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Syphilis, once a cause of devastating epidemics, is a sexually transmitted disease caused by the bacterium Treponema pallidum. The disease can be effectively diagnosed and treated with antibiotic therapy. In 2006, over 36,000 cases of syphilis were reported, including 9,756 cases of primary and secondary syphilis were reported to the U.S. Centers for Disease Control and Prevention. Although treatment is available, the early symptoms of syphilis can be very mild, and many people do not seek treatment when they first become infected. The fact that syphilis increases the risk of transmitting and acquiring the human immunodeficiency virus (HIV) that causes AIDS is becoming a major concern (CDC 2007).
"Syphilis has been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases." (CDC 2007). In May 2009, the numbers of syphilis cases were rising rapidly in North Carolina. It was already more than twice as many cases than all of 2008 (Johnson 2009). The disease continues into four stages as the bacterium makes its way to different organs in the body. During the early stages of syphilis, the symptoms are usually very mild. Later, when syphilis is no longer contagious, untreated syphilis can cause serious heart abnormalities, mental disorders, blindness, other neurological problems, and death. There is a growing concern about the increased susceptibility to HIV, the virus that causes AIDS, for those in the early stages of syphilis, if they have had sex with someone infected with HIV (Mayo Clinic 2008).
Predisposing Risk Factors
One is at an increased risk of acquiring syphilis if they engage in high-risk sexual activity. These risk factors include unprotected sex, sex with multiple partners, having sex with a new partner, or having sex under the influence of drugs or alcohol, or a man who has sex with men, or infected with the human immunodeficiency virus (HIV). The more sexual partners one has, the more likely he/she is to get syphilis or another sexually transmitted disease (STD). Even if he/she had syphilis and had been treated for it previously, one can contract the STD again (Mayo Clinic 2008). Without treatment, syphilis can lead to permanent brain, nerve, and tissue damage throughout the body. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. Treatment can help prevent future damage but cannot repair or reverse damage that has already occurred (Cooper 2009).
The primary stage of syphilis originates with the entry of Treponema pallidum spirochete through the skin or mucous membranes. Syphilis is passed from person to person through direct contact with a syphilis sore, or during vaginal, anal, or oral sex. Sores occur mainly on the external genitals, vagina, anus, or in the rectum, but can also occur in the mouth and on the lips. Pregnant women can pass the disease on to their babies. "All pregnant women are screened with a blood test called Venereal Disease Research Laboratory (VDRL) test, which is based on the presence of antibodies produced in response to the infection."(Leifer 2005). Transmission of syphilis cannot occur through contact with toilet seats, doorknobs, swimming pools, bathtubs, or eating utensils (CDC 2007). Neurosyphilis can occur at any time after the initial infection. This happens when the spirochete spreads to the central nervous system (CNS). If the person has HIV, neurosyphilis may occur earlier in the course of infection, during secondary or latent syphilis. The damage is associated with neurologic symptoms, including cranial nerve abnormalities causing extraocular or facial muscle palsies, tinnitus, hearing loss or symptoms of meningitis. Eye diseases may occur in conjunction with neurosyphilis.
Syphilis develops in four stages. Symptoms vary with each stage, but the stages may overlap. Symptoms do not always occur in the same order. One may be infected with syphilis and not notice any symptoms for years. If one has HIV infection at the same time, the symptoms of syphilis may be different for an individual without HIV infection. The first stage of syphilis also called the primary stage, present with signs and symptoms within ten days or up to three months from exposure. A small, painless sore called a chancre appears on the genitals or wherever the bacteria entered the body. It is usually just one chancre, but multiple sores may develop. Another sign is enlarged lymph nodes in the groin area. The chancre will heal without treatment, but the syphilis infection remains in the body. In some people, syphilis then moves to the secondary stage. In the secondary stage the symptoms occur within two to ten weeks of the chancre appearing. The signs and symptoms are skin rash on the palms of the hands and the soles of the feet, fever, fatigue, soreness and aching, swollen lymph glands, sore throat, and wart-like sores on the genital area or in the mouth. These signs and symptoms may disappear within a few weeks or come and go for as long as a year. From the secondary stage, syphilis then moves to the latent or hidden stage of syphilis. In this stage no symptoms occur. The latent stage can last for years. If the latent stage is not treated the disease progresses to the tertiary or late stage of syphilis. About 15 to 30 percent of people infected with syphilis enter the tertiary stage. The late stage of the disease can damage the heart, brain, eyes, nerves, liver, bones, and joints. These problems occur many years after exposure to the infection. Signs and symptoms of late syphilis include uncoordinated muscle movements, paralysis, numbness, gradual blindness, dementia, and possible death (Mayo Clinic 2008).
Some health care providers can diagnose syphilis by examining material from the chancre using a dark-field microscope. The Treponema pallidum spirochete is difficult to grow in culture and is very tiny. The syphilis bacteria will show up under the microscope if present in the sore. After the infection occurs, the body produces syphilis antibodies than can be detected by an accurate, safe, and inexpensive blood test. This is another way to determine whether someone has syphilis. The rapid plasma reagin (RPR) test and the automated reagin test (ART) are other nontreponemal tests used to indirectly check for syphilis by detecting the presence of antibodies that the body forms in response to the bacteria. If nervous system complications of syphilis occur, a doctor may suggest collecting a sample of cerebrospinal fluid through a lumbar puncture (Mayo Clinic 2008). The diagnosis of neurosyphilis may be difficult because some testing of cerebrospinal fluid may provide false-negative results. Treponemal enzyme-linked immunosorbent assay (ELISA), fluorescent treponemal antibody absorption (FTA-ABS) and polymerase chain reaction (PCR) tests for treponemal DNA are some new methods being introduced to improve specificity. Even after the disease has been successfully treated a low level of antibodies will likely stay in the blood for months or years. Every pregnant woman should have a blood test for syphilis because syphilis can infect and possibly kill the developing baby (CDC 2007).
Syphilis is easy to cure in its early stages. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. A single injection of penicillin can cure a person who has had syphilis for less than a year. If one is allergic to penicillin, the doctor will recommend another antibiotic. If one has had syphilis for longer than a year, he/she may need additional doses. Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even though the pregnant individual is treated for syphilis during her pregnancy, the newborn child should receive antibiotic treatment. Penicillin is the standard treatment for infants and children with congenital syphilis. The first day one receives treatment he/she may experience what is known as the Jarisch-Herxheimer reaction. Symptoms include fever, chills, nausea, aching pains and headache. This reaction usually does not last more than one day (Mayo Clinic 2008).
An important factor is teaching about follow-up treatment. After one is treated for syphilis he/she should have periodic blood tests to make sure the penicillin is effective. These follow-up tests are usually done six and twelve months after treatment. Sexual contact should be avoided until treatment is complete and blood tests show that the infection is cured. All sexual partners should be notified so they can be tested and receive treatment if necessary. Any individual who contracts syphilis should be tested for HIV. Sores of primary and secondary syphilis may be highly infective. Gloves should be worn when direct contact with the sores is likely, and proper hand hygiene must be performed after gloves are removed (Mayo Clinic 2008).
There are currently no new treatments for syphilis. The disease is still being treated with antibiotics. Penicillin is the drug of choice if the patient is not allergic to it. Blood tests are still collected to diagnose the sexually transmitted disease. After being successfully treated, someone can still be re-infected with the disease. Between 2005 and 2006, the number of reported primary and secondary syphilis cases increased 11.8 percent. In 2006, 64% of the reported primary and secondary syphilis cases were among men who have sex with men (CDC 2007).
Syphilis is a serious bacterial disease and should be treated as soon as possible. If diagnosed and treated in a timely manner, syphilis can be cured without any complications. Individuals should be educated on abstinence and using protection when engaging in sexual activities and sexual intercourse. Early detection of the disease is the most important factor. When syphilis is not detected early and treated properly, it can lead to a variety of illnesses and even death.