What is
syphilis?
Syphilis is a
complex 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.
How is
syphilis spread?
Syphilis is
passed from person to person through direct contact with a syphilis sore. Sores
occur 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 by toilet
seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or
eating utensils.
What are the
signs and symptoms in adults?
Primary
Stage
The time between infection with syphilis and the start of the first symptom
can range from 10-90 days (average 21 days). The primary stage of syphilis is
usually marked by the appearance of a single sore (called a chancre), but
there may be multiple sores. The chancre is usually firm, round, small, and
painless. It appears at the spot where syphilis entered the body. The chancre
lasts 3-6 weeks, and it will heal on its own. If adequate treatment is not
administered, the infection progresses to the secondary stage.
Secondary
Stage
The second stage starts when one or more areas of the skin break into a rash
that usually does not itch. Rashes can appear as the chancre is fading or can
be delayed for weeks. The rash often appears as rough, red or reddish brown
spots both on the palms of the hands and on the bottoms of the feet. The rash
also may also appear on other parts of the body with different
characteristics, some of which resemble other diseases. Sometimes the rashes
are so faint that they are not noticed. Even without treatment, rashes clear
up on their own. In addition to rashes, second-stage symptoms can include
fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight
loss, muscle aches, and tiredness. A person can easily pass the disease to sex
partners when primary or secondary stage signs or symptoms are present.
Late
Syphilis
The latent (hidden) stage of syphilis begins when the secondary symptoms
disappear. Without treatment, the infected person still has syphilis even
though there are no signs or symptoms. It remains in the body, and it may
begin to damage the internal organs, including the brain, nerves, eyes, heart,
blood vessels, liver, bones, and joints. This internal damage may show up many
years later in the late or tertiary stage of syphilis. Late stage signs and
symptoms include not being able to coordinate muscle movements, paralysis,
numbness, gradual blindness and dementia. This damage may be serious enough to
cause death.
Can a newborn
get syphilis?
Depending on how
long a pregnant woman has been infected, she has a good chance of having a
stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly
after birth. If not treated immediately, an infected baby may be born without
symptoms but could develop them within a few weeks. These signs and symptoms can
be very serious. Untreated babies may become developmentally delayed, have
seizures, or die.
How is
syphilis diagnosed?
A health care
provider can diagnose syphilis by using dark field microscopy to examine
material from infectious sores. If syphilis bacteria are present in the sore,
they will show up with a characteristic appearance.
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.
How common is
syphilis?
In the United
States, over 35,600 cases of syphilis were reported by health officials in 1999,
including 6,650 cases of primary and secondary syphilis (a decline of 5.4% from
1998) and 556 cases of congenital syphilis in newborns. More cases occur each
year than come to the attention of health officials. Of the nine states with the
highest 1999 syphilis rates (2-5 times higher than the national rate of 2.5
cases per 100,000), eight were in the South. Although syphilis rates remain
higher in the South than in other regions, the South had a 32% decline in the
primary and secondary syphilis rate from 1997 to 1999, illustrating that the
greatest improvements in disease control have taken place where syphilis
incidence has been the greatest. In 1999, 25 counties accounted for 50% of all
primary and secondary syphilis cases. Two hundred sixty-five counties had
syphilis rates above the U.S. Public Health Service's Healthy People 2000
objective of 4 cases per 100,000. These 265 counties (9% of the total number of
counties in the U.S.) accounted for approximately 74% of the total primary and
secondary syphilis cases reported in 1999.
In 1999,
syphilis occurred primarily in persons aged 20 to 39, and the reported rate in
men was 1.5 times greater than the rate in women. The incidence of syphilis was
highest in women aged 20 to 29 years and in men 30 to 39. Some fundamental
societal problems, such as poverty, inadequate access to health care, and lack
of education are associated with disproportionately high levels of syphilis in
certain populations. Cases of primary and secondary syphilis in 1999 had the
following race or ethnicity distribution: African Americans 75%, whites 16%,
Hispanics 8%, and others 1%. Syphilis reflects one of the most glaring examples
of racial disparity in health status, with the rate for African Americans nearly
30 times the rate for whites.
What is the
link between syphilis and HIV?
While the health
problems caused by syphilis in adults and newborns are serious in their own
right, it is now known that the genital sores caused by syphilis in adults also
make it easier to transmit and acquire HIV infection sexually. There is a 2- to
5-fold increased risk of acquiring HIV infection when syphilis is present.
Is there a
cure for syphilis?
Yes! A single
dose of penicillin, an antibiotic, will cure a person who has had syphilis for
less than a year. Larger doses are needed to cure someone who has had it 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. Penicillin treatment will kill the syphilis
bacterium and prevent further damage, but it will not repair any damage already
done. 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, if
necessary, receive treatment.
Will syphilis
recur?
Having had
syphilis does not protect a person from getting it again. Antibodies are
produced as a person reacts to the disease, and, after treatment, these
antibodies may offer partial protection from getting infected again, if exposed
right away. Even though there may be a short period of protection, the antibody
levels naturally decrease in the blood, and people become susceptible to
syphilis infection again if they are sexually exposed to syphilis sores.
How can
people protect themselves against infection?
Two people who
know that they are not infected and who have sex only with each other cannot
contract syphilis. When someone's syphilis status is unknown, a good defense
against becoming infected during sex is to use a latex condom before beginning
sex and to keep it on until the penis is withdrawn. However, condoms do not
provide complete protection because syphilis sores can sometimes be on areas not
covered by a condom. This is equally important for other STDs, including HIV, as
well. Only lab 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. Washing the genitals, urinating, or douching after
sex does not prevent STDs, including syphilis. Any unusual discharge,
sore, or rash, especially in the groin area, should be a signal to stop having
sex and to see a doctor at once.
HOW IS SYHILIS DIAGNOSED?
Syphilis is sometimes called "the great imitator" because its early
symptoms are similar to those of many other diseases. Sexually active people
should consult a doctor or other health care worker about any 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 do not also have syphilis.
There are three ways to diagnose syphilis.
- Recognizing the signs and symptoms
- Examining blood samples
- Identifying syphilis bacteria under a microscope
The doctor usually uses all these approaches to diagnose syphilis and decide
upon the stage of infection.
Blood tests also provide evidence of infection, although they may give
false-negative results (not show signs of an infection despite its presence) for
up to 3 months after infection. False-positive tests (showing signs of an
infection when it is not present) also can occur. Therefore, two blood tests are
usually used. Interpretation of blood tests for syphilis can be difficult, and
repeated tests are sometimes necessary to confirm the diagnosis.
HOW IS SYPHILIS TREATED?
Unfortunately, the early symptoms of syphilis can be very mild, and many
people do not seek treatment when they first become infected.
Doctors usually treat patients with syphilis with penicillin, given by
injection. They use other antibiotics for patients allergic to penicillin. A
person usually can no longer transmit syphilis 24 hours after starting
treatment. Some people, however, do not respond to the usual doses of
penicillin. Therefore, it is important that people being treated for syphilis
have periodic blood tests to check that the infectious agent has been completely
destroyed.
People with neurosyphilis may need to be retested for up to 2 years after
treatment. In all stages of syphilis, proper treatment will cure the disease.
But in late syphilis, damage already done to body organs cannot be reversed.
WHAT ARE THE EFFECTS OF SYPHILIS IN PREGNANT WOMEN?
A pregnant woman with untreated, active syphilis is likely to pass the
infection to her unborn child. In addition, miscarriage may occur in as many as
25 to 50 percent of women acutely infected with syphilis during pregnancy.
Between 40 to 70 percent of women with active syphilis will give birth to a
syphilis-infected infant.
Some infants with congenital syphilis may have symptoms at birth, but most
develop symptoms between 2 weeks and 3 months later. These symptoms may include
- Skin ulcers
- Rashes
- Fever
- Weakened or hoarse crying sounds
- Swollen liver and spleen
- Yellowish skin (jaundice)
- Anemia (low red blood cell count)
- Various deformities
People who care for infants with congenital syphilis must use special
cautions because the moist sores are infectious.
Rarely, the symptoms of syphilis go undetected in infants. As infected
infants become older children and teenagers, they may develop the symptoms of
late-stage syphilis, including damage to their bones, teeth, eyes, ears, and
brains.
CAN SYPHILIS CAUSE OTHER COMPLICATIONS?
Syphilis bacteria frequently invade the nervous system during the early
stages of infection. Approximately 3 to 7 percent of persons with untreated
syphilis develop neurosyphilis, a sometimes serious disorder of the nervous
system. In some instances, the time from infection to developing neurosyphilis
may be up to 20 years.
Some people with neurosyphilis never develop any symptoms. Others may have
headache, stiff neck, and fever that result from an inflammation of the lining
of the brain. Some people develop seizures. People whose blood vessels are
affected may develop symptoms of stroke with numbness, weakness, or visual
problems. Neurosyphilis may be more difficult to treat, and its course may be
different, in people with HIV infection or AIDS.
HOW CAN SYPHILIS BE PREVENTED?
The open sores of syphilis may be visible and infectious during the active
stages of infection. Any contact with these infectious sores and other infected
tissues and body fluids must be avoided to prevent spread of the disease. As
with many other STDs, using latex male condoms properly during sexual
intercourse may give some protection from the disease.
Screening and treatment of infected individuals, or secondary prevention, is
one of the few options for preventing the advanced stages of the disease.
Testing and treatment early in pregnancy are the best ways to prevent syphilis
in infants and should be a routine part of prenatal care.
WHAT RESEARCH IS GOING ON?
Developing better ways to diagnose and treat syphilis is an important
research goal of scientists supported by the National Institute of Allergy and
Infectious Diseases (NIAID). New tests are being developed that may provide
better ways to diagnose syphilis and define the stage of infection.
In an effort to stem the spread of syphilis, scientists are conducting
research on the development of a vaccine. Molecular biologists are learning more
about the various surface components of the syphilis bacterium that stimulate
the immune system to respond to the invading organism. This knowledge will pave
the way for development of an effective vaccine that can ultimately prevent this
STD.
A high priority for researchers is developing a diagnostic test that does not
require a blood sample. Saliva and urine are being evaluated to see whether they
would work as well as blood. Researchers also are trying to develop other
diagnostic tests for detecting infection in babies.
Another high research priority is the development of a safe, effective
single-dose oral antibiotic therapy for syphilis. Many patients do not like
getting an injection for treatment, and about 10 percent of the general
population is allergic to penicillin.
The genome of the bacterium that causes syphilis has been sequenced through
NIAID-funded research. The DNA sequence represents an encyclopedia of
information about the bacterium. Clues as to how to diagnose, treat, and
vaccinate against syphilis have been identified and are fueling intensive
research efforts on this ancient but intractable disease.
