Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Syphilis is an infection that is caused by a microscopic
organism called
Treponema
pallidum. The
disease can go through three active stages and a latent
(inactive) stage.
In the initial or primary stage of syphilis, a painless
ulcer (the chancre) appears in a sexually-exposed area, such as the penis,
mouth, or anal region. Sometimes, multiple ulcers may be present. The chancre
develops any time from 10 to 90 days after infection, with an average time of 21
days following infection until the first symptoms develop. Painless, swollen
glands (lymph nodes) are often present in the region of the chancre, such as in
the groin of patients with penile lesions. The ulcer can go away on its own
after 3 to 6 weeks, only for the disease to recur months later as secondary syphilis if the primary stage
is not treated.
Secondary syphilis is a systemic stage of the disease,
meaning that it can involve various organ systems of the body. In this stage,
therefore, patients can initially experience many different symptoms, but most
commonly they develop a skin rash that does not itch. Sometimes the skin rash of
secondary syphilis is very faint and hard to recognize; it may not even be
noticed in all cases. In addition, secondary syphilis can involve virtually any
part of the body, causing, for example, swollen glands (lymph nodes) in the
groin, neck, and arm pits, arthritis, kidney problems, and liver abnormalities. Without treatment,
this stage of the disease may persist or resolve (go away).
Subsequent to secondary syphilis, some people will
continue to carry the infection in their body without symptoms. This is the
so-called latent stage of the infection. Then, with or without a latent stage,
which can last as long as twenty or more years, the third (tertiary) stage of
the disease can develop. Tertiary syphilis is also a systemic stage of the
disease and can cause a variety of problems throughout the body including:
abnormal bulging of the large vessel leaving the heart (the aorta), resulting in
heart problems;
the development of large nodules (gummas) in various organs
of the body;
infection of the brain, causing a
stroke, mental confusion,
meningitis, problems with sensation, or weakness (neurosyphilis);
involvement of the eyes leading to sight deterioration; or
involvement of
the ears resulting in deafness. The damage sustained by the body during the
tertiary stage of syphilis is severe and can even be fatal.
How is syphilis diagnosed?
A diagnosis of the chancre (primary stage of disease)
can be made by examining the ulcer secretions under a microscope. A special microscope (dark
field), however, must be used to see the distinctive corkscrew-shaped Treponema
organisms. Since these microscopes are rarely detected, the diagnosis is most
often made and treatment is prescribed based upon the appearance of the chancre.
Diagnosis of syphilis is complicated by the fact that the causative organism
cannot be grown in the laboratory, so cultures of affected areas cannot be used
for diagnosis.
For secondary and tertiary syphilis, the diagnosis is
based upon antibody blood tests that detect the body's immune response to the Treponema organism.
The standard screening blood tests for syphilis are
called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen
Reagent (RPR) tests.
These tests detect the body's response to the infection, but not to the actual
Treponema organism that causes the infection. These tests are thus referred to
as non-treponemal tests. Although the non-treponemal tests are very effective in
detecting evidence of infection, they can also produce so-called false positive results
for syphilis. Consequently, any positive non-treponemal test must be confirmed
by a treponemal test specific for the organism causing syphilis, such as the
microhemagglutination assay for T. pallidum (MHA-TP) and the fluorescent
treponemal antibody absorbed test (FTA-ABS). These treponemal tests directly
detect the body's response to Treponema pallidum.
Patients with secondary, latent, or tertiary syphilis will almost always have
a positive VDRL or RPR, as well as a positive MHA-TP or FTA-ABS. Several months
after treatment, the non- treponemal tests will generally decrease to
undetectable or low levels. The treponemal tests, however, will usually remain
positive for the remainder of the patient's life whether or not they have been
treated for syphilis.
How is syphilis treated?
Depending on the stage of disease, the treatment options for syphilis vary as
summarized in the table below.
Stage of Infection
Preferred
Treatment
Alternative
Treatments
Primary infection, secondary infection,
or latent
infection (for less than 1
year)
Benzathine penicillin
injection
2.4 million units (single dose)
Doxycycline 100 mg
orally twice per day for 14 days
or
tetracycline 500
mg orally four times per day for 14 days
Late
latent infection (for>1 year), cardiovascular disease,
or gumma
Benzathine penicillin
G injection 2.4 million units every week for 3
weeks
Doxycycline 100 mg
orally twice per day for 28 days
or
tetracycline 500
mg orally four times per day for 28 days
Neurosyphilis (involvement of the nervous system), eye
disease
Aqueous crystalline
penicillin G 3-4 million units every four hours intravenously
or
24 million units
Procaine penicillin
injection 2.4 million
units each day with probenecid 500 mg orally four times per
day, both for
10-14 days
What should a person do if exposed to someone with syphilis?
Anyone who has been sexually exposed to an individual with the ulcer
or skin rash of syphilis can potentially become infected. Persons who
were exposed within 90 days preceding their partner being diagnosed with
primary, secondary, or latent syphilis should be treated with one of the regimens for
primary or secondary disease, even if antibody tests are negative. If the
exposure occurred more than 90 days before the partner was diagnosed, the
exposed individual should undergo a non-treponemal test (RPR or VDRL tests). If the test
is not readily available and/or follow-up is not guaranteed, the person
should be treated as for primary or secondary syphilis. Finally, long- term
sex partners of people with later (>one year duration) latent infection or tertiary syphilis
should be evaluated by a physician and undergo blood tests for syphilis. The
decision regarding treatment should be based upon whether the person has any
symptoms of primary, secondary, or tertiary syphilis and the results of their
blood tests for syphilis.
Scabies are itch mites that burrow under the skin and produce intense itching that's usually worse at night. Symptoms of scabies are small bumps and blisters on the wrists, knees, between the fingers, on the back of the elbows, in the groin and on the buttocks. Treatment involves applying a mite-killing cream, antihistamines for itch relief, washing bedclothes and linens.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Genital herpes, a viral infection by the herpes simplex virus (HSV), is transmitted during sexual contact with the mucous-covered linings of the mouth, vagina, or the genital skin. A typical outbreak begins with an itching or tingling sensation followed by redness of the skin and blister formation. The blisters and ulcers that form when the blisters break are painful to the touch, and last from 7 days to 2 weeks. Though there is no cure for herpes, there are ways to treat outbreaks.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Prostatitis is a painful condition of the prostate gland. There are four types of prostatitis, acute bacterial, chronic bacterial, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Diagnosis is made with a digital rectal exam, urinalysis, ultrasound, MRI, biopsy, or blood test. Treatment depends upon the type of prostatitis.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Blood in semen is also known as hematospermia. Blood in semen can be caused by many conditions affecting the tubes that distribute semen from the testicles (seminal vesicles) or the prostate gland. Symptoms that may accompany blood in semen include blood in the urine, fever, painful urination, pain with ejaculation, tenderness, and swelling in the testes or groin area. Urinalysis, ultrasound, and MRI may be used to diagnose blood in the semen. Treatment depends upon the underlying cause of blood in the semen.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
Pubic lice (crabs) are parasitic insects found in the genital area, and are primarily spread through sexual contact. Symptoms of crabs include itching and visible nits (lice eggs) and crawling lice. Treatment includes using lice-killing shampoo and washing bedding and clothing in hot water.
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Medication is the only treatment for trichomoniasis.
The HPV virus (genital warts) in men can cause health problems. Genital warts are confined primarily to the moist skin of the genitals or around the anus. Genital warts are caused by the human papillomaviruses (HPVs), which are transmitted through sexual contact.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
AIDS is the advanced stage of HIV infection. Symptoms and signs of AIDS include pneumonia due to Pneumocystis jiroveci, tuberculosis, toxoplasmosis, seizures, weakness, meningitis, yeast infection of the esophagus, and Kaposi's sarcoma. Anti-retroviral therapy (HAART) is used in the treatment of AIDS.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
A urethral stricture, or narrowing of the urethra, may cause decreased urine output. Symptoms include painful urination, urinary retention, and pelvic pain. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing.
Drug resistance (antimicrobial resistance) is the ability of bacteria, fungi, parasites, and viruses to grow, even in the presence of a drug that would normally kill it (or limit it's growth). Drug resistance is a growing problem, particularly for infections such as MRSA, VRE (vancomycin-resistant enterococci), tuberculosis, HIV, STDs, gonorrhea, flu, pneumonia, malaria, E. coli, salmonella, Campylobacter, which causes diarrhea and gastroenteritis. Learn how to protect yourself from resistance to drugs.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
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