Syphilis


Written by : Dr.M.D.Mazumdar, MD

Syphilis is one of the most common sexually transmitted diseases, occuring in almost 3.6% of the people with an active sexual life ( Journal of Community Medicine, India)

It is caused by a parasite (a spirochaete) called Treponema Pallidum (Spirochaeta Pallida). Although mainly seen in the genital area, syphilitic sores can also be seen on hands, on the lips, mouth or even on the breasts.

Spread of Syphilis

Syphilis is mainly spread by sexual activity - vaginal, anal and oral sex. It is usually acquired by direct contact with another person who has an open sore or ulcer.

During sexual contact, the organism can pass from an open syphilitic sore in the genital region of one person (whether male or female) to the other.

Kissing and close bodily contact can also cause spread of the disease if one of the persons has an open syphilitic sore.

It can spread from the mother to the baby during pregnancy - the condition thus caused, is known as congenital syphilis and it can cause abnormalities or even death of the baby.

Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

This article will discuss syphilis occuring in the female genital region.

Signs and Symptoms of Syphilis

There are three stages of syphilis - Primary, Secondary and Tertiary. The signs and symptoms differ in the different stages of the disease.

Primary Stage of Syphilis

  • Primary Sore: The disease starts on the lower genital organs as a small, rounded or oval blister-like growth that breaks down in a day or two to form an ulcer or sore, with a thin watery secretion. This is called the primary sore or syphilitic chancre. The chancre typically occurs 10 to 20 days after contact with an infected person although it may be as long as 90 days. The sores occur mainly in the labia majora, labia minora, base of the clitoris, posterior wall of the vagina and on the cervix.

    The ulcer or sore has a reddish brown colour, a hard, indurated base and an irregular sharp margin. It is more or less painless, although the surrounding tissues may be slightly inflamed. Sometimes, this ulceration may be so slight that it may pass unnoticed by the patient.

  • Cervical Sore: On the cervix, the chancre starts as a greyish growth that breaks down to form a reddish area resembling a cervical erosion. Syphilis of the cervix can even be mistaken for cervical erosion.

  • Enlarged Lymph Nodes: The lymph nodes of the inguinal area (along the panty line between the legs and the abdomen) may be enlarged and hard, but painless.

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Secondary Stage of Syphilis

The ulcer soon heals spontaneously in about 8 weeks time. The secondary stage of syphilis starts when the spirochaetes from the primary sore enter the blood stream. The symptoms in the secondary stage are:

  • General Ill Health: The patient may suffer from general ill health with loss of appetite, mild fever and headache.

  • Skin Rashes: Reddish brown skin rashes appear that are raised from the surface of the skin and do not itch. The rashes are typically bilaterally symmetrical, that is, they appear on the left and the right side of the body at similar places - if they appear on the left elbow, they will also appear on the right elbow at the same place. Occasionally the rashes may also have blisters containing pus.

  • Condylomata Lata: These are moist flat-topped coarse warts around the vulva and anus. Areas of necrosis are seen on top of the warts.

  • Loss of Hair: There may be occasional loss of hair.

  • Ulceration: Sometimes ulceration or white mucous patches are seen in the mouth and inside the throat.

  • Enlargement of lymph nodes: Lymph nodes in different parts of the body may enlarge, especially those in the throat.

  • Duration: This stage can last for many years, even upto 2 years with the woman unaware or negligent of the infection. During this time she is a source of infection to her sexual partners.

Tertiary Stage of Syphilis

In untreated patients, the tertiary stage of syphilis can last for many years. During this time, the spirochaetes can attack the eyes, the joints, the blood vessels, the heart and the central nervous system.

Localised hard areas called 'gummas' may be formed in any part of the body. In the vulva, the gummas may break down to form shallow ulcers, with a red inflamed and edematous area surrounding them.

Syphilis in Pregnancy

Syphilis can infect the baby in infected pregnant patients, either while still in the uterus or during childbirth.

If infection occurs while in the uterus, the baby may be born with a number of abnormalities. Infection during childbirth usually affects the baby's eyes, causing a severe form of eye infection.

Diagnosis of Syphilis (STD)

  • In the primary stage of the disease, secretions taken from the base of the ulcer should be examined for the presence of the T.Pallidum organism. These can be demonstrated using dark-ground illumination microscopy.

  • In the later stages, blood tests can be diagnostic of the disease. The VDRL slide test (Venereal Diseases Reference Laboratory) test should be carried out in all cases of suspected sexually transmitted diseases ( STD ). This test will be positive in all case of syphilis except in the very early infections.

  • Certain specific tests like the TPHA test and the FTA-ABS test is done to confirm infection by T.Pallidum. They are done in conjunction with the VDRL slide test. Treponemal antibody tests usually become positive two to five weeks after the initial infection

Treatment of Syphilis

  • Local Treatment of the ulcers are useless since the spirochaetes enter the blood stream at an early stage.

  • Penicillin is the drug of choice. Penicillin can be given as deep intramuscular injections daily for 10 days. Long-acting penicillins are given weekly for 3 weeks.The spirochaetes disappear from the sores in 24 hours. Blood tests become negative in 4 weeks.

  • Oxytetracycline and erythromycin are given in patients sensitive to penicillin, but they are not as effective against the spirochaete as penicillin.

  • All women should be observed for 2 years following complete cure.

  • Penicillin should also be given to pregnant women who have been infected at any time with syphilis. This helps to protect the baby.

  • The baby should be assessed immediately after delivery for any signs of syphilis (std) and treated if necessary. She should be assessed again after 6 weeks and 3 months after birth.

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