Syphilis is one of the gravest and most subtle sexual transmitted diseases. Many patients manifest no symptoms and if there is no timely diagnosis and proper treatment the disease becomes chronic and systematic, manifesting itself in diverse ways, afflicting the skin, mucous membranes, the intestine as well as the circulatory and the nervous systems. The patients who manifest no symptoms are by no means considered as no carriers of the disease.
Syphilis is caused by an exceptionally infectious bacterium called spirochete pallidum which appears in the ancient times in Greece, Rome and China and is referred to as “venereal plague”. Indirect infection is uncommon since the bacterium is destroyed in environmental conditions. It is sensitive to medium heat, cold, dryness, disinfectants and antibiotics. The disorders stemming from syphilis are almost solely attributed to the inflammatory immune reaction of the body. The disease is transmitted:
a) During intercourse through secretions and erosions and is favored by heat and humidity of the genitals and the mouth. There is a 33% chance of infection after an intercourse with a bearer.
b) After contact with the blood of a bearer.
c) Through blood transfusion.
d) During pregnancy if the mother is ill while the embryo may be infected via the placenta or during childbirth.
One third of the individuals who come in contact with the bacterium will develop the disease.
Within 20 days of the infection syphilic ulcer will appear mainly on the genitals, the tongue, the lips, the tonsils, the fingertips but also on other parts where an abrasion may aid the entrance of the bacterium. The disease appears mainly in men aged 20 to 40 and consists of three stages.
Stage one (primary syphilis) the ulcer appears within 2 to 3 weeks after infection. Even without treatment 75% will heal spontaneously and the patient will not realize it particularly when the ulcers are internal (vaginal- anal).
Stage two. 35% of those who did not receive treatment for stage one will pass on to stage two within six weeks. The patient manifests symptoms resembling common flu (fever, fatigue, rash, muscle and joint aches, loss of appetite) as well as other symptoms including enlarged lymph nodes and enlarged liver and spleen. The ulcers may persist for months and spread bearing further skin damages but a complete absence cannot be excluded.
The patient develops rashes in the palms and soles of feet, torso, as well as loss of hair of the scull and beard.
The symptoms of the second stage if not treated will subside and remain latent for a period up to four years. It usually concerns patients (about 25%) who received no treatment during the second stage of the disease.
The patient may not manifest symptoms but he remains a bearer. He ceases to be a bearer within 1-2 years since the commencing of the disease. One third will enter the third stage syphilis which comprises the final stage of the disease.
Stage three. The disease may infect the cardiovascular system, the central nervous system and may lead to the development of gummas on various organs of the body.
a) Gummatous/ benign (16%) within 1 to 46 years
b) Cardiovascular (10%) within 20 to 30 years
c) Neurosyphilis (7%) within 3 to 50 years following infection
Treatment
Apart from clinical manifestations which may not be clear, diagnosis may be carried out through blood tests (VDRL, RPR and FTA-ABS) which trace substances released by the syphilis bacterium. The treatment is based on antibiotics and varies according to stage.
The patient must also be submitted to serological tests during the third, sixth, twelfth and twenty-fourth months after the diagnosis of the illness to check on the resolution of the infection. Sexual intercourse must be avoided until two consecutive serological tests prove that the infection has been cured.
