Syphilis: Overview of Symptoms, Diagnosis, and Treatment

Syphilis is a sexually transmitted disease that can also be called lues. It is caused by the bacterium treponema pallidum that spreads through broken skin or mucous membranes of the genitals. Pregnant women can transmit it to their children, so a specific analytical test is carried out in every pregnant woman to rule it out. It is contracted by direct contact with a syphilitic ulcer but not by contact with toilets, swimming pools, bathtubs, nor by sharing cutlery or clothing.

Syphilis is a more frequent disease in urban areas, with a peak incidence among homosexual men and more frequently in those coinfected with HIV. The most infected population group are the young adults ages 15-25.

Phases of the disease

Syphilis has been called the "great mimic" as it produces symptoms and signs that can be confused with other diseases.

The illness has several stages:

• Primary syphilis
• Secondary syphilis
• Tertiary syphilis
• Quaternary syphilis

This disease can also be divided into early or early syphilis, which includes primary and secondary and late syphilis which includes tertiary and quaternary.

Symptoms

Symptoms vary depending on the state of the disease. The lack of treatment is the main reason why it develops towards more advanced stages.

Primary syphilis symptoms

The symptoms of primary syphilis are the appearance of a non-painful open sore called a chancre and that it is present in the genitals, mouth, skin, rectum or vagina. The appearance of the chancre usually occurs about three weeks after infection, although sometimes it appears later. The lymph nodes in the region become inflamed and if no treatment is performed in a period between 3 and 6 weeks, both the chancre and the chancre disappear. In case of not giving adequate treatment the disease can progress to more advanced phases and give more important complications.

Secondary syphilis symptoms

The secondary syphilis stage usually occurs between 2 and 8 weeks later of the appearance of the chancre, but in some occasions the two phases can occur at the same time. Secondary syphilis is characterized by a rash that can be highly variable in appearance and affects both skin and mucous membranes and is usually painless or painless.

This rash also usually affects the palms of the hands and the soles of the feet. In this phase, there is a passage of treponema pallidum into the bloodstream, so systemic symptoms such as fever, malaise, arthralgias or myalgias, swollen lymph nodes, headache, weight loss and fatigue.

Symptoms in the tertiary phase

After the secondary phase, a latent phase of syphilis is entered in which symptoms disappear and it can last for many years. This person continues to have syphilis even if they do not have any symptoms. If secondary syphilis is not cured, treponema pallidum reproduces and accumulates in various tissues such as bones, skin and mucosa, nervous tissue, heart and arteries giving rise to the following symptoms:

• The skin lesions These are the so-called gums, which start as rounded nodules, which fistulize and end up forming a circular ulceration. In the mucosa they are usually located on the palate, pharynx, larynx and nasal septum.
• In the bone they can also give gums that produce nodules of newly formed bone evident in the, especially of the skull, face, tibiae and clavicles.
• The cardiovascular injuries They occur in 12% of tertiary syphilis cases and mainly affect the wall of the aorta artery and the aortic valve. Injuries to the aorta artery lead to significant dilations of this blood vessel called aneurysms that have a very high risk of rupture.
• In the central nervous system it can give inflammation of the meninges which are the membranes that cover the brain producing meningitis.

Symptoms in the quaternary phase

Quaternary syphilis is characterized by presenting a condition called tabes dorsalis, more frequent in men and affecting the spine with an alteration of sensation with motor incoordination. In addition there may be one that evolves into blindness. Quaternary syphilis can also produce progressive dementia that begins insidiously and progresses to exaggerated euphoria or deep depression.

Syphilis in pregnant women

Pregnant women can transmit syphilis to the fetus. This contagion occurs in 50-90% of primary and secondary syphilis cases and decreases to less than 30% in late latent syphilis. Infection to the fetus can cause late abortions due to alteration in the function of various fetal organs. In other cases the fetal size is decreased or premature births occur.

Some fetuses do not present symptoms of congenital syphilis at birth but later the disease develops that can cause skin eruptions, typical nasal discharge, laboratory abnormalities. Children who have later symptoms, after two years of life, present dental and bone disorders that may be accompanied by mental retardation.

Diagnosis

Diagnosis of the disease is made with a culture of secretion of the initial lesions or with blood tests.

Treatment

Treatment of syphilis is based on penicillin but the doses necessary for its cure depend on the period in which the disease is found. On some occasions, within a few hours of starting treatment, a reaction to it may occur in the form of malaise, fever, headache, muscle and joint pain, called Jarish-Herxheimer reaction.

Precautionary measures

The sexual partner must also be treated due to the high contagious power of the disease. The cure of the disease must be confirmed by blood tests. Like all sexually transmitted diseases, the main prevention of this disease is by use of condoms in sexual intercourse.