Sexually Transmitted Diseases (STDs In Men) (cont.)
Syphilis
What is syphilis?
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 patients 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: (1)
abnormal bulging of the large vessel leaving the heart (the aorta), resulting in
heart problems; (2) the development of large nodules (gummas) in various organs
of the body; (3) infection of the brain, causing a stroke, mental confusion,
meningitis (type of
brain infection), problems with sensation, or weakness (neurosyphilis); (4)
involvement of the eyes leading to sight deterioration; or (4) 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.
Next: Human Papillomavirus (HPV) »
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