Syphilis

What is syphilis?

Although its incidence dropped substantially during the 1990s, this potentially deadly disease is on the rise again in the U.S. According to the Centers for Disease Control and Prevention (CDC), cases of syphilis have risen every year since 2000. The United States has the highest rate of syphilis infection in the developed world. The Scandinavian countries, in contrast, eradicated the disease long ago.

One of the many difficulties of combating syphilis, experts say, is the fact that its early symptoms are similar to those of common illnesses like colds and flu. This causes some people to be lax in getting medical treatment and some doctors to misdiagnose the disease. That's why syphilis, which is known on the street as the pox or "bad blood," has been labeled "the great imitator" by the medical community.

What causes it?

This sexually transmitted disease is caused by a bacterium called Treponema pallidum and is spread by sexual contact, usually in the form of vaginal, oral, or anal sex. If left untreated, it can cause a range of serious illnesses, insanity, and even death.

What are the symptoms?

As the disease runs its course, it progresses through four stages, each with different symptoms:

  • In the primary stage, a painless ulcer called a chancre typically appears in your genital area three to four weeks (although it can be as much as 13 weeks) after you've first been infected with syphilis. You may also have swollen lymph glands. The hard oval-shaped chancre, which rarely hurts or itches, is very contagious. Women in particular may not notice it, since it often occurs inside the vagina. It can also develop on the vulva, cervix, anus, or perineum (the small area between the anus and the vulva), and on the penis or on the mouth; in rare cases it appears on your hands or other parts of your body. The chancre lasts about four to eight weeks and then disappears, even if you do nothing. But the infection itself, if left untreated, advances to the next stage.
  • In the secondary stage, the syphilis bacteria spread through the bloodstream and typically cause a red rash on the palms of your hands and the soles of your feet (this happens anywhere from two weeks to four months after the chancres have disappeared). You may also have flat grayish-white bumps that look like warts around your genitals or in your mouth and throat; again, these are highly contagious. Other symptoms can include headaches, hair loss, lack of appetite, diarrhea, nausea, mild fever, and pain in the muscles, joints, or bone. (In other words, the symptoms are a lot like having the flu.) This stage may continue for as long as two years; then, as in the primary stage, the symptoms go away by themselves.
  • In the latent stage, about two years after you first contracted syphilis, the infection enters a dormant period. Although few people have any symptoms during this phase, a blood test will show that you're still infected. This stage may last for a few years -- or the rest of your life. About one-third of all people who haven't gotten treatment by this time will go on to the final stage of syphilis. The disease is thought to be infectious during the first year or two of the latent stage, but can no longer be spread through sexual contact after that.
  • In the late, or final, stage of the disease, the bacteria may cause severe damage to many of your internal organs, including your brain, heart, and spinal cord. Some people develop painful sores called gummas on the tongue or skin or in the mouth, bones, nervous tissue, or heart. The last stage usually begins within 10 years of the original infection and can end in paralysis, blindness, dementia, and death. Syphilis isn't contagious during this final stage.

How can it be treated?

The good news is that syphilis can be fully cured. Your doctor can usually diagnose it with a simple blood test, and he'll probably prescribe penicillin, which is extremely effective against the disease. If you're diagnosed as having syphilis in its primary or secondary stage, you can usually be cured with a single injection of penicillin. (Pregnant women and people who are allergic to penicillin are generally desensitized and treated with it as well.) A later stage of the disease may require repeated doses, along with treatment for any other damage caused by the bacteria. Since many people with syphilis may also have been exposed to HIV, you should be tested for HIV, too.

It's crucial that you contact all your current and recent sexual partners so that they can be checked and treated. This could save their lives as well as those of the people they might infect, so be prepared to answer questions about your sexual history. State laws usually require labs that perform syphilis testing to report all positive tests to the state health department, along with the individuals' names and addresses. A state health department employee will then give you a call to determine your sexual contacts, even if your physician has already done so. If you have primary stage syphilis, the state health department employee will generally want to contact all the sexual partners you've had during the previous three months; if the infection is in the secondary stage, he'll expand that to the previous six months. If you have an early latent-stage infection, he'll want to call everyone you've had sex with for the last year.

You'll need to have at least two follow-up exams in the year following your treatment to make sure you've been cured. It's extremely important to show up for those appointments.

How can I protect myself from syphilis?

If you're not in a long-term monogamous relationship, always make sure either you or your partner uses a condom during sex. Be cautious about using condoms that are lubricated with spermicides -- according to guidelines issued by the Centers for Disease Control and Prevention, spermicides don't protect against STDs. In fact, says the CDC, frequent use of spermicides containing nonoxynol-9 can cause genital lesions that may actually increase your risk of contracting STDs. Keep in mind that the bacteria can also be transmitted by way of unprotected anal or oral sex. Check with your local women's health clinic; they can usually provide "dental dams" (thin sheets of plastic) to use during oral sex.

If you're considering having sex with a new partner, both of you should first be tested for STDs, according to the CDC.

What are the dangers to pregnant women and their babies?

They're enormous. If you are thinking about getting pregnant and may have been exposed to syphilis, get tested. Women infected with syphilis can pass the deadly bacteria through the placenta to their fetuses, who are likely to die or suffer birth defects as a result.

If you are already pregnant, get the screening: You may be able to prevent harm to your child by getting treatment. All pregnant women should be screened for syphilis, once at the beginning of pregnancy and, if they're considered high-risk, again at 28 weeks. Even if you are cured, there is a chance your baby may still have birth defects because of the pretreatment exposure to the disease.

Among pregnant women with primary- or secondary-stage syphilis, about half will miscarry or have babies who are stillborn or die shortly after birth. Most of the babies born to the rest will suffer from congenital syphilis, which can cause blindness, brain damage, and other problems. In 2007, the rate of congenital syphilis was 10.5 out of every 100,000 live births -- an increase of 12.9 percent from 2006.

Congenital syphilis has been divided into two categories: early (occurring within the first two years of life) and late (recognized two or more years after birth). The symptoms of early congenital syphilis usually arise three to seven weeks after birth and include jaundice (yellowish skin), sores on the skin or in the mouth, hepatitis, anemia, and low birthweight. The symptoms of late congenital syphilis include retardation, blurred vision, Hutchinson's teeth (short, peg-shaped upper incisors), facial abnormalities (including saddlenose and protuberant jaw), seizure disorders, and bone and joint problems.

References

Some Facts About Syphilis. Centers for Disease Control and Prevention. May 2001

Congenital Syphilis. National Library of Medicine. Updated August 15, 2001.

Centers for Disease Control. Sexually Transmitted Diseases Treatment Guidelines 2002.

Overall Syphilis Rate Rises for First Time Since 1990. Centers for Disease and Prevention Press Release. November 1, 2002.

Centers for Disease Control. Syphilis -- CDC Fact Sheet. May 2004.

Centers for Disease Control. Trends in Reportable Sexually Transmitted Diseases in the United States. 2006.

Centers for Disease Control. Syphilis. January 2009.

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