Syphilis is disease that is caused by a bacterial invasion. The bacteria is a spirochaete bacterium called Treponema pallidum. This disease can be transmitted by sexual contact or kissing. There are many names that are used in social settings for Syphilis, ‘syph’, ‘the Pox’, ‘cupid’s Disease’ and the ‘French disease.’ Though these names sound cute, syphilis is a serous disease, which can be passed from mother to child during gestation and through direct contact that is not necessarily sexual.
Syphilis has been called the “Great Imitator” because its symptoms were confused with other conditions. Before serum blood testing was available, diagnosis was extremely difficult because so many other diseases had the same symptoms. The stigma of syphilis probably made doctors hesitant to make the diagnosis. Syphilis is treated with antibiotics. Untreated syphilis can cause severe damage to the heart, brain, and other areas of the nervous system and eventually can be fatal.
Syphilis symptoms are manifestations of stages of the disease. There are five stages of syphilis:
The stages are based on the symptoms and the period of incubation (the time from infection, to manifestation of symptom). The last four stages result in failure to seek treatment for syphilis.
Primary syphilis appears from ten to ninety days after initial exposure. The average is twenty one days. During incubation, the patient has no symptoms. The manifestation of this stage is a chancre on the genitals or rectum, regardless of the sex. Lymph nodes in the area may also swell. The chancre can last up to six weeks and heal without treatment.
Secondary syphilis symptoms appear one to six months after the primary stage of the disease. The presentation of a symmetrical rash on the trunk, arms and legs is the first sign of secondary syphilis. This rash is symmetrical, does not itch and is red or pink in color. Other symptoms include sore throat, tiredness, and weight loss, headache, fever, and stiff neck, sensitivity to light and swollen lymph nodes. Two percent of patients can develop acute meningitis. Also rare are patients who develop hepatitis, renal disease, hypertrophic gastritis, patchy protitis, a rectal mass, arthritis, ulcerative colitis, iritis, uveitis and optic neuritis. Contagiousness is at its peak during the secondary syphilis stage.
Tertiary syphilis occurs anywhere from a year to ten years after the initial infection. The manifestation of this disease is gummas occurring in the skin and mucous membranes. Gummas are soft masses or growths that occur anywhere in the body including the bones. Other symptoms can affect the joints such as Charcott’s joints and Clutton’s joints. These conditions are a degeneration of joint surfaces and bilateral knee effusions, respectively. Severe manifestations of tertiary syphilis are neurosyphilis and cardiovascular syphilis.
Generalized paresis of the insane is a neurological condition that presents as personality changes, hyperactive reflexes, Argyll-Robertson pupils, Tabes dorsalis and changes in emotional affect. Argyll-Robertson pupils are considered a diagnostic indicator of syphilis and present as pupils which constrict in response to focusing the eyes, not light and are generally uneven and small in size. Tabes dorsalis is a movement ataxia causing a shuffling walk due to its affect on the spinal cord.
Heart complications can be aortic aortitis, aneurysm of sinus of Valsalva, aortic regurgitation and aortic aneurysm. Syphilica aortitis can cause a bobbing of the head, known as de Musset’s sign. These cardiovascular manifestations of syphilis are what cause death from syphilis.
Latent syphilis is defined by having blood serum positive syphilis, yet no signs or symptoms of the disease. Early latent syphilis is defined as a positive diagnosis of up to one year after infection without symptoms or indicators of the disease. Late latent syphilis is defined as being infected for over a year, but no symptoms of physical evidence f the disease. These distinctions are important for treatment and risk of spreading the disease.
The last stage is called neurosyphilis. This is syphilis that has invaded the neurological system. This is not a chronological stage, because it can occur at any point after infection. Neurosyphilis is described in four separate symptoms, which may occur simultaneously: asymptomatic neurosyphilis; meingovascular syphilis, tabes dorsalis, and general paresis. Up to forty percent of patients with syphilis have asymptomatic central nervous system involvement. Acute syphilitic meningitis appears within two years of initial infection with ten percent of patients diagnosed during the secondary phase. Symptoms are headache, light sensitivity, stiff neck, and cranial nerve abnormalities.
The Wassermann test was the first effected test for syphilis developed in 1906. The test did provide false positive results. In 1930, the Hinton test was developed and had fewer false positive results. Currently, there are a few tests that provide relatively reliable results. The complicating factor is that the bacterium can be responsible for other treponomal infections such as yaws and pinta. A reliable, fast test is microscopic illumination of the dark ground illumination of the chancre fluid. Neurosyphilis is diagnosed when lymphocytes are detected in the cerebral spinal fluid after a positive diagnosis of syphilis has been made.
Treatment for syphilis depends on the stage of the disease. Primary, secondary and early latent syphilis are treated with penicillin. Patients who are allergic to penicillin can be treated with oral tetracyclines. If a cerebral spinal fluid exam reveals no neurosyphilis then 7.2 million units of benzathine penicillin G is administered in three doses via intramuscular injection over the course of three weeks. Patient with neurosyphilis receive aqueous crystalline penicillin G, intravenously. No oral antibiotic medications are used for neurosyphilis, due to the seriousness of the condition.
Avoiding sexual contact with a person who has syphilis may be impossible. The best way to prevent contracting syphilis is to use condoms and avoid unprotected sex.
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