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Syphilis
1) What is syphilis ?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium
Treponema pallidum. It has often been called “the great imitator”
because so many of the signs and symptoms are indistinguishable from
those of other diseases.
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2)
How common is syphilis ?
In the United States, health officials reported over 36,000 cases of
syphilis in 2006, including 9,756 cases of primary and secondary (P&S)
syphilis. In 2006, half of all P&S syphilis cases were reported from 20
counties and 2 cities; and most P&S syphilis cases occurred in persons
20 to 39 years of age. The incidence of P&S syphilis was highest in
women 20 to 24 years of age and in men 35 to 39 years of age. Reported
cases of congenital syphilis in newborns increased from 2005 to 2006,
with 339 new cases reported in 2005 compared to 349 cases in 2006.
Between 2005 and 2006, the number of reported P&S syphilis cases
increased 11.8 percent. P&S rates have increased in males each year
between 2000 and 2006 from 2.6 to 5.7 and among females between 2004 and
2006. In 2006, 64% of the reported P&S syphilis cases were among men who
have sex with men (MSM).
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3)
How do people get syphilis ?
Syphilis is passed from person to person through direct contact with a
syphilis sore. Sores occur mainly on the external genitals, vagina,
anus, or in the rectum. Sores also can occur on the lips and in the
mouth. Transmission of the organism occurs during vaginal, anal, or oral
sex. Pregnant women with the disease can pass it to the babies they are
carrying. Syphilis cannot be spread through contact with toilet seats,
doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or
eating utensils.
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4)
What are the signs and symptoms in adults ?
Many people infected with syphilis do not have any symptoms for years,
yet remain at risk for late complications if they are not treated.
Although transmission occurs from persons with sores who are in the
primary or secondary stage, many of these sores are unrecognized. Thus,
transmission may occur from persons who are unaware of their infection.
Primary Stage
The primary stage of syphilis is usually marked by the appearance of a
single sore (called a chancre), but there may be multiple sores. The
time between infection with syphilis and the start of the first symptom
can range from 10 to 90 days (average 21 days). The chancre is usually
firm, round, small, and painless. It appears at the spot where syphilis
entered the body. The chancre lasts 3 to 6 weeks, and it heals without
treatment. However, if adequate treatment is not administered, the
infection progresses to the secondary stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage.
This stage typically starts with the development of a rash on one or
more areas of the body. The rash usually does not cause itching. Rashes
associated with secondary syphilis can appear as the chancre is healing
or several weeks after the chancre has healed. The characteristic rash
of secondary syphilis may appear as rough, red, or reddish brown spots
both on the palms of the hands and the bottoms of the feet. However,
rashes with a different appearance may occur on other parts of the body,
sometimes resembling rashes caused by other diseases. Sometimes rashes
associated with secondary syphilis are so faint that they are not
noticed. In addition to rashes, symptoms of secondary syphilis may
include fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches, and fatigue. The signs and
symptoms of secondary syphilis will resolve with or without treatment,
but without treatment, the infection will progress to the latent and
possibly late stages of disease.
Late and Latent Stages
The latent (hidden) stage of syphilis begins when primary and secondary
symptoms disappear. Without treatment, the infected person will continue
to have syphilis even though there are no signs or symptoms; infection
remains in the body. This latent stage can last for years. The late
stages of syphilis can develop in about 15% of people who have not been
treated for syphilis, and can appear 10 – 20 years after infection was
first acquired. In the late stages of syphilis, the disease may
subsequently damage the internal organs, including the brain, nerves,
eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms
of the late stage of syphilis include difficulty coordinating muscle
movements, paralysis, numbness, gradual blindness, and dementia. This
damage may be serious enough to cause death.
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5)
How does syphilis affect a pregnant woman and her baby ?
The syphilis bacterium can infect the baby of a woman during her
pregnancy. Depending on how long a pregnant woman has been infected, she
may have a high risk of having a stillbirth (a baby born dead) or of
giving birth to a baby who dies shortly after birth. An infected baby
may be born without signs or symptoms of disease. However, if not
treated immediately, the baby may develop serious problems within a few
weeks. Untreated babies may become developmentally delayed, have
seizures, or die.
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6)
How is syphilis diagnosed ?
Some health care providers can diagnose syphilis by examining material
from a chancre (infectious sore) using a special microscope called a
dark-field microscope. If syphilis bacteria are present in the sore,
they will show up when observed through the microscope.
A blood test is another way to determine whether someone has syphilis.
Shortly after infection occurs, the body produces syphilis antibodies
that can be detected by an accurate, safe, and inexpensive blood test. A
low level of antibodies will likely stay in the blood for months or
years even after the disease has been successfully treated. Because
untreated syphilis in a pregnant woman can infect and possibly kill her
developing baby, every pregnant woman should have a blood test for
syphilis.
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7)
What is the link between syphilis and HIV ?
Genital sores (chancres) caused by syphilis make it easier to transmit
and acquire HIV infection sexually. There is an estimated 2- to 5-fold
increased risk of acquiring HIV if exposed to that infection when
syphilis is present.
Ulcerative STDs that cause sores, ulcers, or breaks in the skin or
mucous membranes, such as syphilis, disrupt barriers that provide
protection against infections. The genital ulcers caused by syphilis can
bleed easily, and when they come into contact with oral and rectal
mucosa during sex, increase the infectiousness of and susceptibility to
HIV. Having other STDs is also an important predictor for becoming HIV
infected because STDs are a marker for behaviors associated with HIV
transmission.
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8)
What is the treatment for syphilis ?
Syphilis is easy to cure in its early stages. A single intramuscular
injection of penicillin, an antibiotic, will cure a person who has had
syphilis for less than a year. Additional doses are needed to treat
someone who has had syphilis for longer than a year. For people who are
allergic to penicillin, other antibiotics are available to treat
syphilis. There are no home remedies or over-the-counter drugs that will
cure syphilis. Treatment will kill the syphilis bacterium and prevent
further damage, but it will not repair damage already done.
Because effective treatment is available, it is important that persons
be screened for syphilis on an on-going basis if their sexual behaviors
put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact
with new partners until the syphilis sores are completely healed.
Persons with syphilis must notify their sex partners so that they also
can be tested and receive treatment if necessary.
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9)
Will syphilis recur ?
Having syphilis once does not protect a person from getting it again.
Following successful treatment, people can still be susceptible to
re-infection. Only laboratory tests can confirm whether someone has
syphilis. Because syphilis sores can be hidden in the vagina, rectum, or
mouth, it may not be obvious that a sex partner has syphilis. Talking
with a health care provider will help to determine the need to be
re-tested for syphilis after being treated.
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10)
How can syphilis be prevented ?
The surest way to avoid transmission of sexually transmitted diseases,
including syphilis, is to abstain from sexual contact or to be in a
long-term mutually monogamous relationship with a partner who has been
tested and is known to be uninfected.
Avoiding alcohol and drug use may also help prevent transmission of
syphilis because these activities may lead to risky sexual behavior. It
is important that sex partners talk to each other about their HIV status
and history of other STDs so that preventive action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male and female
genital areas that are covered or protected by a latex condom, as well
as in areas that are not covered. Correct and consistent use of latex
condoms can reduce the risk of syphilis, as well as genital herpes and
chancroid, only when the infected area or site of potential exposure is
protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are
no more effective than other lubricated condoms in protecting against
the transmission of STDs. Use of condoms lubricated with N-9 is not
recommended for STD/HIV prevention. Transmission of an STD, including
syphilis cannot be prevented by washing the genitals, urinating, and/or
douching after sex. Any unusual discharge, sore, or rash, particularly
in the groin area, should be a signal to refrain from having sex and to
see a doctor immediately.
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Pictures of Syphilis
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