Symptoms
Primary
syphilis
First
stage
-
An ulcer (a chancre ["shan-ker"]) appears
within 10 days to 3 months after exposure, but usually within 2-6 weeks
-
The chancre may be painless and can remain undetected inside
the body, so may go unnoticed
The chancre usually appears on the part
of the body exposed to the partner’s ulcer, such as:
-
the anus
-
the cervix
-
the lips
-
the penis
-
the tongue
-
the vagina
-
the
vulva
-
other parts of the body
These usually disappear within a few weeks whether
treated or not. If left untreated during the primary stage, about
one-third will continue on to chronic stages.
Secondary
syphilis
The
most common symptoms include:
-
a
rash of flat, red lesions over the whole body (including the palms
of the hands and soles of the feet)
-
fever
-
swollen
glands
-
broad-based
papules (lumps or warts) in warm, moist sites
-
mucous
patches or snail-track ulcers in the mouth, appearing from 3-6 weeks after the chancre develops
Active
bacteria are present in the sores, so physical contact (sexual or
nonsexual) with the broken skin of an infected person is not recommended
as transmission of the disease is possible.
After several weeks or months the rash seems to heal itself.
Other symptoms such as:
also may occur but will usually disappear without treatment.
The secondary stage of secondary syphilis appears 2-4 months after infection, lasting several weeks and often recurring in the following 2 years and can come and go over the next1-2 years.
Latent
stage syphilis
A
stage of infection caused by T. pallidum in which organisms persist in
the infected person's body without causing symptoms or signs.
Latent
syphilis is subdivided into:
Early
Late
Unknown categories
Tertiary
(Late) syphilis
A minority (up to 30%) of individuals with untreated syphilis may develop tertiary syphilis with lesions many years after the initial infection.
The lesions can be benign, causing no serious disability, or they may involve the:
as well as
heart
and blood vessels (cardiovascular syphilis), producing severe
complications resulting in :
Some
syphilis cases (especially latent or late stages), need to have a
lumbar puncture (spinal tap) to check for infection of the nervous
system.
Other
clinical signs of syphilis (late) include:
Inflammatory
lesions of the:
-
bones
-
cardiovascular system
-
skin
Occasionally other areas of the body may be affected such as:
Late
syphilis usually becomes apparent after 15-30 years of untreated
infection.
Neuro-syphilis
The
bacteria often invades the central nervous system during the early
stages of infection. Approximately 3-7% of persons with
untreated syphilis develop neuro-syphilis.
Some people never develop any
symptoms, some experience headache, stiff neck, and fever, resulting from
inflammation of the lining of the brain and others develop seizures.
Blood vessels affected by the bacteria can result in symptoms similar to
a stroke:
-
numbness
-
visual complaints
-
weakness
It has
been known to take up to 20 years to develop neuro-syphilis.
Neuro-syphilis is difficult to treat especially for those with HIV infection. Elevated CSF protein or leukocyte count in the
absence of other known causes of these abnormalities may occur.
The
widespread use of antibiotics makes modern-day syphilis harder to
detect as there may be no genital symptoms, or any symptoms of secondary
syphilis.
Effects
of Syphilis in Pregnant Women
An
untreated pregnant woman with active syphilis will pass the
infection to her unborn child:
Hepatitis
screening should be done as well. A fetal death taking place after
a 20-week gestation or if the fetus weighs more than 500gms with an
untreated mother at delivery is classified as a syphilitic stillbirth.
Babies
with congenital syphilis can have symptoms at birth, but symptoms can
develop two weeks to three months later, including:
*The
moist sores of congenital syphilis are infectious.
When
infected infants become older children and teenagers, late-stage
syphilis symptoms may occur, including damage to:
-
bones
-
brain
-
eyes
-
ears
-
teeth
The
rise in infant syphilis morbidity (death) has become a public health concern
that warrants attention.
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Diagnosis
Because
its early symptoms are similar to many other conditions people who are
sexually active should consult a doctor about any unusual rash or
sore in the genital area.
Three
methods may be used in diagnosis of syphilis:
Bacteria Identification
A surface scraping from the ulcer or chancre is
taken and examined under a special 'darkfield' microscope to
detect the organism itself.
Accurate
clinical diagnosis in the newborn is possible only with positive
'darkfield' findings from skin lesions or placenta, or congenital syphilis
classical signs seen on examination.
Cord blood should not be used for infant serologic testing because the high incidence of false positives and false negatives is high.
Blood Tests
Evidence of infection is given. False-negative results which do not show signs of infection despite its presence can appear for up to
3 months after infection. False-positive tests also occur, therefore,
two blood tests are normally used.
t is sometimes difficult to
interpret blood tests for syphilis so repeated tests are
often necessary to confirm the diagnosis.
The
blood-screening tests most often used are:
False-positive results showing signs of infection when it is not
present occur in people with:
-
autoimmune disorders
-
certain viral
infections
-
other condition
A confirmatory blood test is
carried out when the initial test is positive, such as:
Syphilis antibodies
(proteins made by a person's immune system to fight infection) can be
detected. These antibodies do not protect against syphilis infection in
a previously infected person because once antibodies are formed, they
remain in the body for many years.
It
is hoped that a diagnostic test that does not require a blood sample can
be produced. Tests are being carried out on saliva and urine to see if
they produce comparable results to blood.
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Treatment
Syphilis is treated with penicillin, usually administered by injection. A
person no longer usually transmits syphilis 24 hours after beginning
treatment.
Some people, however, do not respond to the usual doses of
penicillin, therefore, it is important that people being treated for
syphilis have periodic blood tests to check that the bacteria has been
completely destroyed. Persons with neuro-syphilis may need to be retested
for up to 2 years after treatment.
People with an allergic reaction to penicillin should consult their doctor for appropriate antibiotic advice. Safe, effective, single-dose oral antibiotic treatment for syphilis is being sought for people who are
allergic to penicillin (10% of population).
Proper treatment in all stages of the disease will cure the disease, but in late syphilis, damage already done to body organs cannot be reversed.
The
serology or treatment of infected pregnant women under certain
conditions may present unusual signs. HIV positive persons may
have unusual syphilitic infections often with central nervous system
involvement.
Treatment failures although rare do happen with subsequent
advancing to neuro-syphilis, because of an impaired cellular or hormonal
immune response in the HIV infected person leading to an altered
presentation of syphilis (Seronegative secondary syphilis).
Repeated
blood tests are necessary for at least a year after treatment to monitor
possible treatment failure. People who have had tertiary syphilis should
be followed up for many years.
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