Syphilis

Causes/associated factors
Syphilis is caused by a bacterium called Treponema pallidum. The disease can affect people of any age, but most cases occur from ages 20 to 39. Rates for syphilis are much higher in the southern region of the United States. The risk of contracting syphilis increases with the number of sexual partners you have.

Transmission
Syphilis enters the body through mucuos membranes or skin. It's nearly always spread through vaginal, oral or anal sex. If you have syphilis, you're most contagious during the first two stages of the disease. Early antibiotic treatment is often effective within 24 to 48 hours. If the disease progresses, you may need more extensive treatment.

Signs/symptoms
There are four stages of syphilis, each with its own symptoms. Symptoms may first appear during any of the four stages.
Stage 1: Primary syphilis
A typically painless ulcer, called a chancre, develops 10 days to three months after exposure. The chancre is typically found on the penis, vulva, vagina, tongue or lips. Sometimes it develops inside the body where it can't be seen, such as on the cervix or in the rectum. During this period, you may also notice swollen lymph nodes in the area near the ulcer.

You're contagious during this stage. Although the chancre will go away on its own within two to six weeks, the condition progresses to secondary syphilis for about one-third of infected people who don't seek treatment.

Stage 2: Secondary syphilis
A brown rash develops three to six weeks after the primary chancre appears. The rash may appear anywhere on the body, but it's most common on the palms of the hands and soles of the feet. Other symptoms during this stage include fever, headache, a general feeling of discomfort and enlarged lymph nodes.

You're still contagious during this stage. Although the symptoms of secondary syphilis often disappear without treatment within six weeks, the symptoms may come and go for years. Without treatment, the disease progresses even further for about one-third of infected people who don't seek treatment.

Stage 3: Latent syphilis
Once the secondary stage passes, you may enter the latent stage. There are no symptoms during this stage, and you're probably no longer contagious. Latent syphilis may last a lifetime. Eventually, about one-third of those with latent syphilis develop tertiary syphilis.

Stage 4: Tertiary syphilis
By this stage, the syphilis bacteria have spread throughout the body. Although you're no longer contagious, the bacteria may affect your bones, heart, brain, eyes, nervous system, joints or nearly any other part of the body. You may experience paralysis (the inability to move a part of the body), dementia or heart problems. Tertiary syphilis can be fatal.


Diagnosis
The doctor will ask questions about your medical and sexual history and do a physical exam.
In the early stage, the doctor may analyze tissue samples from the chancre. In all stages, a blood test is typically done. If the disease is in the late stage, you may need a lumbar puncture (placing a needle into the spinal canal to collect samples of spinal fluid) to detect the bacteria in your cerebral spinal fluid.

Because you can have more than one infection at the same time, the doctor may also screen you for other STDs and possibly HIV (the virus that causes AIDS).


Treatment
Penicillin is the medication of choice for all stages of syphilis. If you're allergic to penicillin, your doctor may recommend another antibiotic, or penicillin desensitization so that you can take penicillin. Follow-up blood tests may be done to make sure the treatment was effective. If you have latent or tertiary syphilis, you may need to receive the antibiotic for an extended period of time.
Penicillin is the only medication documented as effective for people who have neurosyphilis (syphilis affecting the nervous system). In this case, you'll need desensitization to penicillin if you're allergic to it so that you can be effectively treated.

Although a syphilis infection can usually be treated successfully at any point, the organ damage resulting from untreated syphilis can't be repaired. If you're diagnosed with syphilis, you must notify your sexual partners so they can be tested and treated. It's essential to comply with your doctor's recommendations for follow-up once you've been treated for syphilis.


Complications
If left untreated, the bacterium that causes syphilis may move throughout your body and damage various organs. Serious mental, visual or heart problems are possible. Also, open chancre sores create easy places for HIV to enter your body, significantly increasing the risk of being infected with HIV. In some cases, untreated syphilis is fatal.

Pregnancy-specific information
Syphilis carries a special risk for women. You can spread the disease to an unborn child during any stage of syphilis through the placenta (a structure in the womb that develops during pregnancy to nourish the baby and help him or her discard waste).
All pregnant women should be tested for syphilis early in pregnancy. If you develop symptoms, it's important to seek treatment right away. Penicillin is the only medication documented as effective for pregnant women. Under these circumstances, you'll need desensitization to penicillin if you're allergic to it so that you can be effectively treated.

Untreated syphilis can cause premature delivery, stillbirth or neonatal death (death that occurs within the first six weeks after birth). Children born with syphilis may develop highly contagious skin sores, swollen liver and spleen, jaundice (yellowing of the skin or whites of the eyes) and anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron).


Senior-specific information
Growing older is not a risk factor for syphilis.

Prevention
Abstinence is the most effective way to prevent syphilis. If you're sexually active, mutual mutual monogamy with an uninfected partner will reduce your risk of contracting syphilis and other sexually transmitted diseases.
If you're not in a mutually monogamous relationship, reduce the risk of contracting syphilis and other STDs by:

limiting your number of sexual partners
making sure each sexual partner is tested for STDs and completes proper treatment, if necessary, before you have sexual contact
using a latex or polyurethane condom consistently during any vaginal, oral or anal sexual contact
Keep in mind that a condom doesnrts that may be affected. Female condoms may offer more protection because they cover more surface area. If you choose latex condoms -- the most effective in preventing the spread of STDs -- use only water-based lubricants. The chemicals in other lubricants may break down the latex in the condom.

Syphilis cases must be reported to the health department, but confidentiality will be maintained. If you have symptoms of syphilis, especially if you're pregnant, consult your doctor right away. If you or your partner(s) are infected, avoid sexual contact until your doctor confirms that treatment was successful.