Definition

Syphilis is due by infection by spirochaetes (spiral organisms) called Treponema pallidum. This is a widespread infection involving primarily young people between 20 and 35 years of age. There has been a gradual increase of syphilis over the last few years. Incubation period is 10 days to 3 months.
Signs and Symptoms

The disease may be divided into 4 stages:

Primary syphilis is a local infection involving the mucocutaneous sites and lymph nodes. A typical lesion is called a chancre which is normally a single painless ulcer commonly seen on the foreskin, penile shaft, vulva or cervix. There is usually painless enlargement of the lymph glands. A small percentage of cases may be found affecting the lips, mouth, nipple or anus. Very rarely multiple or painful lesions may be found similar to herpes simplex.

Secondary syphilis develops 6 to 8 weeks after the primary symptoms and consists of fever, rash and generalized lymph node enlargement. The rash is generalized, symmetrical and extends to the palms and soles. There may be superficial ulcers affecting the mouth which may be either grey or indeed snail track. Around the anus flat, moist, warty lesions called condylomata lata may occur. Other symptoms may be meningitis, arthritis, or infection of the eye.

Latent syphilis is an asymptomatic state where slow tissue damage may occur.

Tertiary syphilis (late syphilis) may affect many parts of the body. This is characterized by slow growing granulomatous lesions which affect the nervous system leading to general paralysis of the insane and demyelination of the spinal cord resulting in pains, loss of feeling and difficulty walking. Changes in the joint so-called Charcot's joints may develop due to loss of nerve supply. Dementia may occur. Very rarely changes in the aorta may result in an aneurysm.

Tests

In primary syphilis diagnoses can be made by microscopy of the discharge or even aspirating fluid from the enlarged lymph glands. Antibodies may also be detected in the blood.

Treatment

Penicillin is the treatment of choice for all forms of syphilis. Primary syphilis can be completely cured following daily or twice daily intramuscular injections of Penicillin for 14 days. Secondary syphilis can be treated in the same way.

Treatment of late syphilis however may not always reverse the tissue damage though it may improve the central nervous system signs. When treating late syphilis an extreme reaction to the antibiotic may occur which rarely may cause epilepsy or a stroke. This may be avoided by steroid administration.
Complication of Syphilis Related to Infection in Pregnancy

This may lead to abortion or transparental infection of the foetus resulting in early long term disease.

By Dr J.D.C Ross MD FRCP