Syphilis

What is syphilis?

Syphilis is an infectious, contagious venereal disease that is caused by the microbe known to scientists as treponema pallidum. It is one of the less common sexually transmitted infections (STI).

How common is syphilis?

There were a decreasing number of cases of syphilis diagnosed over the past years…until recently! In the Montreal area, the number of cases declared dropped from 32 confirmed infections in 1990 to one case in 1998. Notably, between september 200 and july 2001, a total of 15 cases were identified. For the year 2002 to date, there are already 27 cases of active contagious syphilis reported, and this for the period ending in October.

How is the syphilis microbe transmitted?

Syphilis is transmitted via sexual relations with a partner who is both infected and contagious. Sexual relations at risk include genital, oral and /or anal contact, and this with or without penetration.

What are the symptoms of syphilis?

The incubation period (time between contact and the appearance of the first symptoms) varies somewhat between 10 and 90 days. Symptoms of syphilis may pass unrecognized, or may be misinterpreted…at times there are no initial symptoms at all! When present, the clasical symptoms of syphilis manifest themselves in three stages as follows :

Primary syphilis

Approximately three to four weeks after sexual contact with an infected, contagious partner, a chancre (a superficial skin ulcer with well-defined edges and an inflamed base up to 1,0cm in diameter) may appear at the site of the microbe’s entry. The chancre is typically painless (this is in contrast with genital herpes which causes painful ulcers). There may be associated swollen lymph nodes(small painless lumps that are centers of immune system activity) in the inguinal region (groin). It is contact with such a syphilitic chancre that the infection is transmitted. This initial chancre routinely heals itself spontaneously within three to eight weeks.

Secondary syphilis

If syphilis is left untreated, the infection will evolve and manifest itself, several weeks after the primary stage, with a skin and mucus membrane eruption (red lesions), fever, fatigue, headaches and muscular aches and pains. Once again, if left untreated, these symptoms will resolve on their own…but the infectious microbe remains behind. It is at this point that syphilis passes into its latent phase. This « silent period » may last for many years and permits the infection to evolve without any obvious external symptoms. At this point, the only method of detecting the presence of syphilis is via a blood test specific for syphilis.

Tertiary syphilis

After many years, even as long as ten to thirty years, syphilis may progress to the point where it may result in serious organ system complications including skin, bone and vital nervous system or cardiovascular system maninfestations.

Men and syphilis

In men, the primary syphilitic chancre is typically localized to the penile glans, however, may be found elswhere on the penis or pubis. At times the anus and/or rectum may be the site of primary infection. The chancre may also be found on the lips, tongue, tonsils, fingers…any site which may have come into contact with and infectious lesion. It is important to note that seeing as that the primary lesion is typically painless, it may be missed or ignored…particularly if it is in an out of view location (anus, rectum or back of the throat).

Women and syphilis

The manifestations of primary syphilis are identical in women, with lesions typically found on the external or internal genital organs…once again leaving open the possibility that this painless lesion go unnoticed (when internal).

Syphilis and pregnancy

The risk of transmission of syphilis from an infected mother to her unborn fetus during pregnancy is quite elevated, approaching a 50 % infection rate. When transmission and infection of the fetus occurs during pregnancy the resulting complications may include a spontaneous miscarriage, a pre-term or premature delivery or stillbirth. It is extremely important that the infected pregnant woman be treated and followed closely.

Syphilis in the newborn

Newborns infected with syphilis are often free of symptoms upon delivery (2/3 of cases) and may even have negative syphilis test results if their mother was treated towards the end of her pregnancy. The infection and symptoms may develop during the first two years of life, or later in some cases. A close follow-up is essential. At times, the symptoms may be subtle including such signs as : low birth weight, a skin eruption or rash, nasal infection or anemia.

What is the interaction between syphilis and HIV/AIDS?

In patients infected with HIV/AIDS, a co-infection with syphilis is often much more severe and may progress more rapidly than in the healthy individual. An aggressive treatment approach is strongly recommended…discuss this with your physician.

How is syphilis diagnosed?

Generally speaking, syphilis is a disease that is easy to diagnose. When a chancre is present in the initial stage, a microscopic evaluation of secretions swabbed from the surface of the lesion will permit your physician to observe the presence of the treponema pallidum microbe. In its more advanced stages, and during the latent phase, a simple blood test (called the VDRL) will permit confirmation of infection. Occasionally blood tests may be difficult to interpret, and additional blood tests will be undertaken – when appropriate.

Is there a cure for syphilis?

Syphilis responds very well to treatment with penicillin. The dose of penicillin prescribed will depend on the stage of the infection – your physician will determine the amount and treatment period. If you are allergic to penicillin, do not panic!, there are several other available antibiotics that are equally effective. Once treated, your physician will schedule you for periodic blood tests (approximately every 6 months) over two years in order that your cure may be confirmed.

Jarisch-Herxheimer reaction

At times, an impressive inflammatory reaction may develop in the 8 to 12 hours following the initiation of treatment for syphilis. In its mild form, it presents with fever, headaches and muscular aches and pains. In severe cases it may be accompanied by rapid breathing and a dangerously low blood pressure (hypotension). It is generally not necessary to interupt therapy as the reaction typically only persists for several hours. Management of such a treatment complication includes rest and medications to control uncomfortable symptoms such as fever and pain (aspirin or acetaminophen).

Your physician will assist you in determining the appropriate treatment approach for you.

Who is at risk of contracting syphilis?

The risk of contracting syphilis is increased when enaging in unprotected sexual relations, with or without penetration of the vagina, anus or mouth with :

• a new sexual partner (male or female) who has not been evaluated by a physician to exclude the presence of syphilis or other STI;
• a partner who has one or more sexual partners (with or without your knowledge);
• more than one sexual partner;
• an anonymous sexual partner;
• a high-risk sexual partner (i.e. escort, prostitute or sex-trade worker)

How can I prevent transmission to my sexual partner(s)?

• The systematic and proper use of a latex condom is an effective means of protection against the transmission of syphilis.
• In the presence of an ulcer, an unusual sore, pimple or redness it would be prudent to refrain from sexual relations and consult your physician.
• You should consider routine STI screening tests, including a test for syphilis, at a frequency appropriate to your sexual lifestyle (particularly if you have multiple sexual partners). Discuss the testing interval with one of our physicians.
• Talk about sexual health and STI testing with your partner(s).
• Advise all sexual partners over the previous three to twelve months (according to the stage of syphilis), thereby interrupting the chain of transmission and avoiding re-contamination after treatment. It is thanks to effective antibiotics and partner notification (public health concern) that the numbers of syphilis have declined over the decades.

How can I avoid contracting syphilis?

• Use a male or female condom or dental dam (for oral-genital sex) at all times with all sexual partners.
• Sexual abstinence or a stable monogamous relationship with an syphilis-free partner is an effective means of preventing syphilis as well as other STIs (this requires STI screening) in the sexually active adult population.