Friday, October 31, 2014

Definition

This sexually transmitted disease (STD), which in its late stages can cause mental disorders, blindness, and death, is caused by a corkscrew-shaped bacterium called Treponema pallidum.

Description

Syphilis, which swept through Europe in a devastating epidemic during the late 15th century, is now readily treated with antibiotics.

Syphilis, which is known as the great imitator because it mimics so many other diseases, is making its strongest comeback in 40 years in the U.S.. The surging number of cases reflects social and economic factor s like changing sexual habits; drug abuse, particularly trading sex for crack; rising rates of pregnancy among teenagers who do not use contraceptives to protect against infection, and declining support for public health services, which has limited tracing some cases.

Health officials are also deeply concerned about the links between syphilis and AIDS. The open sores of syphilis are believed to make it easier for the AIDS virus to enter the body.

The infection is acquired by direct contact with the sores of someone who has an active infection. Although the bacterium is usually transmitted through the mucous membranes of the genital area, the mouth, or the anus, it also can pass through broken skin on other parts of the body.

A pregnant woman with syphilis can transmit the disease to her unborn child, who may be born with serious mental and physical problems. The syphilis bacterium is very fragile, however, and the infection is rarely, if ever, spread by contact with objects such as toilet seats or towels.

Because the early symptoms of syphilis can be very mild, many people do not seek treatment when they first become infected. However, untreated infected people can infect others during the first two stages of the disease, which can last for up to 2 years.

Causes

Unsafe sex is the primary causal factor in contracting primary syphilis.

Symptoms

The first symptom of primary syphilis is a usually painless open sore called a chancre (pronounced "shanker"). The chancre can appear within 10 days to 3 months (usually 2 to 6 weeks) after exposure.

Because the chancre is ordinarily painless and sometimes occurs inside the body, it may go unnoticed. It is usually found on the part of the body exposed to the bacteria, such as the penis, the vulva, or the vagina. A chancre also can develop on the cervix, tongue, lips, or fingertips. The chancre disappears within a few weeks, but the disease continues. If not treated during the primary stage, the disease may progress through three other stages.

Secondary syphilis is marked by a skin rash that appears anywhere from 2 to 12 weeks after the chancre disappears. The rash may cover the whole body or appear only in a few areas, such as the palms of the hands or soles of the feet. Because active bacteria are present in these sores, any physical contact - sexual or nonsexual - with the broken skin of an infected person may spread the infection at this stage.

The rash may be accompanied by flu-like symptoms such as mild fever, fatigue, headache, sore throat, as well as patchy hair loss, swollen lymph glands throughout the body, and other problems. The rash usually heals within several weeks or months, and the other symptoms subside as well.

The signs of secondary syphilis occasionally come and go over the next 1 to 2 years. Like the symptoms of the primary stage, those of secondary syphilis can be very mild and go unnoticed.

If untreated, syphilis then lapses into a latent stage during which the patient is no longer contagious.

Many people who are not treated will suffer no further consequences of the disease. However, from 15 to 40 percent of those infected go on to develop the complications of late, or tertiary, syphilis, in which the bacteria damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. This stage can last for years, or even for decades.

Late syphilis, the final stage, can lead to mental illness, blindness, heart disease, and death.

Diagnosis

Syphilis has sometimes been called "the great imitator" because its early symptoms are similar to those of many other diseases.

People who have more than one sex partner should consult a doctor about any suspicious rash or sore in the genital area. Those who have been treated for another STD such as gonorrhea should be tested to be sure they have not acquired syphilis.

There are at least three ways to diagnose syphilis: a doctor's recognition of its symptoms, microscopic identification of syphilis bacteria, and blood tests.

To diagnose syphilis by identifying the bacteria, the doctor takes a small amount of tissue from a chancre and has it examined under a special "darkfield" microscope.

Blood tests also provide evidence of infection, although they may give false negative results (not show signs of infection despite its presence) for up to 6 weeks after the infection occurred.

Interpretation of blood tests for syphilis can be difficult, and repeated examinations are sometimes necessary to confirm the diagnosis. In some patients with syphilis (especially in the latent or late stages), a lumbar puncture (spinal tap) must be done to check for infection of the nervous system.

The most common of the screening tests are the VDRL (Venereal Disease Research Laboratory) test and the rapid plasma reagin (RPR) test. More accurate blood tests specifically detect the patient's immune response to the syphilis bacterium. These tests include the fluorescent treponemal antibody-absorption (FTA-ABS) test that can accurately detect 70 to 90 percent of cases.

Your physician may also recommend HIV testing.

Treatment

Syphilis is treated with penicillin, administered by injection. Other antibiotics can be used for patients allergic to penicillin.

A small percentage of patients do not respond to the usual doses of penicillin. Therefore, it is important that patients have periodic repeat blood tests to make sure that the infectious agent has been completely destroyed and there is no further evidence of the disease.

In all stages of syphilis, proper treatment will cure the disease, but in late syphilis, damage already done to body organs cannot be reversed.

Questions

What tests need to be done to rule out other diseases?

Is it contagious?

Have any body organs been damaged? To what extent?

What type of medication will you be recommending? Are there any side effects?

How long will the medication be administered?

What is the prognosis?

Prevention

Patients with infectious syphilis should abstain from sexual activity until rendered noninfectious by antibiotic therapy.

Talk openly with your partner about STDs, HIV, and hepatitis B infection, and the use of contraception. All sexually active persons should consider using latex condoms to prevent STDs and HIV infection, even if they are using another form of contraception.

Latex condoms used consistently and correctly are an effective means for preventing disease (and pregnancy). Since latent condoms protect covered parts only, the exposed parts should be washed with soap and water as soon after contact as possible. This applies to men and women.