Syphilis

The Syphilis is a widespread chronic infection caused by Treponema pallidum which is usually sexually transmitted and to the alternating episodes of activity, interrupted by episodes of latency.

Why is it produced?

After an incubation period of three weeks on average, a primary lesion appears, frequently accompanied by regional lymphadenopathy (close to the primary lesion).

Subsequently, a phase of secondary bacteremia (bacteria in the blood) accompanied by mucocutaneous lesions and generalized lymphadenopathy, which is followed by a latent period of subclinical infection lasting many years.

In approximately one third of untreated cases, there is a third phase characterized by progressive and destructive mucocutaneous, musculoskeletal or parenchymal lesions, aortitis, or manifestations of the central nervous system .

Almost all cases of syphilis are acquired through unprotected sexual contact with infected lesions (the mucocutaneous lesions). Other less frequent forms of transmission are non-sexual personal contact, infection acquired in utero from mother to child (congenital syphilis) or through blood transfusions.

Symptoms of syphilis

Primary syphilis

The typical lesion of primary syphilis is located on the skin and is called a chancre. The primary chancre begins as a single painless papule that soon erodes and often, but not always, indurates, acquiring a cartilaginous consistency on palpation.

In heterosexual men, the chancre is usually located on the penis, while in homosexual men it is common to find it in the anal canal or rectum, in the mouth, or on the external genitalia.

In women, the most frequent sites are the cervix and vulvar lips. Because of this, primary syphilis can go unnoticed, especially in homosexual men and women.

Other atypical lesions ranging from a small papule to an eroded ulcer are common, depending on the amount of treponemes that are inoculated and the individual’s immune system.

Regional lymphadenopathy usually accompanies the primary syphilitic lesion, appearing during the first week after the lesion begins. Depending on the location of the chancre, lymphadenopathy appears in the groin (in both), in the iliac or perirectal region.

In general, the chancre heals in four to six weeks (limit of two to twelve) while the lymphadenopathy can persist for months.

Secondary syphilis

Varied injuries occur. A skin rash can appear, of many possible types, distributed throughout the body, including soles, palms, face and scalp. These lesions can affect the hair follicles (where the hair is born) and cause alopecia and hair loss on the head, eyebrows and beard. In the folds and humid and hot areas, the papules grow and form large, moist, pink or grayish-white lesions, very contagious called condylomata planes. Lesions on the mucosa are known as mucous plaques and are generally not painful.

General symptoms may be pharyngeal pain, fever , weight loss, malaise, anorexia, headache, and meningitis . Other less frequent complications are hepatitis , glomerulonephritis (kidney disease), gastritis and other inflammations of the digestive tract, joint and eye involvement.

Late syphilis

Meningeal involvement can occur with headache, nausea, vomiting, neck stiffness, cranial nerve palsy (nerves responsible mainly for the face), seizures, and changes in mental status. The so-called general paralysis is characterized by alterations in personality, eye reflexes, hallucinations, memory loss, disorientation, and language disturbances.

Another characteristic syndrome is tabes dorsalis that includes gait disturbances, sensitivity (mainly pain and temperature), impotence, and urinary bladder disturbances. Vascular manifestations are limited to the great vessels. Symptoms appear 10 to 40 years after infection. Cardiovascular complications are more common and appear earlier in men than in women, and may be more common in blacks than whites.

Eye lesions can be iritis, accompanied by pain, photophobia and decreased vision, chorioretinitis or pupillary alterations.
Benign late syphilis is defined by lesions called gums. Gums are painful, sometimes ulcerated, inflammatory lesions that appear mainly on the skin, musculoskeletal system, roof, upper respiratory tract, larynx, liver and stomach, although they can appear in any organ.

Congenital syphilis

Transmission of treponema from mother to child can occur at any time during pregnancy, but congenital syphilis lesions generally appear after the fourth month of gestation.

How is it diagnosed?

It is necessary in addition to clinical suspicion, the determination of Treponema pallidum in infected tissues, in the blood, or the determination of antibodies created against said microorganism by the infected individual. For this, techniques such as dark field examination, indirect immunofluorescence and specific serological tests are used.

Syphilis treatment

Benzylpenicillin is the treatment of choice in all stages of syphilis. In each of them, and according to the symptoms, the dose and duration of treatment should be adjusted. In cases of allergy to penicillins, tetracyclines are usually used.

Shortly after treatment the so-called Jarisch-Herxheimer reaction may begin, consisting of fever, chills, myalgia, headache, tachycardia, tachypnea, and hypotension. The possible appearance of this reaction should be noted that is treated with bed rest and aspirin.

Avoiding syphilis

The prevention of syphilis depends on the use of condoms in risky sex, in the control of blood transfusions and in the detection and treatment of infected cases.