Curriculum · Public Health and Communicable Diseases
Syphilis
What it is
Syphilis is caused by a spirochete, Treponema pallidum, and it shows itself as an anogenital ulcer or sore. Transmission is by sexual contact most commonly, by vertical transmission during pregnancy, which gives congenital syphilis, and rarely via blood transfusion. The incubation period is 10-90 days, counted from contact with the spirochaete. From the secondary phase the disease then progresses to a tertiary phase, and the common long-term lesions are cardiovascular and neurological.
Causes and risk
Screening is by the Rapid plasma Reagin (RPR) test, and it is offered to the high risk factor group and to pregnant women. The risk factors listed are high-risk sexual behavior, meaning unprotected sex and exchange of sex for money, limited access to healthcare, and poverty.
How it presents
Primary syphilis is the chancre, a hard ulcer, written elsewhere as an erythematous papule and a painless ulcer. Secondary syphilis is a rash in the palms and soles, lymphadenopathy and condylomata lata. Tertiary syphilis is the gummas, granulomas in skin, mucosa, bone, joints and viscera, written elsewhere as the gummatous ulcer. A fourth stage is named, and it is vascular. Set out stage by stage it is longer. Primary syphilis is a painless chancre at the site of infection, which heals in 3-6 weeks, with non-tender regional lymphadenopathy; the chancre is an indurated, firm papule which may become ulcerated and has a raised firm edge, may be accompanied by inguinal lymphadenopathy, and most commonly occurs on the vulva. Secondary syphilis follows 6 weeks after the disappearance of the chancre: systemic symptoms of fever, malaise and sore throat, a maculopapular rash that includes the palms and soles and is often associated with alopecia, and condyloma lata, moist wart-like lesions in the genital area, papules that occur particularly in the anogenital area and in the mouth. Latent syphilis is the asymptomatic stage and it divides in two: early latent, under 1 year of infection, is still infectious; late latent, over 1 year, is non-infectious. Tertiary syphilis occurs years after initial infection, with gummas, granulomatous lesions in skin, bones or organs, cardiovascular syphilis such as aortitis, and neurosyphilis such as tabes dorsalis and general paresis. A table of stages puts the timing beside the features and reads slightly differently. Primary is 3-4 weeks after exposure, a painless chancre at the inoculation site. Secondary is timed there as 4-8 weeks after the appearance of the primary chancre, rather than after its disappearance, with rash, condyloma lata and systemic symptoms common. Latent is asymptomatic, early being under 1 year after infection and late over 1 year after infection. Tertiary is 1-10 years after infection and divides three ways: benign, the gummatous lesions; cardiovascular, aortitis and coronary arteritis; and CNS, tabes dorsalis and paresis. The first lesion is described in another place as beginning as a painless papule that transforms into the classic chancre. Congenital syphilis, from transmission during pregnancy, gives rhinitis (snuffles), hepatosplenomegaly and jaundice, and as late manifestations Hutchinson teeth, saddle nose deformity and saber shins.