Health Encyclopedia

Syphilis - primary

Definition

Syphilis is a frequently diagnosed and reported sexually transmitted disease.

Alternative Names

Primary syphilis

Causes, incidence, and risk factors

Syphilis is an infectious disease caused by the corkscrew-shaped bacterium (spirochete), Treponema pallidum. This type of bacteria causes infection when it gets into broken skin or mucus membranes, usually of the genitals. It is most often transmitted through sexual contact, although other means of transmission are possible.

Syphilis occurs worldwide. The rate of syphilis is higher in urban, rather than rural, areas, and the number of cases is rising most rapidly in men who have sex with men. Young adults, ages 15-25, are the highest-risk population. People have no natural resistance to syphilis.

Because people may be unaware that they are infected with syphilis, many states require tests for syphilis before marriage. All pregnant women who receive prenatal care are screened for syphilis to prevent the syphilis infection from passing from the mother to the newborn (congenital syphilis).

Syphilis has three stages:

Secondary syphilis, tertiary syphilis, and congenital syphilis are not seen as often in the United States as they were 20 or 30 years ago because of the availability of free, government-run sexually transmitted disease clinics, screening tests for syphilis, public education about STDs, and prenatal screening.

Symptoms

Primary syphilis symptoms include:

Small, painless open sore or ulcer (called a chancre) on the genitals, mouth, skin, or rectum that should heal by itself in 3-6 weeks
Enlarged lymph nodes in the area containing the chancre

The bacteria continues to multiply in the body, but there is little outward evidence of disease until the appearance of the second stage.

Signs and tests

Dark field examination of fluid from sore
FTA-ABS fluorescent treponemal antibody test
RPR
STS (serologic test for syphilis -- any of the other tests may be used)
VDRL

Treatment

Syphilis can be treated with antibiotics, such as penicillin G benzathine, doxycycline, or tetracycline (for patients who are allergic to penicillin). Length of treatment depends on the extent of the syphilis and factors such as the patient's overall health.

Syphilis during pregnancy: Penicillin is the drug of choice. Tetracycline cannot be used because it is dangerous to the fetus, and erythromycin may not prevent congenital syphilis in the fetus. People who are allergic to penicillin should ideally be desensitized to it, then treated with penicillin.

Several hours after getting treatment for the early stages of syphilis, people may experience Jarish-Herxheimer reaction, which is caused by an immune reaction to the breakdown products of the infection.

Symptoms of this reaction include:

Chills
Fever
General feeling of being ill (malaise)
Headache
Joint aches
Muscle aches
Nausea

These symptoms usually disappear within 24 hours.

Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure that the infection is gone. Avoid sexual contact when the chancre is present, and use condoms until two follow-up tests have indicated that the infection has been cured.

The sexual partner should also be treated. Syphilis is extremely contagious in the primary and secondary stages.

Expectations (prognosis)

Syphilis can be completely cured if diagnosed early and treated thoroughly.

Complications

Cardiovascular syphilis
Congenital syphilis
Neurosyphilis
Secondary syphilis
Syphilitic meningitis
Tertiary syphilis

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of syphilis.

If you have had intimate contact with a person who has syphilis or any other STD, or have engaged in any high-risk sexual practices, including having multiple or unknown partners or using intravenous drugs, contact your doctor or get screened in an STD clinic.

Prevention

People with multiple sex partners, partners they don't know, or partners involved in any high-risk sexual practices are at risk for STDs. A person who recognizes that he or she is at risk has taken the first step toward prevention.

Abstinence from sexual activity is the only foolproof way to avoid catching syphilis. Protected sex (using condoms) is the next most reliable method of preventing STDs. Condoms act as a barrier to the transmission of infectious organisms, and should be used in any and all high-risk sexual situations.

Syphilis is a reportable disease, as required by law. The infection must be reported by the health care provider to public health authorities. Information gathered from this reporting helps public health investigators identify, locate, and treat infected sexual contacts. This action helps prevent the continued spread of infection.

Review Date:11/12/2007
Reviewed By:Arnold L. Lentnek, M.D., Division of Infectious Diseases, Kennestone Hospital, Marietta, GA. Review provided by VeriMed Healthcare Network.

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