syphilis
(sif'ĭ-lĭs 
)
[Syphilis, a shepherd in a Latin poem who had the disease ]
A multistage infection caused by the spirochete Treponema pallidum.
syphilitic,
(sif‵ĭ-lit'ik )
SEE: illus.
Incidence: In the U.S., approx. 50,000 people contract syphilis each year (the CDC counted 38,992 cases in 2019, and undercounting of sexually transmitted infections is common). Nearly 60% of all new syphilis infections in the U.S. occurred in men who have sex with men.
Causes: The disease is typically transmitted sexually by direct contact with the skin or mucous membranes of a person with active infection. A small number of congenital infections occur during pregnancy.
Symptoms and Signs: Spirochetes readily penetrate skin and disseminate from the site of inoculation to regional lymph nodes, the bloodstream and multiple other sites, including the central nervous system (CNS). After an incubation period of 10 days to 2 months, a papule appears on the skin that develops into a painless ulcer (chancre) characteristic of the primary stage of infection. Chancres and other syphilitic lesions are highly infectious. The genital organs are the most common site of primary infection and formation of chancres, although chancres may appear on other points of contact, e.g., the lips, mouth, anus, or rectum.
Chancres usually disappear within 3 to 6 weeks even without treatment. Within a few days to several months, the secondary stage of syphilis appears: a widespread body rash, often with systemic symptoms, e.g., fever, headache, generalized lymph node swelling, nausea, vomiting, weight loss, and malaise. Highly infectious moist, broad, pink or grayish white papules may appear in the perineum (condyloma latum), along with shallow ulcers in the mouth (mucous patches). Hair loss, usually temporary, may also occur, and the nails may become brittle and pitted. If the infection is not eradicated with antibiotics, it establishes latent infection that may cause multiple destructive changes in many organ systems years later.
In the latent (tertiary) stage of syphilis, tissue destruction occurs in the aorta, the CNS, bone, and skin. The consequences may include aortic aneurysm, meningitis, sensory and gait disturbances, dementia, and optic atrophy.
Diagnosis:
SEE: serological tests for syphilis.
Treatment: Intravenous or long-acting intramuscular preparations of penicillin are typically given to patients with syphilis. The duration of treatment varies depending on the stage of the disease and on whether there are comorbid illnesses, e.g., HIV infection, or complications, e.g., evidence of neurosyphilis. Doxycycline or tetracycline may be substituted in nonpregnant patients who are allergic to penicillin although, because of potential bacterial resistance, patients allergic to penicillin should be considered cand idates for desensitization. Pregnant patients are not given tetracycline or doxycycline because they discolor primary teeth in the infant.
Patient Care: The patient is taught about the illness and the importance of locating all sexual contacts, treatment, and the need for follow-up care. The patient should avoid sexual contact with anyone until the full course of therapy has been completed, including previous partners who have not received adequate evaluation and treatment, if indicated, for syphilis. Contact precautions are instituted from the time the disease is suspected until 24 hr after initiation of proper antibiotic therapy and whenever draining lesions are present. Stand ard precautions apply. The patient is informed about safe sex practices and consistent condom use to prevent infection with syphilis and other STDs. Pregnant patients are screened for syphilis to prevent prenatal transmission. Rape victims are tested at the time of the attack and again 1 to 2 weeks later. All cases of syphilis must be reported to local public health authorities by both health care providers and laboratories.
cardiovascular s.Tertiary syphilis involving the heart and great blood vessels, esp. the aorta. Saccular aneurysms of the aorta and aortic insufficiency frequently result.
congenital s.Syphilis transmitted from the mother to the fetus in utero. Transplacental fetal infection may occur if a pregnant woman is not treated by the 18th week of gestation or contracts the disease later in pregnancy. In the U.S. in 2000, 529 cases of congenital syphilis were reported. Infection of a fetus with syphilis increases the risk of birth defects and stillbirth. SYN: prenatal syphilis.
early s.Syphilis that was contracted less than 1 year ago.
endemic s.Chronic, nonvenereal syphilis infection of childhood. It is characterized in its early stages by mucocutaneous or membrane lesions. Later, gummas of bone and skin occur. Penicillin is the treatment of choice.
extragenital s.Syphilis in which the primary chancre is located elsewhere than on genital organs.
late s.Syphilis that was contracted more than one year ago.
latent s.The phase of syphilis during which symptoms are absent and the disease can be diagnosed only by serological tests.
meningovascular s.A form of neurosyphilis in which the meninges and vascular structures of the brain and spinal cord are involved. It may be localized or general. SYN: meningovascular neurosyphilis.
prenatal s.Congenital syphilis.
SEE: serological tests for syphilis.
tertiary s.The third and most advanced stage of syphilis.