Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum. It can essentially affect every organ of the body and can mimic various diseases. If left untreated the disease presents in 3 stages: primary syphilis, secondary syphilis and latent syphilis. Rarely the disease can also result to tertiary syphilis with severe complications.
Syphilis as a disease has a great historical significance. It received its name from a shepherd named Syphilus in 1530. The disease was introduced in Europe by Columbus after he returned from the West Indies and its spread in Europe was attributed to frequent wars during that period. Its frequency has decreased after the 2nd world war due to the discovery of penicillin. Its frequency increased again in the 1980s with the emergence of acquired immunodeficiency syndrome (AIDS) and is more common in homosexual men and prostitutes.
It is characterized by the emergence of the syphilitic sore, known as chancre, which occurs on average 21 days following contact with the infectious lesion of another person. The sore is usually solitary, hard and painless and is localized in the genitals. Most common sites of localization are the vagina, the vulva, the cervix, the glans, the penis, the mons pubis (pudenda) and the oral cavity. After 1‑2 weeks the regional lymph nodes can be palpated hard and painless. Following 3‑6 weeks the sore resolves leaving a scar at the site of infection. If this stage is left untreated, spirochete remains in the organism and leads to secondary syphilis.
is caused by the haematogenous and lymphatic spread of primary syphilis when left untreated and occurs about 6 weeks following the onset of the ulcer (sore). Its duration is 2‑10 weeks. Secondary syphilis has skin and mucosal presentation and is often confused with other skin diseases.
Fever, malaise, pharyngitis, headache, lymphadenopathy
Generalized maculopapular rash with no pruritus (itching) with desquamation (syphilitic roseola) that may persist for weeks or months
Papules with squamous (patchy) borders on the palms and soles
Alopecia irregular in shape
White liquid lesions like papillomas on the genitals. Such a lesion is called flat condyloma
All of these lesions are highly contagious and if left untreated they often relapse within the first year.
It is the stage where there are no active lesions present and secondary syphilis progresses. The patient looks healthy, but hematology tests indicate treponemal infection..
Tertiary syphilis occurs in 25% of patients who were not treated in the earlier stages of the disease. Characteristic of this stage is the infection of distant organs, such as the cardiovascular system, the nervous system, the liver, the bones, etc.
It is the transmission of Treponema pallidum from the untreated mother to the fetus. Of the infants born from an affected mother, 50% will die at birth or shortly after and 40% of those will develop symptoms of congenital syphilis.
The symptoms include rash, bone lesions, enlargement of the liver and spleen, deafness and visual impairment. The infant will be born healthy if the mother receives treatment against syphilis before the 16th week of gestation (pregnancy).
Syphilis can be diagnosed by clinical examination and laboratory testing.
Diagnosis can be achieved by direct visual inspection and detection of the microorganism from the ulcers of primary syphilis using microscopy.
Other serological (hematological) tests that aid in the diagnosis are VDRL, RPR and AFT-ABS. A specialist dermatologist is the most suitable person to evaluate these findings and to diagnose syphilis as well as its stage.
The differential diagnosis of syphilis should be done in order to differentiate from a variety of skin diseases, with the most important ones being the following:
Genital herpes, traumatic ulcers, condylomata, pityriasis rosea, psoriasis, rushes of viral etiology and drug eruptions
Nowadays, the treatment of syphilis is easy and radical and the drug of choice is penicillin.
- In primary and early latent syphilis, treatment is carried out with single intramuscular administration of benzathine penicillin G administrated at a dose of 2.4million units.
- In secondary and tertiary syphilis, benzathine penicillin G is intramuscularly administered at a dose of 2.4million once a week for 3 consecutive weeks.
- Patients who are allergic to penicillin are treated with doxycycline or tetracycline.
Treatment success is certified by the decrease of RPR marker.
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