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Presentation

The stage of syphilis determines the symptoms observed in the patients. Symptoms of syphilis vary greatly with the stage of the disease. In some cases, the patient may be infected but never noticed the symptoms for years [5].

Primary syphilis: Chancre is the first sign of syphilis. It appears as a small sore on the skin and is the point from where the bacterium has entered the body. It develops after 3-4 weeks after exposure and is painful, so often goes unnoticed. The chancre heals within six weeks, on its own.

Secondary syphilis: There can be a rash on the trunk or sometimes the entire body, even within a few weeks after the original chancre healing. The rash is not itchy or may be accompanied by wart-like sores in the mouth as well as the genital areas.

Latent syphilis: If syphilis is not treated, the disease moves from secondary to latent stages. This stage can last for several years.

Tertiary (late) syphilis: The complications of the tertiary (late) syphilis can develop if the disease is not treated on time. About 15-30% of the patients not treated for syphilis may graduate to this stage. Damage to the brain, nerves, eyes, brain, blood vessels, liver, joints, and bones is observed in such patients.

Congenital syphilis: Babies born to infected mothers gets the infection through the placenta or even during birth. These children may be asymptomatic or show symptoms that often go unnoticed such as a rash on the palms of the hands and soles of feet. As the disease progresses, congenital syphilis manifests as deafness, teeth deformities, and saddle nose.

Cervical Lymphadenopathy
  • Inguinal lymphadenopathy arises in men with ulcers on the genitals and cervical lymphadenopathy in patients with ulcers in the mouth.[dermnetnz.org]
  • Syphilis presenting as isolated cervical lymphadenopathy: two related cases. J Infect. 2009;58:76–8. PubMed CrossRef Google Scholar 57. Cummings MC, Lukehart SA, Marra C, et al.[doi.org]
Generalized Lymphadenopathy
  • Among 139 infants with symptomatic congenital syphilis in 3 series, the most common early signs were hepatosplenomegaly (71%), rash (68%), fever (42%), neurosyphylis (23%), pneumonitis (17%), rhinitis ( snuffles ; 14%), generalized lymphadenopathy (14%[doi.org]
  • A generalized swelling of the lymph nodes ( generalized lymphadenopathy ) is also common.[menshealth.about.com]
Inguinal Lymphadenopathy
  • Inguinal lymphadenopathy arises in men with ulcers on the genitals and cervical lymphadenopathy in patients with ulcers in the mouth.[dermnetnz.org]
Fever
  • A 37 year old man with a 2 year history of progressive cognitive decline, unilateral tinnitus and deafness presented with complex partial seizures and a fever.[ncbi.nlm.nih.gov]
  • This response is characterized by low-grade fever, myalgias, headache and malaise that begin within a few hours after initiation of therapy and last for 12–24 h.[cmaj.ca]
Fatigue
  • Other, less common signs and symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.[beforeplay.org]
  • The rash usually does not cause itching but may be associated with fever, swollen lymph nodes, sore throat, headache, muscle aches, and fatigue.[jamanetwork.com]
  • […] syphilis) will develop, including A skin rash that can occur anywhere on the body, but is usually present on the palms of the hands and soles of the feet Sores in the mouth and on the genitals or anus Swollen lymph glands Mild fever Sore throat Headache Fatigue[healthychildren.org]
  • Syphilis About 2 to 10 weeks after the first sore appears, you may develop the following: A skin rash that causes small, reddish-brown sores Sores in your mouth, vagina, or anus Fever Swollen glands Weight loss Hair loss Headache Extreme tiredness ( fatigue[webmd.com]
  • Fever , enlarged lymph nodes , fatigue , weight loss , hair loss , headaches , and muscle aches have all been reported in the secondary stage of syphilis.[medicinenet.com]
Malaise
  • This response is characterized by low-grade fever, myalgias, headache and malaise that begin within a few hours after initiation of therapy and last for 12–24 h.[cmaj.ca]
  • It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest.[sti.guidelines.org.au]
Prostitute
  • Medical researchers sought out prostitutes with syphilis to deliberately pass on the sexually transmitted disease to men through intercourse. Other men were injected.[theguardian.com]
  • Prostitutes with syphilis were used to infect male prisoners. The researchers deceived the study subjects about the experiment and concealed the facts of their infection.[web.archive.org]
  • Outside poetry, prostitution bears the brunt of the blame, though the real culprit was testosterone. Men infected prostitutes who then passed it on to the next client who gave it back to a new woman in a deadly spiral.[theguardian.com]
  • A weeks-to-decades-long latency period follows, and then the infamous syphilitic degeneration: spinal deformities causing a shuffled-walk, cardiovascular damage causing “de Musset’s sign” (the head-bobbing first observed in Parisian prostitutes), and[giantmicrobes.com]
Unsafe Sexual Practices
  • “The increasing incidence of syphilis in military members is of significant public health concern because this finding suggests that some servicemembers have been engaging in unsafe sexual practices that increase the likelihood of acquisition of other[stripes.com]
  • Excessive use of alcohol or other drugs can cloud your judgment and lead to unsafe sexual practices. Screening for pregnant women People can be infected with syphilis and not know it.[mayoclinic.org]
  • This is believed to be partly due to increased promiscuity, prostitution, decreasing use of condoms, and unsafe sexual practices among men who have sex with men.[en.wikipedia.org]
  • These are available for purchase online. not sharing sex toys avoiding alcohol and drugs that could potentially lead to unsafe sexual practices Having syphilis once does not mean a person is protected from it.[medicalnewstoday.com]
Saddle Nose
  • nose A50.59 Other late congenital syphilis, symptomatic A50.6 Late congenital syphilis, latent A50.7 Late congenital syphilis, unspecified A50.9 Congenital syphilis, unspecified A51 Early syphilis A51.0 Primary genital syphilis A51.1 Primary anal syphilis[icd10data.com]
  • Later manifestations of congenital syphilis include bone and teeth deformities, such as “saddle nose” (due to destruction of the nasal septum), “saber shins” (due to inflammation and bowing of the tibia), “Clutton’s joints” (due to inflammation of the[emedicine.com]
Hoarseness
  • Other symptoms may occur such as tiredness, fever, sore throat, headaches, hoarseness, loss of appetite, patchy hair loss and swollen glands.[health.ny.gov]
Nasal Discharge
  • About half the time, however, he may have signs and symptoms such as a yellow-mucous nasal discharge (snuffles), rashes, skin ulcers, fluid retention, bone infection, fever, swollen spleen and liver, low red blood cell count (anemia), and jaundice (yellowing[healthychildren.org]
Nausea
  • Symptoms and signs of this reaction include: Chills Fever General ill feeling ( malaise ) Headache Muscle and joint pain Nausea Rash These symptoms usually disappear within 24 hours.[medlineplus.gov]
  • This can cause symptoms, such as high fever, profuse sweating, night sweats, nausea, and vomiting.[poz.com]
  • The first day of treatment might be accompanied by a day-long condition known as the Jarisch-Herxheimer reaction; symptoms of the Jarisch-Herxheimer reaction include fever, chills, nausea, achy pain, headache, and tachycardia.[soc.ucsb.edu]
Lesion of the Tongue
  • Abstract A 2-year-old infant boy presented with a large ulcerative lesion on his tongue. The grandmother who cared for the boy was in the habit of chewing food before giving it to the boy and had active syphilis.[ncbi.nlm.nih.gov]
Hepatosplenomegaly
  • Among 139 infants with symptomatic congenital syphilis in 3 series, the most common early signs were hepatosplenomegaly (71%), rash (68%), fever (42%), neurosyphylis (23%), pneumonitis (17%), rhinitis ( snuffles ; 14%), generalized lymphadenopathy (14%[doi.org]
  • There was no hepatosplenomegaly. Fig. 1: Papulosquamous lesions on the patient's trunk. Fig. 2: Mucous patches involving the lips. Fig. 3: Involvement of the palm. Blood samples were taken for HIV antibody and VDRL testing.[cmaj.ca]
Heart Disease
  • Without treatment, the infection can lead to heart disease, blindness, mental problems, or death. Syphilis Menu What is syphilis? Syphilis is an infection caused by the bacteria Treponema pallidum.[my.clevelandclinic.org]
  • It can cause blindness, brain damage, heart disease, or death. Pregnant women who have syphilis can pass it to their baby, which could make the baby very sick. You could also pass it on to your partners, even if you aren’t aware of symptoms.[teensource.org]
  • Tertiary syphilis can cause muscle coordination problems, mental illness, blindness, heart disease — and, ultimately, death.[web.archive.org]
Saber Shin
  • Later manifestations of congenital syphilis include bone and teeth deformities, such as “saddle nose” (due to destruction of the nasal septum), “saber shins” (due to inflammation and bowing of the tibia), “Clutton’s joints” (due to inflammation of the[emedicine.com]
Bone Pain
  • pain vision loss hearing loss joint swelling saber shins, a bone problem in the lower legs scarring of the skin around the genitals, anus, and mouth gray patches around the outer vagina and anus In 2015, the WHO confirmed Cuba as the first country in[medicalnewstoday.com]
  • They can cause bone pain at night and the chronic inflammation can cause a high temperature and a low blood count (anaemia). Neurosyphilis This means that the syphilis infection is affecting your central nervous system (CNS).[patient.info]
Tinnitus
  • A 37 year old man with a 2 year history of progressive cognitive decline, unilateral tinnitus and deafness presented with complex partial seizures and a fever.[ncbi.nlm.nih.gov]
Alopecia
  • A 42-year-old patient, HIV negative, presented with a 2-month history of progressive generalized thinning of the hairs and small non-scarring irregular alopecia patches of the parietal-occipital areas of the scalp.[ncbi.nlm.nih.gov]
  • Secondary syphilis of other viscera convert 091.69 to ICD-10-CM 091.7 Secondary syphilis, relapse convert 091.7 to ICD-10-CM 091.8 Other forms of secondary syphilis 091.81 Acute syphilitic meningitis (secondary) convert 091.81 to ICD-10-CM 091.82 Syphilitic alopecia[icd9data.com]
  • Other skin findings of secondary syphilis are condylomata lata and patchy alopecia. Condylomata lata are painless, highly infectious gray-white lesions that develop in warm, moist sites.[emedicine.com]
Blister
  • The lesions may be flat or raised, scaly or hive-like, and they can even manifest with pus-filled blisters (pustules). Whatever the appearance, the lesions are highly contagious and can readily pass the disease to others.[menshealth.about.com]
  • […] rash, which may look like rough "copper penny" spots or fine red dots on the palms of the hands and soles of the feet A skin rash on the arms, legs, and trunk — The rash can take a variety of forms, such as small blotches or indented circles; small blisters[drugs.com]
  • FAST FACTS Syphilis is a sexually transmitted infection (STI) that causes infected sores, blisters or ulcers on your genitals, anus (bottom) or mouth.[avert.org]
Mucocutaneous Rash
  • Symptoms include low-grade fever, generalized adenopathy, headache, malaise and a mucocutaneous rash. The rash is usually nonpruritic and covers the entire body in a symmetric pattern.[cmaj.ca]
Foot Ulcer
  • Spinal cord disease results in unsteady gait, bladder disturbance, impotence and sensory changes (tabes dorsalis) resulting in collapsed joints (Charcot's joints) and foot ulcers .[dermnetnz.org]
  • Spinal cord disease results in unsteady gait, bladder disturbance, impotence and sensory changes (tabes dorsalis) resulting in collapsed joints (Charcot's joints) and foot ulcers.[dermnetnz.org]
  • As a result, deep foot ulcers can occur. Syphilis in pregnancy and congenital syphilis Syphilis infection can be passed from a pregnant mother to her unborn baby (fetus), via the placenta.[patient.info]
Skin Ulcer
  • About half the time, however, he may have signs and symptoms such as a yellow-mucous nasal discharge (snuffles), rashes, skin ulcers, fluid retention, bone infection, fever, swollen spleen and liver, low red blood cell count (anemia), and jaundice (yellowing[healthychildren.org]
  • The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration usually between 1 cm and 2 cm in diameter) though there may be multiple sores.[en.wikipedia.org]
  • Primary symptoms include: Appearance of a single, firm, usually painless, non-itchy skin ulceration called a “chancre.” The chancre typically appears three to 90 days after exposure to the bacterium. Appearance of multiple chancres.[soc.ucsb.edu]
Headache
  • A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%).[ncbi.nlm.nih.gov]
  • Dr Redlich said that another condition, giant cell arteritis, an autoimmune disease which causes inflammation of the arteries, could account for Hitler's headaches, cardiac symptoms and vision problems.[news.bbc.co.uk]
  • Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired).[cdc.gov]
Syphilitic Chancre
  • Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients.[ncbi.nlm.nih.gov]
  • From Wikidata Jump to navigation Jump to search sexually transmitted infection syphilitic chancre great pox edit Language Label Description Also known as English syphilis sexually transmitted infection syphilitic chancre great pox Statements instance[wikidata.org]

Workup

Diagnosis of syphilis can be done by performing the tests on the samples of blood, fluids from the sore and the cerebral spinal fluid.

Performing the blood tests confirm the presence of antibodies in the body. Antibodies are produced when the body is exposed to an infection. A positive result of the test indicates that the person is infected with syphilis. Antibodies remain in the body for many years, even if the disease has been treated. A negative result, however, does not necessarily mean the patient is not infected with syphilis as the antibodies are not detected for up to three months after the infection. In that case, the patient is advised to take the test again after 3 months.

The sores that form the hallmark of syphilis are scraped and a small sample of the cells from this sore is analyzed under the microscope in the laboratory. This test is performed only in the primary and secondary syphilis when the sores are present. When analyzed in the laboratory, it can show the presence of bacteria in the scrapings, thus confirming syphilis [7].

Analysis of the cerebrospinal fluid is performed to diagnose CNS involvement. For this, the sample of cerebrospinal fluid is collected through a lumbar puncture, and the fluid is tested in the laboratory.

Treponema Pallidum
  • We have demonstrated previously that three full-length flagellins of Treponema pallidum, namely FlaB1, FlaB2 and FlaB3, did have diagnostic value in the serodiagnosis of syphilis.[ncbi.nlm.nih.gov]
  • Background: Syphilis is a sexually transmitted disease (STD) caused by the spirochete Treponema pallidum , and it persists to be a major public health problem in Africa, including Ethiopia.[ncbi.nlm.nih.gov]
  • 상세불명의 매독 Croatian LUES Polish Zakażenie Treponema pallidum , Kiła , Syfilis Hungarian syphilis, nem meghatározott , Vérbaj , Treponema pallidum fertőzés , syphilis , syphilis k.m.n.[fpnotebook.com]
  • NAS, Sifilide non specificata, Infezione da treponema pallidum, Lue, Sifilide Portuguese Sífilis NE, Infecção por Treponema pallidum, Sifílis, Sífilis Spanish Lúes, Sífilis NEOM, Sífilis no especificada, Infección por Treponema pallidum, sífilis, SAI[fpnotebook.com]
  • Complete genome sequence of Treponema pallidum , the syphilis spirochaete. Science 1998 ; 281: 375 – 88 . Google Scholar Crossref Medline ISI 26. Cumberland, MC , Turner, TB.[doi.org]

Treatment

Penicillin is the preferred drug for the management of syphilis. Guidelines for the dosage regimen of the penicillin for different stages of syphilis are present, with later stages requiring a long course of treatment because of the slow rate of replication of bacteria. Penicillin is the only drug used widely for managing neurosyphilis, and congenital syphilis. The common penicillin used to manage syphilis is Benzathine penicillin G. In patients with syphilis, penicillin allergy skin test must be performed [6].

In patients who are allergic to penicillin, tetracyclines, erythromycin, ceftriaxone have shown anti-treponemal activity. Doxycycline and azithromycin are also good options to manage syphilis. Studies have shown the efficacy of these two drugs [8].

Monitoring syphilis in patients ensures that the treatment is done adequately. Inpatient care is reserved for late-stage patients with syphilis. For patients who were successfully treated for must perform the follow-up visits at 3, 6 and 12-month interval. HIV patients who are treated with non-penicillin regimen must be monitored for life. After 24 months of therapy, patients with neurosyphilis must be reevaluated.

Treatment is said to have failed if the symptoms of syphilis return. The reappearance of symptoms is called “relapse”. Adequate treatment must be initiated in cases of relapse. Pregnant patients with syphilis should go for venereal disease research laboratory (VDRL) testing every month for the duration of pregnancy.

Prognosis

Though the cure of syphilis at the early stages is easy (penicillin), in the later stages damage done to the organs cannot be reversed. Secondary syphilis is cured, if detected early, and is completely treated.

Treatment can last from within weeks to almost a year, in some cases. In the absence of treatment, up to one-third of the patients will develop complications of syphilis. Late syphilis can cause permanent disability and can also lead to death in some cases.

Complications

  • If not treated properly, syphilis can cause damage to the entire body. It also increases the risk of HIV by several-fold. A syphilis lesion can bleed easily allowing easy passage of the virus.
  • Gummas are small bumps that develop on the patient’s skin, liver and bones. This generally occurs in the later stages of syphilis. Administration of antibiotics can cause these gummas to disappear.
  • Neurological problems such as stroke, deafness, meningitis, dementia and visual problems are common among patients with syphilis.
  • Cardiovascular problems in syphilis can occur when there is bulging and inflammation of the large vessel, aorta, and other blood vessels.
  • Pregnancy: Syphilis can pass from the infected mother to her baby. Congenital syphilis increases the chances of miscarriage and stillbirth in this group of the population.

Etiology

The pathogen that causes the syphilis infection is the spirochete, T pallidum. This is a human pathogen and does not occur naturally in any other species. Transmission of this spirochete occurs when it penetrates the mucosal membranes or abrasions on the epithelial surfaces. The most common mode of spread of the disease is through sexual contact [2]. T palladium cannot survive dryness or exposure to disinfectant.

Risk factors for transmission of syphilis:

  1. Unprotected sex
  2. Intravenous drug use
  3. Promiscuous sex
  4. Healthcare providers or workers are at the occupational risk

Epidemiology

Region

The prevalence of syphilis varies from region to region. Developing countries and some areas of America, and Eastern Europe have a greater prevalence of syphilis. The highest reports of the occurrence of syphilis are from South and Southeast Asia. In 1999, Siberia reported a prevalence of syphilis as 1300 per 100,000 populations [3].

Age distribution

The highest frequency of syphilis is observed in years of peak sexual activity. Syphilis is more common in men and women in the age group of 15-40 years.

Sex distribution

Men are more frequently affected by syphilis (primary and secondary) than women.

Ethnicity

Non-Hispanic Blacks are at a greater risk of syphilis than non-Hispanic whites. Since 2005, the incidence of both primary and secondary syphilis has increased in all the races and ethnicities.

Sex distribution
Age distribution

Pathophysiology

Primary syphilis is characterized by ulceration due to the migration of mononuclear leukocyte infiltration, lymphocytes, and macrophages. It generally heals spontaneously. Secondary syphilis, however, is caused by the spread of infection and causes widespread vasculitis. The lesions of secondary syphilis contain treponemes. Though the reasons for the secondary syphilis are still not clear, it is believed to be related to cell-mediated immunity.

The progression of latent syphilis to late syphilis occurs in only about 40% of the patients. Neurosyphilis is seen in about 10% of the patients with untreated syphilis, and it can occur at any stage. It is characterized by inflammation (chronic) of the meninges, caused by the invasion of the bacteria in the CNS by treponemes. When the treponemes cause occlusion of the aorta, the condition is called cardiovascular syphilis [4]. When there is a long-term inflammation of the walls of the vessel, it can cause an aneurysm and weakening of the aortic walls.

Prevention

Till date there has been no vaccine developed to prevent syphilis. However, safe sex practices, including use of condoms can help reduce the chances of syphilis several-fold [10]. It is advisable to wash or douche the genitals after the sexual act. Treating the infected mother early in the pregnancy can prevent neonatal syphilis [9].

Summary

Syphilis is an infectious disease which is caused by the spirochete Treponema pallidum. It is contracted by sexual contact with the infectious lesions, from the mother to the fetus through the blood transfusion and sometimes through the breaks of the skin, which comes in contact with the infected lesions.

Syphilis mimic the presentation of several other infections and immune-mediated processes in advanced stages, hence also called,” the great imposter”.

The disease starts off as a painless sore in and around the genitals, rectum, and mouth, and spread from one person to another via the skin or mucous membrane. The bacteria remain dormant after initial infection for decades, before it becomes active again.

Early detection of the disease can help treat the condition even with a single injection of penicillin [1]. If not treated early, syphilis can damage the heart, brain or other organs and emerge as a life-threatening disease. There are four stages of syphilis: Primary, secondary, latent and tertiary.

Patient Information

The first presentation of syphilis is a small and painless sore or ulcer, which is known as chancre on the skin, rectum, and genitals. The lymph nodes are also enlarged around the sore area. These symptoms characterize primary syphilis. Skin rash, patches around the vagina, penis, and mouth, general ill feeling, loss of appetite, joint and muscle pain, changes in the vision and hair loss are some of the other presentations of syphilis observed in patients.

References

Article

  1. Dismukes WE, Delgado DG, Mallernee SV, Myers TC. Destructive bone disease in early syphilis. JAMA. Dec 6 1976;236(23):2646-8.
  2. CDC. Summary of notifiable diseases, United States, 1997. MMWR Morb Mortal Wkly Rep. Nov 20 1998;46(54):ii-vii, 3-87
  3. Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941--1993. Sex Transm Dis. Jan-Feb 1996;23(1):16-23
  4. Harrison LW. The Oslo study of untreated syphilis, review and commentary. Br J Vener Dis. Jun 1956;32(2):70-8
  5. CDC. Primary and secondary syphilis--United States, 2003-2004. MMWR Morb Mortal Wkly Rep. Mar 17 2006;55(10):269-73.
  6. Fiumara NJ. Treatment of primary and secondary syphilis. Serological response. JAMA. Jun 27 1980;243(24):2500-2
  7. Young H. Syphilis. Serology. Dermatol Clin. Oct 1998;16(4):691-8
  8. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006.MMWR Recomm Rep. Aug 4 2006;55:1-94
  9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. 33 2008.;Atlanta, Georgia
  10. Golden MR, Wasserheit JN. Prevention of viral sexually transmitted infections--foreskin at the forefront. N Engl J Med. Mar 26 2009;360(13):1349-51

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Last updated: 2018-07-11 08:06