La syphilis

What is syphilis?

• It is a sexually transmitted infection caused by a bacteria called treponema pallidum.

How do I catch it?

• Non-protected sexual intercourse with an infected individual (oral, vaginal, anal)
• Mother-to-child transmission (transplacental infection)
• Contaminated blood transfusion
• Sharing of contaminated needles (while injecting drugs with an infected individual…)

What are the stages of syphilis?

Syphilis is divided into the following stages:

• (A): Primary syphilis

1. Occurs 9 to 90 days following the infection.
2. Presents as a painless ulcerations (called chancre) located on the penis, vulva or cervix (of the uterus).

• (B): Secondary syphilis

1. Occurs a few weeks to two years after the primary stage of syphilis.
2. Presents as a painless skin rash, often located on the palms and soles.
3. Lymph node enlargement
4. Wart-like growths in the genital and anal areas (“condyloma lata”)
5. Other signs include hair loss, ulcers in the mouth, inflammation of the brain and liver.

Secondary Syphilis located on the Trunk

Secondary Syphilis located on the Palms

• (C): Latent syphilis

1. No symptoms nor signs are present but internal organs may continue to be affected by the disease process.
2. Early latent syphilis: less than one year after the infection.
3. Late latent syphilis: more than one year after the infection.

• (D): Tertiary syphilis

1. Occurs between 5 and 30 years after secondary syphilis.
2. Is characterized by irreversible damage such as the brain (mental illness), blood vessels and the heart (heart failure), nerves and the spina cord (sensitivity disorders and/or paralysis).

• (E):  Congenital syphilis

1. Bone deformity
2. Loss of vision
3. Deafness
4. Face deformity
5. Teeth deformity
6. Skin rashes
7. Neonatal death

How is syphilis diagnosed?

1. Positive screening blood tests (4 to 6 weeks after exposure) called VDRL (venereal disease research laboratory) or RPR (rapid plasma reagin).
2. A positive screening test must be confirmed by a positive TPPA (Treponema-Pallidum-Hemagglutinations-Assay) or the demonstration of antibodies.
3. Secretions of a chancre of skin lesions can be examined with a microscope (dark field) to detect the organism.

How is syphilis treated?

1. The injection of penicillin is the best treatment.
2. Oral antibiotics are available for patients allergic to penicillin.
3. In primary, secondary and latent syphilis, a well done treatment enables a complete cure.
4. In tertiary and congenital syphilis, the treatment can stop the progression of the disease but cannot always restore normal function, nor reverse permanent damage.

What must I do?

• See a medical doctor now if you think you mighht be infected.
• Inform your doctor of all drug allergies.
• Do not engage in sexual intercourse as long as the treatment has not been completed.
• Follow the advice of the doctor, most notably for the need to do multiple blood tests to guaranty a full cure.
• Do not donate your blood.
• Ensure that you sexual partners also comme for screening that they can be treated if an infection is present.
• It is possible to be reinfected, because no immunity is gained from a first infection.

Important

• Early detection and treatment ensure a complete cure.
• Remember to inform your doctor if you have already previously been treated for syphilis.
• Always adopt a “safer sex attitude” (see below) with prostitutes and casual acquaintances.

What does “safer sex attitude” mean?

• It is a sexual intercourse with no contact between the secretion fluids (vaginal secretions, sperm).
• Use condoms (male or female available) for each sexual intercourse.
• Do not consume alcohol before or during the sex act as it could impair your judgement.

Contributors

Dr Husain Ali Mahdi Juma  (دكتورحسين علي جمعه) – dermatologist. Manama, Bahrain

National Skin Centre. Singapore