Medical information – Syphilis

What is Syphilis?

Syphilis or lues is a sexually transmitted disease caused by the bacterium Treponema pallidum. Infection with T. pallidum often occurs through mucous membranes or skin epithelium during both genital and oral sexual contact. Via the lymph vessels the bacteria is led to the lymph nodes and will eventually also spread via the blood to different organs. Syphilis has a highly variable clinical course, which can lead to the symptoms of syphilis not being recognized or late.

How common is Syphilis?

The number of diagnoses of syphilis has risen substantially in the past decade in the UK. There have been several local outbreaks across England, the largest of which was in London between 2001 and 2004. Rates are highest among men who have sex with men. However, syphilis is still one of the less common sexually transmitted infections in the UK. Between 2009 and 2010, there were 2,624 cases of syphilis diagnosed in the UK.

The effect of Syphilis in the body

Syphilis has several stages which can be distinguished on the basis of the clinical picture and are dependent on the duration of the infection. The stages are: primary syphilis, secondary syphilis, latent syphilis and tertiary syphilis. During the first three stages (primary syphilis, secondary syphilis and syphilis latens recens) the disease is contagious and is called infectious syphilis. Tertiary syphilis is not infectious.

How should we imagine that?

Primary syphilis Primary syphilis (also referred to as lues I) has an incubation period ranging from ten to ninety days, with an average of three weeks. Typical of primary syphilis is the development of a sore (ulcer) at the site of infection (usually around the penis or vagina, but sometimes also in the anus or in the mouth). The ulcer often heals spontaneously within three to six weeks. Secondary syphilis After three to six weeks after the onset of the primary ulcer, in 60%-90% of untreated patients develops the clinical picture of secondary syphilis (also called lues II). This involves a diffuse rash, which is accompanied by loss of appetite, nausea, headache, insomnia, fever, muscle and joint pains, and lymph node swelling. Usually, spontaneous recovery occurs. However, In this early phase of the infection (infection less than a year ago), problems may occur. Latent syphilis After secondary syphilis there occurs an asymptomatic period. If the infection is less than a year ago, is usually spoken of lues latens recens. Lues latens recens is contagious and is among the infectious syphilis (along with primary and secondary syphilis). Dates the infection of more than a year ago, or is of unknown duration, it is referred to, respectively, syphilis latens tarda or syphilis latens. This form of syphilis is not contagious. Sometimes at this stage there are occasionally returning ulcers. Tertiary syphilis About one-third of untreated patients in the latent phase gets tertiary syphilis, and two-thirds remain latent for life. Late latent syphilis is not infectious. Two to four years after infection tertiary organsyphilis may occur, where ultimately internal organs such as the heart and blood vessels or the nervous system are affected. At this stage, neurosyphilis may also occur. This form of syphilis may be accompanied by headache, confusion, personality change, loss of cranial nerves and dementia.

What can you do with a Syphilis-infection?

It is important that you take actions to avoid infecting others. Discuss with your primary doctor or health care provider how you can keep the risk of infection of other people in your area as small as possible. Discuss with them too when you have people with whom you have sex, or had in the past, should warn.

Can a Syphilis-infection be prevented?

Education and personal hygiene are the cornerstones here. Contact with lesions or infected material should be avoided. Condom use during sexual contact (including oral sex) is very effective. For all the STDs applies that early detection and treatment (if possible), coupled with proper education about safe sex, especially for specific target groups (the so-called high-risk networks), is the most preferred strategy for prevention. In the UK the further policy is screening all pregnant women for syphilis and testing all blood donors.

The causative agent of Syphilis

The causative agent of syphilis is Treponema pallidum subspecies pallidum, a spiral-shaped bacterium belonging to the family of Spirichaetaceae. In humans, four pathogenic and six non-pathogenic Treponema are known. T. pallidum ssp. pallidum is a strictly anaerobic growing, obligate human pathogen and varies in diameter from 0.10 to 0.18 µm and from 6 to 20 µm in length, stained too weak for a light microscope, but visible by dark field microscopy as a spiral-shaped bacterium with a corkscrew-like motion. T. pallidum ssp. pallidum has 9-24 windings and six flagella. The bacteria grow relatively slow (division time every 30-33 hours).

Vaccination or medication?

A vaccine against syphilis is not available. Recommended treatment for syphilis is penicillin G (benzylpenicillin), depending on the stage.

You have tested positive. And now?

If you have tested positive for antibodies against the Syphilis causing Treponema pallidum bacteria you should report directly to your doctor or a medical specialist to carry out a blood test.

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