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Syphilis
Overview

Syphilis isn’t always a big topic of conversation. It is a sexually transmitted disease (STD) that has always been prevalent in sexually active adults, pregnant women, and newborns born to mothers with syphilis. As of 2013, over 56,000 new cases of syphilis were reported. This is higher than new cases of HIV. Actually, the number of cases in newborns is going down. This is most likely due to better screening during pregnancy and education. This article will help you understand more about syphilis, how it is managed, and prevention tips.

What Is Syphilis?

Syphilis is a sexually transmitted bacterial infection. The bacteria is a spirochete known as, Treponema pallidum. When the infection first appears, there is a small bump somewhere near where transmission occurred. These sores known as a Chancre, are usually in the genital area, anal area, or around the mouth. The chancre contains the bacteria and contact with the sore can spread the infection.
Syphilis can stay in the body for years without causing symptoms so early treatment is important. Latent syphilis in the late stages can cause issues in the brain, heart, and cause damage to many other organs. It can be fatal.
There are three stages to Syphilis:
Primary. This is when the chancre first appear. The incubation period for syphilis is around 10 to 90 days, but symptoms average about 21 days after infection. The sore/chancre is most often small, round, and isn’t painful. Wherever the chancre is found is the site of transmission. These sores last from 3 to 6 weeks and treatment needs to be started at this time to prevent transmission to others and progression of the disease.
Secondary. Between 6 weeks and 3 months after the chancre heals, the secondary stage of syphilis begins. A rash appears on the body, but does not itch. These are rough, red, and brown spots that most often occur on the soles of the feet and palms of the hands. If there is no treatment, the disease progresses to latent syphilis.
Latent/Tertiary. This stage appears after the one year mark and can persist up to 30 years or longer. There are usually no symptoms of syphilis, but you are still infected. This stage can cause damage to the organs and nervous system. There is even a possibility of death from latent/tertiary syphilis.

Syphilis Symptoms

The symptoms of syphilis usually follow the stage of the disease. They include:
Painless Sore/Chancre (Primary Stage)

Rash all over the body (Secondary Stage)

Muscle aches (Secondary Stage)

Fever (Secondary Stage)

Sore throat (Secondary Stage)

Lymph node swelling (Secondary Stage)

No symptoms (Latent Stage)

Memory loss (Tertiary Stage)

Trouble thinking (Tertiary Stage)

Anxiety (Tertiary Stage)

Heart conditions (Tertiary Stage)

Liver disease (Tertiary Stage)

Joint pain (Tertiary Stage)

Bone disease (Tertiary Stage)

Syphilis Risk Factors

Risk Factors for Syphilis
Syphilis is transmitted sexually. You cannot contract syphilis from the following; toilet seats, doorknobs or swimming pools. The following behaviors do raise your risk of infection:
Not using a condom during sex

Compromised immune system (HIV, AIDS, or other conditions that weaken immunity)

Gay men

Multiple sexual partners

Street drug use

Pregnant women with syphilis can spread the infection to their baby

Touching a chancre on someone’s skin

Diagnosing Syphilis

Any tests for syphilis need to look for the spirochete, treponema. They can also look for antibodies to the bacteria which build up over time. Testing can be on blood, spinal fluid, or the fluid from the chancre. They include:
VDRL – Venereal Disease Research Laboratory and RPR – Rapid Plasma Reagin. These are the first line of testing for sexually transmitted diseases, but will not tell you if you are infected with syphilis. They can also be positive due to other disease processes “false positive.” Your doctor will usually start with these tests and then move on to a more specific test.
Treponema Testing – FTA-ABS, TP-PA, and EIA. These tests detect the pregnant of antibodies to the syphilis bacteria. This test needs to be performed on every pregnant women during the prenatal screening tests and at the third trimester workup. These tests should also be done on newborns born to mothers that have positive test results for syphilis, even if the infection is not active.
Cultures. A sample of fluid from either the spinal fluid or an active chancre can reveal the bacteria. Syphilis is often diagnosed prior to needing this test, but can be helpful in later stages where there are neurological symptoms. In that case, a lumbar puncture may be performed and testing done on the spinal fluid.
The doctor will ask about sexual history and the history of partners if you know it. If you receive a positive diagnosis, you will have to give the names of all sexual partners since the infection started. This information legally must be reported.

Syphilis Treatment

The only way to clear a syphilis infection from the body is with penicillin. Currently, no home remedies or alternative medicine treatments have been proven to cure syphilis. If you catch syphilis early, you will only need one injection of Benzathine penicillin G given at a dose of 2.4 million units. This treatment works for syphilis in the primary stage, the secondary stage, or even latent syphilis. People who have late stage syphilis receive three doses given one dose per week for three weeks.
It is important to understand that if the infection goes untreated long enough to cause damage in the late stages, the three dose treatment will only cure the syphilis and not reverse any damage caused to the body by the infection.
There are not enough studies to show that other antibiotics or medications will treat syphilis. Some studies show that Tetracycline drugs may be effective. If another drug is used, it will be important to have your labs checked to make sure it is treating the infection effectively.
If you are diagnosed with syphilis, it is important to not have sex until you are finished with treatment. Using a condom is not helpful in the early stages, especially if the chancre is outside the reproductive organs. You will also need to notify any sexual partners that you came in contact with during the time period you believe you were infected. They will need evaluation and treatment for syphilis. In partners of those diagnosed, they usually give the penicillin injection whether they contracted the infection or not.
Treatment after Care
Follow-up with your doctor as they recommend for re-testing

Do not have sex until the infection has cleared from your body

Get tested for HIV and other STD’s

Report any unusual side-effects of medication to your doctor

Tell your doctor if you develop new sores or symptoms of syphilis

Complications of Treatment
Jarisch-Herxheimer Reaction. Spirochetes release toxins into the body when they die off during treatment. After the injection is given and treatment begins taking effect you may notice the symptoms of this including; headache, chills, fever, aches, and nausea. This goes away quickly, but let your doctor know if it happens.
Allergies to Penicillin. Since penicillin is the only recommended effective treatment for syphilis, doctors may opt to treat a penicillin allergy and give the medication anyways. You can either be “pre-medicated” with Benadryl before the injection or go through “desensitization.”
Re-infection. One important reason to notify your partner(s) and make sure they get treated is that syphilis does not confer immunity. You can get it over and over again. If you undergo treatment and sleep with a partner that is still infected, you can catch it again.

Lifestyle Changes and Syphilis Prevention

Syphilis Prevention & Lifestyle Changes
Practice abstinence or choose long-term partners that will be monogamous (one partner only)

Use a condom every time you have sex if you are not monogamous

Use a female diaphragm with a spermicide

Birth control i.e. hormones or sterilization, does not protect against STD’s

Get tested for STD’s on a regular basis if you are not in a long-term monogamous relationship. Encourage your partner to get tested.

Syphilis Complications

Chronic Sores. Over a long-term period of time, chronic sores can develop. These are known as, Gummata. They can form on the organs inside the body or on the skin.
Cardiovascular Syphilis. Syphilis can cause the aorta to become inflamed. A “gumma” (above) may also form on the heart muscle. Either of these can damage the heart and is often a cause of death in late syphilis.
Neurosyphilis. Late stage syphilis can invade the brain, spinal cord, and nervous system. It can cause numerous symptoms including; trouble walking, confusion, headache, dementia, numbness in the extremities, neck stiffness, and many other neurological symptoms.

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