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Syphilis (pronounced SIF-uh-lus) is a sexually transmitted disease caused by bacteria.

The highly
infectious disease may also be passed, but much less often, through blood transfusions or from mother
to fetus in the womb. Without treatment, syphilis can cause irreversible damage to the brain, nerves,
and body tissues.
The symptoms of syphilis can mimic many diseases. Sir William Osler stated, "The physician who
knows syphilis knows medicine."
Syphilis Causes
Syphilis is an infectious, often sexually transmitted, disease caused by the bacteriaTreponema pallidum.
The bacteria penetrate chafed skin or the mucous membranes.
• Transmission most often occurs when one person comes into contact with lesions on an infected
person through sexual activity.
• Men are more vulnerable to contracting syphilis than women.
• The active disease is found most often among men and women aged 15-39 years.

Syphilis Symptoms
Syphilis may progress through 3 distinct stages. Sometimes not all 3 may be evident.
• Primary phase: The primary phase usually starts with a sore at the site of infection. The sore
or lesion is called a chancre(pronounced shanker). This sore usually appears as a craterlike lesion on
the male or female genitals, although any part of the body is at risk. Anyone who touches an infected
sore can transmit the infection. This initial lesion develops 3-4 weeks after infection and heals
spontaneously after 1 week. Though the sore goes away, the disease does not. It progresses into the
secondary phase.
• Secondary phase: The secondary phase may develop 4-10 weeks after the chancre. This phase has
many symptoms, which is why syphilis is called the great pretender. It may look like a number of
other illnesses. This phase of syphilis can go away without treatment, but the disease then enters the
third phase. These are the most frequently reported symptoms of the secondary phase:
• Fever
• Joint pain
• Muscle aches
• Sore throat
• Flulike symptoms
• Whole-body rash (usually involving the palms and soles)
• Headache
• Decreased appetite
• Patchy hair loss
• Swollen lymph nodes

• Latent (dormant) phase: The early latent phase (first 1-2 years) is characterized by occasional
relapses back to symptoms of the secondary phase of syphilis. More than 2 years after the start of the
latent phase, you may have no symptoms and are generally not infectious. However, you can still
transmit the infection from mother to fetus or through blood transfusions.
• About a third of people with latent syphilis will progress after many years (or decades) into tertiary
syphilis. During this phase, the heart, brain, skin, and bones are at risk. Luckily, with the advent
of penicillin, this phase is very rarely seen today.
• Congenital syphilis occurs after a fetus is infected in the womb. This form of syphilis causes teeth
abnormalities, bone problems, liver/spleen/kidney enlargement, brain infection, failure to
thrive/poor growth, swollen lymph nodes, yellow skin (jaundice), low blood counts, and skin
rashes.

When to Seek Medical Care


Contact your doctor to examine any strange sores on your penis or vagina. You should also speak to
your doctor about any abnormal rashes that fail to go away within 1-2 days.
You should also call your doctor if you develop a new rash, sore throat, joint swelling, fever, or any
new symptoms during or after the time you are being treated for syphilis.
Although syphilis may be treated in your doctor's office, you should seek emergency care if you have
any vision changes, pain with viewing bright lights, a stiff neck, high fevers, or sudden weakness in
any part of the body. Syphilis can cause strokes.
Exams and Tests
Syphilis can masquerade as any disease. Therefore, your doctor will carefully sort out the symptoms,
ask when they appeared, and take a complete sexual history. The doctor may ask about your use of
condoms and if your sexual partners show any similar symptoms.
• During the primary phase, the doctor will look for a single, painless sore on the male or female
genitalia. The mouth, anus, and other parts of the body may also be the site of the initial infection.
Lymph nodes near a sore may be swollen.
• During the primary phase, the doctor may obtain a sample of your sore and perform a dark-field
(microscope) exam. This test may also be useful during the secondary phase.

• Secondary syphilis frequently presents with a diffuse rash and swollen lymph nodes. Your doctor will
also ask you about the progression of the rash. Your accurate and descriptive answers are very
important. Lesions on the palms and soles of the feet make a diagnosis of syphilis more likely.
• Blood testing is the cornerstone of diagnosis during the secondary phase. The doctor will usually
order one of the following tests. All three help diagnose a syphilis infection.
• RPR (rapid plasma reagin)
• VDRL (venereal disease research laboratory)
• FTA-ABS (fluorescent treponemal antibody absorption) or MHA-TP (microhemagglutination
assay for T pallidum)

• During the tertiary phase, the doctor may need to obtain a sample of your spinal fluid to check for
infection and to measure the success of treatment.

Self-Care at Home
Only antibiotic therapy will treat this infection. You must seek medical care for this disease.
Medical Treatment
Unlike the diagnosis, treatment is fairly straightforward. During the primary, secondary, and early
latent phases of syphilis, a single injection of penicillin cures the disease. People who are allergic to
penicillin (and not pregnant) may be given oral antibiotics (such asdoxycycline, tetracycline,
or erythromycin) for 2 weeks.
• People who are diagnosed to be in the late latent stage of syphilis (and are not sure how long they
have been in this stage) and those with tertiary syphilis will require 3 injections, each 1 week apart.
Oral antibiotics (most likely, doxycycline or tetracycline) are usually given to people in this stage
who are allergic to penicillin.
• If syphilis has advanced to neurosyphilis (or brain involvement), treatment with IV penicillin every 4
hours for 10-14 days may be required. An alternative is penicillin injections (once per day) with
oral probenecid (4 times a day) for 10-14 days.
• A pregnant woman with syphilis must have penicillin, even if she is allergic to it. She must tell her
doctor of this allergy to allow for desensitization procedures.
• After treatment with penicillin, a Jarisch-Herxheimer reaction may occur 2-12 hours after treatment
starts. This reaction is the result of the dying bacteria and may cause previous symptoms to
transiently worsen. Alarming as it may be, this reaction usually ends within 24 hours. Bed rest, pain
relievers (such as aspirin, acetaminophen, or ibuprofen), and liquids can help.

Next Steps
Follow-up
Your doctor will advise you not to have sexual activity until your doctor confirms by blood tests that
you are no longer infectious. This may take 2-3 months. It is important for you to advise your sexual
partners and close contacts to be checked for syphilis. Your local health department can help.
• People being treated for syphilis need repeat blood tests at 3, 6, and 12 months to confirm that the
disease has been eliminated.
• People with neurosyphilis need repeat blood tests and spinal fluid examinations every 6 months for at
least 3 years.
• Pregnant women with syphilis need monthly blood testing for the duration of their pregnancy.

Prevention
Like many other sexually transmitted diseases, syphilis can be prevented with safe sexpractices
including the use of a condom.
Outlook
Syphilis in the first 2 stages continues to be cured with penicillin-unlike other diseases that are
becoming resistant to antibiotics. The outlook for people with tertiary syphilis is less optimistic. In one
study, 20% of people with cardiovascular syphilis died without antibiotic therapy. More than 60% of
these people, however, remain symptom free even without treatment.
Synonyms and Keywords
syphilis, the great mimicker, the great pretender, lues, STD, sexually transmitted
disease, venereal disease, VD, symptoms of syphilis, syphilis symptoms