for years. (Latent phase)

Subsequently, 5-40 years later one can see involvement of the central nervous system, cardiovascular system, or the skeletal system. Central nervous system symptoms include visual changes, hearing loss, gait disturbance, incontinence, dementia or seizures. Cardiovascular system symptoms include formation of aneurysms of the blood vessels, commonly the aorta. Skeletal system symptoms include destruction of bones.

Congenital syphilis in the neonate is manifested by inflammation of the nasal sinuses – “saddle nose”, development of a rash that peels, bowing of the legs, joint pain and liver failure.

Are there any lab tests to diagnose the illness?

Antibody titer tests on blood and spinal fluid are available (VDRL, FTA).

Is there any treatment?

Penicillin is the antibiotic of choice.

What preventive measures can be taken?

Avoid unprotected sexual activity with strangers.

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