Whittington, W. L. T. Collis, C. Dithmer-Schreck, et al. "Sexually Transmitted Diseases and Human Immunodeficiency Virus-Discordant Partnerships Among Men Who Have Sex With Men." Clinical Infectious Diseases 35 (October 15, 2002): 1010-1017.
Centers for Disease Control and Prevention. 1600 Clifton Rd. NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov .
[ sif´ĭ-lis ]
a contagious, usually sexually transmitted disease that leads to many structural and cutaneous lesions and is caused by a spirochete, Treponema pallidum. A congenital type can be acquired by a fetus in utero from the mother.
Diagnosis. Testing for syphilis is usually by a serologic test for syphilis. of which there are two types: (1) the nontreponemal antigen tests detect antibodies to substance (reagin) derived from host tissues; they originated with the wassermann test and are now represented by the vdrl and rapid plasma reagin tests ; (2) the treponemal antigen tests detect specific antitreponemal antibodies; they originated with the Treponema pallidum immobilization test and are now represented by tests such as the microhemagglutination assay–T. pallidum (MHA-TP), and assays using enzyme-linked immunosorbent assay (ELISA) methods. The term “serologic tests for syphilis” is occasionally used with reference only to nontreponemal antigen tests.
A positive test for syphilis should be repeated. A false positive result can be due to other diseases such as malaria, leprosy, and advanced pulmonary tuberculosis, and therefore should not be ignored. A false negative serological test can occur when the infection is too recent to have triggered the production of antibodies. A negative result can also occur if the disease is late symptomatic syphilis or if the patient's immune system is not functioning normally. If treatment of syphilis had been started before the test, the patient's blood could be temporarily nonreactive. Since alcohol interferes with and decreases the intensity of a reaction, it should be considered as a possible cause of a negative result. Once treatment has been started, patients with early syphilis should have repeated testing every three months for one full year.
Primary Syphilis. Within a few hours after the spirochetes penetrate the skin or a mucous membrane, they enter the bloodstream, and usually in about a week they spread throughout the body. The first sign is a painless sore, called a chancre, that appears 9 days to 3 months (usually about 3 weeks) after infection. Usually firm or hard, the chancre may resemble a blister, pimple, or ulcerated open sore. In men, it appears usually on or near the head of the penis. In women, the chancre is commonly found on the labia, but it may be concealed inside the vagina, where it may not be felt or seen. Chancres sometimes develop elsewhere, such as on the lips of the mouth, a breast, or a finger. They also may appear in the anal region. The nearby lymph nodes become hard and swollen.
Even if no treatment is given, the chancre will disappear in 10 to 40 days, often leading to the false conclusion that the disease is cured. Occasionally a chancre fails to develop or is too small to be noticed. Primary syphilis can be cured with antibiotics in adequate doses. (See Atlas 2, Part P.)
Secondary Syphilis. Two to six months after the primary sore disappears, the secondary stage of syphilis begins; it may last up to 2 years. A rash is usually one of the first symptoms. It may cover any part of the body and often spreads over the entire skin surface, including the palms and soles. It does not itch and may resemble the rash of measles as well as of many other diseases. It can be identified positively as a symptom of
syphilis only by a blood test. During secondary syphilis, thin white sores may appear on the mucosa of the mouth and throat and around the genitalia and rectum. Headache, fever, and a general feeling of illness are common. Hair may fall out in patches, bones and joints may be painful, and anemia may develop. Sometimes the eyes are affected. Syphilis is highly contagious in this stage and of great danger to others. If mouth sores are present, the disease may be spread by kissing.
Like primary syphilis, the secondary stage disappears by itself, generally within 3 to 12 weeks, but may return later if the organisms are still present. As in the primary stage, the disease can be cured in the secondary stage by the use of penicillin or other antibiotics. Together, the primary and secondary stages are known as early syphilis.
Tertiary Syphilis. The third, or tertiary, stage of the disease is also known as late syphilis. Its symptoms may develop soon after the secondary symptoms have vanished or they may lie hidden for 15 or more years. A person may be unaware that the disease is present. Even a blood test may be negative.
Late syphilis is less contagious to others but is extremely dangerous to the person who has it. It may be fatal, particularly if the central nervous system or heart is affected. The spirochete can invade any cell of the body and can damage any organ or structure of the body, including the internal organs, bones, joints, and skin. The characteristic lesion of tertiary syphilis is a soft gummy tumor called a gumma.
If late syphilis attacks the heart, aorta, or aortic valve, death may result from rupture of the weakened aorta or from heart failure. When it attacks the central nervous system, general paresis, a severe disease of the brain, may result; if not treated promptly, it will cause insanity and death. Another serious disorder of the nervous system caused by late syphilis is tabes dorsalis. in which there is pain and loss of position sense. Blindness may result if the infection involves the eyes. Other possible effects are deep ulcers on the legs or elsewhere, chronic inflammation of the bones, which is especially painful at night, and perforation of the soft palate.
Cure of late or tertiary syphilis takes longer and is more difficult than that of primary or secondary syphilis. Sometimes the disease cannot be completely cured. As with early syphilis, however, it may be successfully treated with penicillin and other antibiotics.
Congenital Syphilis. Congenital syphilis is transmitted from a diseased mother to her unborn child through the placenta; this often results in spontaneous abortion or stillbirth. Infants with congenital syphilis who are born alive may have a nasal discharge called snuffles. caused by inflammation of the nose, and may be generally weak and sickly. Syphilitic rashes, especially in the genital area, may occur when the baby is 3 to 8 weeks old. Many are born with deformities or later develop any of a wide variety of impairments and disabilities.
To prevent congenital syphilis all pregnant women should have a blood test for syphilis during the early months of pregnancy. Treatment before the fifth month will always prevent infection of the unborn child. A syphilitic mother who is not treated early has only one chance in six of having a healthy child. If a child is born with syphilis, immediate treatment may be effective if the disease has not progressed too far.
Prevention. The skin lesions associated with primary and secondary syphilis can be highly contagious. The Centers for Disease Control and Prevention recommends standard precautions when caring for a patient with syphilis.