Syphilis



Syphilis (SIH-fih-lis) is a sexually transmitted disease that, if untreated, can lead to serious lifelong problems throughout the body, including blindness and paralysis'

KEYWORDS

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Chancre

Congenital Infections

Sexually transmitted disease (STD)

Treponema pallidum

What Is Syphilis?

Syphilis is a disease that is caused by the bacterium Treponema pallidum (treh-puh-NEE-muh PAL-ih-dum). The disease develops in three distinct phases. The first, or primary, stage is marked by a chancre * . In the secondary stage, a rash develops. By the third, or tertiary, stage the disease can cause widespread damage to the body, affecting the brain, nerves, bones, joints, eyes, and heart and other organs. Syphilis does not advance to this point in all infected people, and it does so only if it has not been treated adequately during either of the two earlier stages.

Without treatment, syphilis can be fatal. It also can have serious consequences for babies who become infected in the womb, before birth. If a pregnant woman has syphilis, she can pass it to her fetus * , a condition known as congenital * syphilis. Because the immune system of a baby is not developed fully until the infant is well into the first year of life, infection with syphilis bacteria can lead to severe complications. If pregnant women who are infected are not treated, more than a third of their infants may die before or shortly after birth.

* paralysis (pah-RAH-luh-sis) is the loss or impairment of the ability to move some part of the body.

* chancre (SHANG-ker) is a usually painless sore or ulcer that forms where a disease-causing germ enters the body, such as with syphilis.

* fetus (FEE-tus) is the term for an unborn human after it is an embryo, from 9 weeks after fertilization until childbirth.

* congenital (kon-JEH-nih-tul) means present at birth.

How Common Is Syphilis?

Before the introduction of the antibiotic penicillin in the 1940s, syphilis was rampant in the United States. Although the disease is still relatively common, the number of cases today is far below the high rate of infection early in the twentieth century. According to the U.S. Centers for Disease Control and Prevention (CDC), 31,575 cases (or about 12 per 100,000 people) were reported in 2000 (although the number of actual infections is likely higher, because many cases go unnoticed at first). Of those, 529 were cases of congenital syphilis. Compare that with 485,560 cases overall (or 368 per 100,000 people) in 1941, the first year that the government began tracking syphilis rates.

Is Syphilis Contagious?

Syphilis is a sexually transmitted disease that spreads from person to person through vaginal * , oral * , or anal * intercourse. A pregnant female also can pass the disease to her fetus. People are most contagious during the second stage of the infection.

* vaginal (VAH-jih-nul) refers to the vagina, the canal in a woman that leads from the uterus to the outside of the body.

* oral means by mouth or referring to the mouth.

* anal refers to the anus, the opening at the end of the digestive system through which waste leaves the body.

How Syphilis Changed the Face of
Medical Research

Just a few decades ago syphilis was the subject of the most infamous public health study ever carried out in the United States. From 1932 to 1972 the U.S. Public Health Service conducted a study in Macon County, Alabama, to learn more about the long-term consequences of the disease.

Six hundred poor African-American men, 399 infected with syphilis, participated in the study in exchange for free medical exams, free meals, and burial insurance.

The Tuskegee Syphilis Study became notorious because local doctors who participated in the study were instructed not to treat the men's infections, even after an easy cure with penicillin became widely available in 1947. Although the men had agreed to be part of the project, they were never told they would not be treated filly for their condition. They were simply told that they were part of a study of "bad blood," a local term used for several illnesses.

Public outrage erupted in 1972 when it became known that men with syphilis in the study had been allowed to remain untreated so that doctors could investigate the progression of the disease, and the project was stopped. But that came too late for the men; many were disabled permanently or had died. In the wake of the study, the government moved quickly to adopt policies that protect people who take part in research programs. In 1974, a new law created a national commission to set basic ethical standards for research. New rules also required that participants in government-funded studies be made fully aware of how a study will proceed and voluntarily agree to take part in it. Any study that involves humans also is reviewed before it begins to ensure that it meets ethical standards.

Of course, these changes could not reverse the physical and emotional harm done to the men in the Tuskegee Syphilis Study and to their families. In recognition of that harm, in 1997, President Bill Clinton offered an apology to the survivors, families, and descendants of those men on behalf of the U.S. government.

What Are the Signs and Symptoms of Infection?

Syphilis has been called "the great imitator," because its symptoms can resemble those of many other diseases. Not all people have obvious symptoms, but in those who do, signs of disease appear 10 to 90 days after being infected. The first symptom is a small, usually painless sore known as a chancre that appears where the syphilis bacterium entered the body, such as on the penis or the lips of the vagina * . Without treatment, chancres will heal on their own within 6 weeks. A person who is infected may never even notice a chancre, especially if it is inside the vagina or the rectum * .

When the chancre fades, the disease moves to its second stage 1 to 2 months later. In this phase, a rash of rough reddish or brownish spots appears on the body, including the soles of the feet and the palms of the hands. The rash may be so faint that it is barely noticeable. Second-stage symptoms of syphilis also may include fever, headache, extreme tiredness, sore throat, muscle aches, swollen lymph nodes * , weight loss, hair loss, and ulcers * on mucous membranes * in the mouth and on the genitals * . Wartlike lesions * may appear on the vagina or anus. This stage of the infection also disappears on its own, fooling many people into thinking that they have had a common viral illness.

After the second-stage symptoms clear up, the disease enters a latent, or hidden, period in which there are no signs of illness. The latent period can last for many years, and in some infected people the bacteria do no further damage. In about one-third of people who reach the latent period, the disease progresses to its final stage. This phase has no symptoms at first, but as the bacteria invade and damage nerves, bones, and the heart and other organs, the patient may experience dizziness, headaches, seizures * , dementia * , loss of coordination, numbness, increasing blindness, and paralysis. The disease also can eat away at tissue in the mouth and nose, disfiguring the face. This last stage of the disease can begin 2 to 40 years after a person is first infected.

Babies who are born with syphilis may have symptoms right away or may show signs of the disease within a few weeks or months. Those symptoms include failure to thrive * , irritability, fever, rash, a nose without a bridge (known as saddle nose), bloody fluid from the nose, and a rash on the palms, soles, or face. As these children grow older, they may become blind and deaf and have notched teeth (called Hutchinson teeth). Bone lesions may arise, and lesions and scarring may appear around the mouth, genitals, and anus.

How Is the Diagnosis of Syphilis Made?

If a patient has a chancre or other lesion, the doctor collects a sample of fluid from the sore to examine under a special microscope. Syphilis bacteria in the fluid are visible under magnification. The doctor also may take a blood sample to look for antibodies * to the bacterium. If neurosyphilis (nur-o-SIH-fih-lis, syphilis that has progressed to the point that it affects the brain, spinal cord, and nerves) is suspected, the spinal fluid also may be tested for antibodies. Pregnant women are screened for syphilis during routine prenatal care.

* vagina (vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.

* rectum is the final portion of the large intestine, connecting the colon to the anus.

* lymph (LIMF) nodes are small, bean-shaped masses of tissue that contain immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections,

* ulcers are open sores on the skin or the lining of a hollow body organ, such as the stomach or intestine. They may or may not be painful.

* mucous membranes are the moist linings of the mouth, nose, eyes, and throat,

* genitals (JEH-nih-tuls) are the external sexual organs.

* lesions (LEE-zhuns) is a general term referring to sores or damaged or irregular areas of tissue.

How Is Syphilis Treated?

Even though visible signs of the infection will clear up on their own, patients with syphilis are treated to prevent the disease from progressing to the late, potentially much more harmful stage, or to prevent a pregnant woman's infant from being damaged by the infection. Early-stage syphilis is treated easily with antibiotics. People who are infected with syphilis are advised to notify all their recent sexual partners so that they, too, can be tested for the disease. Patients with advanced cases of the disease often need to be hospitalized. They also receive antibiotics, although medications cannot reverse damage already done to the body.

How Long Does Infection Last?

A single dose of antibiotics can clear up syphilis infections that are less than a year old. Longer-term cases require longer courses of treatment. Congenital syphilis also needs a longer course of treatment. Without treatment, the disease can last for years or even decades.

Does the Disease Have Complications?

Untreated cases of syphilis can lead to destructive tissue lesions known as gummas on the skin, bones, and organs; seizures; damage to the spine that can result in paralysis; heart problems; damage to blood vessels that can lead to stroke * ; and death. According to the CDC, a person with syphilis has a two to five times greater risk of acquiring human immunodeficiency (ih-myoo-no-dih-FIH-shen-see) virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), an infection that weakens the immune system. The reason for this increased risk is that open sores make it easier for HIV to enter the body during sexual contact. Also, people infected with HIV are more likely to experience neurological * complications of syphilis. In infants, syphilis can lead to hearing loss, blindness, neurological problems, and death.

Can Syphilis Be Prevented?

Using latex condoms or not having sex, especially with someone who is known to be infected, can prevent the spread of syphilis and other sexually transmitted diseases. To be effective, the condom has to cover all syphilis sores. Contact with sores in the mouth or on areas such as the rectum that may not be covered by a condom can spread the disease. Doctors advise pregnant women to be tested and, if needed, treated for syphilis to minimize the risk of passing it to the developing fetus.

* seizures (SEE-zhurs) are sudden bursts of disorganized electrical activity that interrupt the normal functioning of the brain, often leading to uncontrolled movements in the body and sometimes a temporary change in consciousness.

* dementia (dih-MEN-sha) is a loss of mental abilities, including memory, understanding, and judgment.

* failure to thrive is a condition in which an infant fails to gain weight and grow at the expected rate.

* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.

* stroke is a brain-damaging event usually caused by interference with blood flow to the brain. A stroke may occur when a blood vessel supplying the brain becomes clogged or bursts, depriving brain tissue of oxygen. As a result, nerve cells in the affected area of the brain, and the specific body parts they control, do not properly function.

* neurological refers to the nervous system, which includes the brain, spinal cord, and the nerves that control the senses, movement, and organ functions throughout the body.

Resources

Organizations

American Social Health Association, P.O. Box 13827, Research Triangle Park, NC 27709. The American Social Health Association has information and fact sheets concerning sexually transmitted diseases, including syphilis, at its website.
Telephone 919-361-8400
http://www.ashastd.org

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC provides fact sheets and other information on syphilis at its website.
Telephone 800-311-3435
http://www.cdc.gov

Website

KidsHealth.org . KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children's health. It contains articles on a variety of health topics, including syphilis.
http://www.KidsHealth.org



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