What is Syphilis?
Syphilis is a venereal disease that is transmitted through vaginal, anal, or oral sexual contact. It can also be passed from a pregnant mother to her unborn baby, or from an infected blood donor to a person who receives the blood contaminated with syphilitic bacteria through a transfusion. But one cannot catch syphilis from toilet seats, door knobs, bathtubs, and shared clothing. You need to be in close, direct contact with an infected person.
The disease is caused by a bacterium called Treponema pallidum. It is a chronic disease with variable clinical and pathological manifestations. Public health programs and penicillin treatment reduced the number of cases of syphilis in the United States from the late 1940s until the 1970s. There was a major increase in syphilis cases in the 2000s, especially among women at ages 20-24 years old, and men at ages 35-39. Approximately 14,000 cases were reported in the United States in 2010. Syphilis has 4 stages: the primary, secondary, latent, and tertiary stages.
What are the Stages of Syphilis?
The Primary Stage
The primary stage of syphilis is characterized by a painless ulceration called a "chancre" (pronounced SHANG-ker), usually found on the penis, anus, and rectum in men, on the vulva, cervix, rectum, and perineum in women, or on the lips or mouth in either gender. This sore that appears in the primary stage resolves on its own due to the immune response of the body, but this immune response does not eradicate the systemic infection. The primary stage occurs almost 3 weeks after infection. Treponema pallidum bacteria are plentiful in the chancre, so contact with this chancre, especially with its serous secretions, transmits the bacteria to another person. The chancre lasts up to six weeks and then heals, although this does not mean the infection is gone. It is best if syphilis is diagnosed during this stage because treatment at this point is quite effective and without much distress.
The Secondary Stage
If not treated, syphilis progresses to the secondary stage in almost 75% of the people infected. It occurs approximately 2-10 weeks after the primary stage. The spirochetes, or spiral-shaped bacteria, spread in the bloodstream, producing widespread mucocutaneous lesions, lymph node swelling, and, less commonly, symptoms in other organs. Rashes appear all over the body, especially on the soles and palms. These rashes are round, flat, and reddish-brown in color. After the sores disappear, the affected areas may be lighter or darker than normal. If the scalp is involved, hair fall often occurs. In the moist areas of the skin like the armpits and inner thighs, typical rashes called condylomalata appear. These rashes are elevated, broad, and silverfish-gray in color with a red border.
This stage is the most infectious due to the multiple number of rashes and lesions. This is also an ideal stage for treatment. Common symptoms are fever, loss of appetite, nausea, and fatigue. Headaches, hearing loss, balance problems, optical disturbances, and aching bones can also occur. Without treatment, lesions may disappear in a few days to weeks or persist for months, sometimes returning after healing. But all ultimately heal, usually without scarring.
The Latent Stage
After the secondary stage, the disease enters the latent period, which is characterized by the complete absence of symptoms. In this dormant stage, the bacteria divide very slowly or do not at all. This stage usually lasts for a few years. If the disease is not diagnosed and treated properly by this stage, the body may progress to the most dangerous stage of syphilis that is the tertiary stage.
The Tertiary Stage
This stage occurs in one-third of untreated patients and lasts for 5 years or more. This last stage can affect many organs of the body, including the brain and heart. This tertiary stage can develop from 2 to 30 years after infection. At this late stage, no symptoms are present and the infection can only be detected through blood tests. However, the disease continues to cause damage and can also result in death. There are three typical manifestations at this stage:
1. Cardiovascular syphilis - This kind of syphilis takes the first place in typical manifestation due to its 80% occurrence. At this stage, there is scarcity of bacteria and increased number of inflammatory cells which are mostly responsible for this kind of cardiovascular problem. It begins with aortitis (inflammation of aorta) which is followed by a dilation of the aortic arch which causes valve insufficiency (the valves between the chambers of heart are not able to close properly leading to regurgitation of blood) and aneurysm (a blood-filled bulge in the wall of the blood vessel). The walls are weak and thin, and can potentially rupture, leading to fatal results. Symptoms include a brassy cough, obstruction of breathing due to pressure on the trachea, hoarseness due to vocal cord paralysis resulting from compression of the left laryngeal nerve, and painful erosion of the sternum and ribs or spine.
2. Neurosyphilis - The infection affects the central nervous system, which includes the brain and the spinal cord. One-third of the cases are found to be asymptomatic neurosyphilis, which is usually supposed when the cerebrospinal fluid (CSF) is checked for abnormalities. In symptomatic neurosyphilis, the syphilitic bacteria stimulate the production of inflammatory factors, increase proteins, and decrease glucose. Symptomatic neurosyphilis is divided into 6 categories:
- Category 1- Neuropsychiatric (common mental disorders like psychosis, dementia, and delirium)
- Category 2- Cerebrovascular accident (problem with vessels that provide blood to brain due to syphilis)
- Category 3- Eyes (uveitis, gradual blindness, or problem with the optic nerves)
- Category 4- Myelopathy (functional problems of the spinal cord)
- Category 5- Seizure (partial or complete seizures)
- Category 6- Brain stem (manifestations will include dysfunction of all cranial nerves and all centers located in the brain stem)
3. Benign tertiary syphilis - This type of syphilis is characterized by typical benign tumor-like formations in bone, skin, and the mucous membranes of the airway and mouth. These tumor-like formations are called gummas. The best explanation behind the formation of gummas is the delayed hypersensitive reaction of our body to the bacteria. Bone pain, tenderness, swelling, and pathological fractures occur when a bone is severely affected. In the mucous membranes, gummas take the form of nodular lesions or sometimes, destructive, ulcerative lesions.