Family doctor

Overview:

• Syphilis is one of the oldest STDs but is less common in recent times
• It is caused by a bacteria which burrows into the genitals
• The disease is spread through sexual contact with an infected person
• The disease causes an ulcer in the first stage and a rash in the second phase
• The symptoms can be mild and a person may not be aware they have it
• Syphilis makes it easier for a person to contract HIV
• Without treatment the disease can cause organ damage, mental illness and death
• An injection of penicillin cures most cases, and kills the bacteria within 24 hours

What is syphilis?

Syphilis is a sexually transmitted disease that has been around for centuries and was once the cause of devastating epidemics.

Even today, there has been a rapid increase in rates in the former Soviet Union. There are reports of an epidemic in eastern Poland with the disease spreading in conjunction with HIV to neighbouring countries. An outbreak in Bristol, UK has also been recently noted.

The disease is caused by a microscopic bacterial organism called a spirochete, a worm-like spiral shaped organism. It infects a person by burrowing into the mouth or genitals.

There are four different stages to the disease. At the beginning of the infection it causes a non-painful ulcer at the site of the infection. However, it can spread throughout the body in later stages, causing damage to many organs, and can be fatal.

Of particular concern is that syphilis makes it easier for a person to contract HIV. Any genital ulceration increases the risk of the HIV virus being transmitted.

The bacteria is spread from the initial ulcer to the skin or mucous membranes of the genital areas, mouth or anus of a sexual partner.

A woman can pass syphilis onto a child and it can be born with serious mental and physical disabilities from the infection.

What are the symptoms?

The early symptoms can be very mild and many people do not realise they have it. Sexually active people should consult a doctor about any suspicious rash or sore on the genitals.

The first symptom is an ulcer which can appear within 10 days to three months after exposure, but mainly within two to six weeks. But because it is painless and may develop inside the body, the patient may not be aware of it.

Ulcers are usually found on the penis, the vulva or the vagina. They could also occur on the cervix, tongue, lips or other parts of the body.

If the condition goes untreated during this stage about one third will develop complications in the later stages.

The secondary stage is characterised by a skin rash that consists of brown sores. The rash can occur anywhere from three to six weeks after the primary ulcer appears. The rash may cover the whole body or appear in a few areas. The palms of the hands and soles of the feet are common sites.

At this stage any contact with the rash of an infected person may spread the infection. The rash usually heals within several weeks or months.

Other symptoms may include mild fever, fatigue, headache, sore throat, hair loss and enlarged lymph glands. These symptoms could still be very mild and it is possible for an infected person not to seek treatment. The symptoms of secondary syphilis may reappear over the next two years.

If left untreated, the disease is no longer infectious after the second stage and many people will suffer no further problems. However, one third will develop complications, with the bacteria damaging the heart, eyes, brain, and nervous system. This stage can last several years.

The final stage can result in mental illness, other neurological problems, and death.

Diagnosing the problem involves the doctor recognising the signs and symptoms, blood tests or microscopic identification of the spirochetes taken from a swab of the infected area. False negative and positive blood tests can occur and two blood tests are usually necessary. Only 75 percent of infected people test positive in the first stage.

What can be done?

This STD can be effectively treated with antibiotic therapy. Treatment depends on the stage of the disease at the time of diagnosis.

The spirochetes are easily eradicated by a long-acting form of injected penicillin. Oral penicillin is not effective against syphilis.

There are alternative drug treatments for people who are allergic to penicillin.

A carrier is usually no longer contagious 24 hours after starting penicillin. However, it may not work in some people and it is important for them to have regular blood tests to ensure the bacteria has been killed.

How can it be prevented?

Any contact with open sores and body fluids of infected people must be avoided to prevent the disease from spreading.

The use of condoms can help stop infection being passed to another person.

Testing and treating pregnant women with penicillin in the early stages of pregnancy is the best way to stop the disease being passed to the child. For this reason routine checking of pregnant mothers is carried out in early pregnancy

Future trends

Scientists are researching better methods to diagnose and treat syphilis

New tests are being developed which expect to make diagnosis easier and identify the stage of infection.

Researchers are looking to develop a diagnostic test for use on saliva or urine, avoiding the need for blood samples.

Scientists are also conducting research on an effective vaccine.

Drug companies also hope to develop an effective oral antibiotic so patients can avoid an injection.

The discovery of the genome of the organism recently has given scientists additional clues about diagnosing, treating, and finding an effective vaccine for the condition.

Getting help

Sexual Health or STD clinics can provide treatment and information about the condition.

Your doctor, gynaecologist, urologist or Family Planning Clinic can also help.