Syphilis, or lues, is a chronic contagious disease caused by a bacterium called Treponema pallidum. It is transmitted mostly through sexual contact, but it is transferable also from mother to fetus. Less often it is possible to get infected through contact with infected person in bad hygienic conditions. As mentioned above, Treponema pallidum enters the body most of the time during sexual intercourse. The gateway thus most often is skin or mucous membrane of the genital area or the mouth. The disease has several different stages and can affect any tissue or organ in the body. Syphilis at the beginning manifests by various non-specific symptoms so that it can mimic various other diseases; later the symptoms and course of the disease becomes unambiguous.
History of Syphilis
Syphilis as a disease was first mentioned in a collection of Chinese medical writings dated 2637 BC. The publication describes clinical symptoms of syphilis and also comes up with first effective treatment for syphilis – mercury administration. Another hypothesis states that syphilis was brought to Europe from America after Columbus had rediscovered it in 1492. This hypothesis, however, was disproved by the fact that syphilis had been known in Germany already since 1472. In history, there were many famous people who are nowadays believed to have suffered and died from this disease. Among these people there are Christopher Columbus, Emperor Gaius Augustus Germanicus, Henry VIII of England (also his children Mary Tudor and Edward II had a congenital form of syphilis), Catherine the Great in Russia along with her son Paul I, Ludwig van Beethoven, Paul Gauguin, and many others.
Stages of Syphilis
Syphilis has several stages, corresponding to the complicated life cycle of the causing bacterium Treponema pallidum. Symptoms of the disease are often atypical, such as ulcers resistant to treatment; several stages might present at once; diagnostic tests are often false negative.
Primary Stage of Syphilis
The primary stage occurs in the area where the bacterium has entered the body – a chancre appears and the lymph nodes in the area swell. The chancre appears approximately 3 weeks after infection and is painless, smooth and shiny. Most commonly it develops in the genital area – in men on the penis, at the mouth of the urethra or on the inner surface of the foreskin, in women at labia minora or majora, on the clitoris or on the uterine cervix. Sometimes it may present in the rectum area (often falsely considered as hemorrhoids), in the mouth or on the breast nipples. This stage of the disease is often missed. After some time without specific treatment the chancre disappears and the disease enters its second stage.
Secondary Stage of Syphilis
The secondary stage of syphilis comes a few months after initial infection. The bacteria spread through the entire body. In this stage, the patients usually suffer increased fatigue, headache, fever, sore throat, joint pain or disorders of hair growth. Generally, the secondary stage is characterized by varied changes in the skin and mucous membranes. There may be a rash all over the body, different types of "pimples" that do not hurt or itch and often occur in groups, sometimes condylomata lata can be present. Condylomata lata are pink bearings that are covered with grey smelly coating and are very contagious. It usually occurs around the anus, on the vulva or on the scrotum. The secondary stage of syphilis lasts 2-3 years. If proper treatment is not started even in the secondary stage, the symptoms slowly diminish and after time the disease passes via latent stadium into the tertiary stage.
Tertiary Stage of Syphilis
The tertiary stage of syphilis develops in several decades (3-15 years after infection). The bacteria continuously damage internal organs of the body, leading slowly to death of the person. Very serious is damage to the cardiovascular system, especially to the aorta, that ruptures easily and subsequent bleeding causes death of the patient. Consequences of the disease are evident also in the nervous system, where mostly brain and spinal cord are affected. Lesions in the back of the spinal cord, called syphilitic myelopathy or tabes dorsalis, are reflected in movement disorders and sensitivity. Damage to the brain is called progressive paralysis and manifests by increasing dementia, speech difficulties, and slowly beginning disintegration of personality. For the tertiary stage of syphilis, formations under the skin called gummas are also typical. Gummas contain yellowish liquid; the covering skin is red and decays over time. After healing of a gumma, there remains a smooth white scar.
Diagnosis of Syphilis
Diagnosis of syphilis is based on serological testing of blood or cerebrospinal fluid. Microscopic examination of a sample of the initial chancre or rush is also possible; causing bacteria can be clearly seen under the microscope.
Treatment of Syphilis
Syphilis is nowadays treated with antibiotics, usually penicillin type. If the treatment is started in an early stage of syphilis (primary or secondary stage), the results are good. It is therefore necessary to see a doctor as soon as possible, if suspicion of syphilis infection exists.
Syphilis is one of the sexually transmitted diseases (STD), along with gonorrhea and HIV/AIDS. Therefore, the best prevention is following principles of safe sex (partner faithfulness, condom use). Use of a condom with unknown sexual partners can significantly reduce the risk of disease transmission.