Taking the Mystery out of Syphilis

• It is important to understand the history of syphilis and how it began in order to fully understand any treatment options.   
• The treatment options for syphilis must be recognized and acknowledged.   
• There are four stages of syphilis that must be understood as each one varies to some degree.  

Syphilis is a sexually transmitted disease caused by the spirochete called Treponema Pallidum.  It is estimated that it was present in medieval times in Europe; however, some information suggests it was present hundreds of years before that.   

Syphilis is caused by the bacteria Treponema Pallidum and treated with penicillin 

There are four stages of syphilis that were discovered as the result of poor treatment options before penicillin. 

Pregnant women are screened each trimester to promptly identify and treat both the mother and fetus. 

History & Origination of Syphilis

Syphilis is stigmatized with each country blaming others for spreading the disease in the 1400s.  Italy, Germany, and the UK called syphilis the French disease.  The Russians called it the Polish disease.  The Danish called it the Portuguese disease.  Northern Africa called it the Spanish disease.  The Turks called syphilis the Christian disease.  The Muslims blamed the Hindus, and the Hindus blamed the Muslims.  In the end, everyone blamed the Europeans for the spread of syphilis.   

Syphilis has increased over the past several years with the highest infection rate being noted in men who have sexual encounters with other men and those with HIV infections.  Congenital syphilis has increased as well.  Infected women pass syphilis to the fetus causing congenital syphilis. 

As a result, it is recommended that syphilis screening be performed in each trimester rather than at the start of the pregnancy.  Treatment with antibiotics reduces morbidity and mortality for both the mother and fetus.  The complications of congenital syphilis are stillbirths, neonatal deaths, bone deformities and neurological impairment. 

Treatment Options

Mercury and arsenic compounds were some of the first substances used for treatment.  Higher doses of mercury resulted in toxicity and often produced death in those being treated with this substance.  As one can imagine, arsenic was not any better.  

Penicillin was discovered in the 1940s and is still the treatment of choice.  Those allergic to penicillin who have more advanced cases are typically desensitized and are still given penicillin.  How much medication one needs, and the length of treatment depends on the stage and symptoms.

Stages of Syphilis

Patient Care and Current Staffing 

Syphilis spreads through the mucous membranes.  Once mucosal invasion occurs there is an incubation period of 3-90 days before the chancre appears at the point of entry of the spirochetes.  The chancre is an ulcerated painless lesion that may even go unnoticed, especially by women. 

Common locations of the chancre are the penis, rectum, lips, mouth, vagina, perineum, and cervix.  The lesions spontaneously resolve without treatment in 3-6 weeks.  The chancre is healed, but syphilis spreads throughout the body as the immune system responds over the next 4-10 weeks.  Without treatment, the infected individual enters into the secondary stage.  

Secondary

A quarter of infected individuals in this stage develop systemic symptoms such as fever, chills, headache, fatigue, anorexia, weight loss, and flu-like symptoms.  These symptoms mimic many different aliments which is why syphilis is called the “great imitator”. 

However, more suspicious symptoms pointing towards the diagnosis may be a generalized rash especially on the palms, lymphadenopathy, patchy alopecia, hepatitis, gastrointestinal, and renal issues.  

Latent

The latent phase is further divided into early latent phase <1 year or late latent phase > 1year.  No symptoms of syphilis are present during the early latent phase, but the individual is still infectious but not as infectious as in the late latent phase.  Without treatment, syphilis progresses to tertiary disease which involves the cardiovascular, central nervous system, and musculoskeletal involvement leading to end organ damage. 

Tertiary

This type occurs within 3-15 years after the initial infection.  In this stage, the disease damages the brain, heart, bones, liver, and nearly all organ systems.  It is the only non-contagious phase of the infection.  There are three different forms of tertiary syphilis and they are gummatous syphilis, neurosyphilis, and cardiovascular syphilis. 

It is important to note that although the tertiary stage is part of the natural history of syphilis, it only develops in about one-third of individuals who do not receive appropriate treatment and has become very rare due to the effectiveness of antibiotic treatment.   

Congenital

The fetus may become infected at any stage of maternal syphilis and at any time in pregnancy.  Congenitalsyphilis has a high rate of miscarriage and stillbirth.  If infants survive the pregnancy, they are frequently asymptomatic for some time.  However, they eventually develop problems with liver and spleen enlargement, teeth and bone deformities, and neurosyphilis.   

The Bottom Line

In summary, syphilis is a type of sexually transmitted disease (STD) that has infected millions of people of all ages and races.  The morbidity and mortality rates of untreated syphilis is extremely high.  The infection damages nearly every organ system before death.

Routine screening and treatment is readily available in developed countries.  The rapid plasma reagin test (RPR) should always be included in STD screenings to improve detection and treatment with the goal of putting an end to this deadly disease.  

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