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Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.
It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.
• over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis
• In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of age
• P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age
• Reported cases of congenital syphilis in newborns increased from 2005 to 2006, with 339 new cases reported in 2005 compared to 349 cases in 2006
• Between 2005 and 2006, the number of reported P&S syphilis cases increased 11.8 percent
• P&S rates have increased in males each year between 2000 and 2006 from 2.6 to 5.7 and among females between 2004 and 2006
• In 2006, 64% of the reported P&S syphilis cases were among men who have sex with men (MSM).
• Direct contact with a syphilis sore- mainly on the external genitals, vagina,anus, or in the rectum
• Sores also can occur on the lips and in the mouth
• Transmission of the organism occurs during vaginal, anal, or oral sex
• Pregnant women with the disease can pass it to the babies they are carrying
• Syphilis cannot be spread through contact with toilet seats, doorknobs,swimming pools, hot tubs, bathtubs, shared clothing, or eating
utensils.
Many people infected with syphilis do not have any symptoms for years, yet
remain at risk for late complications if they are not treated. Although
transmission appears to occur from persons with sores who are in the primary or
secondary stage, many of these sores are unrecognized.
Thus, transmission may occur from persons who are unaware of
their infection.
Primary Stage
• the appearance of a single sore (called a chancre), but there may be multiple
sores. The time between infection with syphilis and the start of the first
symptom can range from 10 to 90 days (average 21 days)
• The chancre is usually firm, round, small, and painless
• It appears at the spot where syphilis entered the body
• lasts 3 to 6 weeks, and it heals without treatment. However, if adequate
treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage
• Skin rash and mucous membrane lesions characterize the secondary stage. This
stage typically starts with the development of a rash on one or more areas of
the body. The rash usually does not cause itching. Rashes associated with
secondary syphilis can appear as the chancre is healing or several weeks after
the chancre has healed
• The characteristic rash of secondary syphilis may appear as rough, red, or
reddish brown spots both on the palms of the hands and the bottoms of the feet.
However, rashes with a different appearance may occur on other parts of the
body, sometimes resembling rashes caused by other diseases
• Sometimes rashes associated with secondary syphilis are so faint that they are
not noticed
• fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight
loss, muscle aches, and fatigue
• The signs and symptoms of secondary syphilis will resolve with or without
treatment, but without treatment, the infection will progress to the latent and
possibly late stages of disease.
Late and Latent Stages
• The latent (hidden) stage of syphilis begins when primary and secondary
symptoms disappear.
• The infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body
• This latent stage can last for years
• The late stages of syphilis can develop in about 15% of people who have not
been treated for syphilis, and can appear 10 – 20 years after infection was
first acquired
• The disease may subsequently damage the internal organs, including the
brain, nerves, eyes, heart, blood vessels, liver, bones, and joints
• Signs and symptoms of the late stage of syphilis include difficulty
coordinating muscle movements, paralysis, numbness, gradual blindness, and
dementia.
• May be serious enough to cause death.
The syphilis bacterium can infect the baby of a woman during her pregnancy.
Depending on how long a pregnant woman has been infected, she may have a high
risk of having a stillbirth (a baby born dead) or of giving birth to a baby who
dies shortly after birth. An infected baby may be born without signs or
symptoms of disease. However, if not treated immediately, the baby may develop
serious problems within a few weeks. Untreated babies may become
developmentally delayed, have seizures, or die.
Some health care providers can diagnose syphilis by examining material from a
chancre (infectious sore) using a special microscope called a dark-field
microscope. If syphilis bacteria are present in the sore, they will show up
when observed through the microscope.
A blood test is another way to determine whether someone has syphilis. Shortly
after infection occurs, the body produces syphilis antibodies that can be
detected by an accurate, safe, and inexpensive blood test. A low level of
antibodies will stay in the blood for months or years even after the disease
has been successfully treated. Because untreated syphilis in a pregnant woman
can infect and possibly kill her developing baby, every pregnant woman should
have a blood test for syphilis.
Genital sores (chancres) caused by syphilis make it easier to transmit and
acquire HIV infection sexually. There is an estimated 2- to 5-fold increased
risk of acquiring HIV if exposed to that infection when syphilis is
present.
Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous
membranes, such as syphilis, disrupt barriers that provide protection against
infections. The genital ulcers caused by syphilis can bleed easily, and when
they come into contact with oral and rectal mucosa during sex, increase the
infectiousness of and susceptibility to HIV. Having other STDs is also an
important predictor for becoming HIV infected because STDs are a marker for
behaviors associated with HIV transmission.
• Syphilis is easy to cure in its early stages. A single intramuscular injection
of penicillin, an antibiotic, will cure a person who has had syphilis for less
than a year
• Additional doses are needed to treat someone who has had syphilis for
longer than a year
• For people who are allergic to penicillin, other antibiotics are available to
treat syphilis
• There are no home remedies or over-the-counter drugs that will cure
syphilis. Treatment will kill the syphilis bacterium and prevent further
damage, but it will not repair damage already done.
Because effective treatment is available, it is important that persons be
screened for syphilis on an on-going basis if their sexual behaviors put them
at risk for STDs. Persons who receive syphilis treatment must abstain from
sexual contact with new partners until the syphilis sores are completely
healed. Persons with syphilis must notify their sex partners so that they also
can be tested and receive treatment if necessary.
Having syphilis once does not protect a person from getting it again. Following
successful treatment, people can still be susceptible to re-infection. Only
laboratory tests can confirm whether someone has syphilis. Because syphilis
sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that
a sex partner has syphilis. Talking with a health care provider will help to
determine the need to be re-tested for syphilis after being treated.
The surest way to avoid transmission of sexually transmitted diseases, including
syphilis, is to abstain from sexual contact or to be in a long-term mutually
monogamous relationship with a partner who has been tested and is known to be
uninfected.
Avoiding alcohol and drug use may also help prevent transmission of syphilis
because these activities may lead to risky sexual behavior. It is important
that sex partner(s) talk to each other about their HIV status and history of
other STDs so that preventive action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male and female genital
areas that are covered or protected by a latex condom, as well as in areas that
are not covered. Correct and consistent use of latex condoms can reduce the
risk of syphilis, as well as genital herpes and chancroid, only when the
infected area or site of potential exposure is protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are
no more effective than other lubricated condoms in protecting against the
transmission of STDs. Use of condoms lubricated with N-9 is not recommended for
STD/HIV prevention. Transmission of an STD, including syphilis cannot be
prevented by washing the genitals, urinating, and/or douching after sex. Any
unusual discharge, sore, or rash, particularly in the groin area, should be a
signal to refrain from having sex and to see a doctor immediately.
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