Syphilis (adults) - Medtick

Syphilis (adults)

What is it?

Bacterial infection that is passed normally via sexual contact.

Some people who contract syphilis never have symptoms and could have the disease for years without knowing.

Diagnosis Tests

  • Dark-field microscopy
  • Genetic techniques (polymerase chain reaction [PCR])
  • Blood tests in combination with the clinical history
    • Specific treponemal test as an initial screening tool (EIA, CLIA, TPPA), followed by confirmation with a different treponemal test.
    • A non-specific VRDL/RPR test is done to help stage the infection or determine the need for treatment.
  • Tests for should also be considered:
  • Syphilis tests are done through blood samples.
  • Oral or anal swabs, and urine samples are tested for other types of diseases.
  • Exposure to an STI until a reliable test can be undertaken is  up to 12 weeks.

Persons in contact with:

When there is any doubt about the source of the infection, it is common to ask about all partners within the last:

  • 3 months for gonorrhoea
  • 6 months for chlamydia
  • 3 months to several years for syphilis depending on history and stage of infection
  • 3 months to several years for H.I.V depending on history and stage of infection

McClean H, Radcliffe K, Sullivan AK, et al. British Association for Sexual Health and HIV (BASHH). BASHH Statement on Partner Notification for Sexually Transmissible Infections. 2012; London: BASHH.


Persons should not resume sexual activity until two weeks after treatment completion or, in the presence of any lesion(s), until all lesions have healed

Kingston M, French P, Higgins S et al. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2016;27(6):421–446. doi: 10.1177/0956462415624059

World Health Organization (WHO). WHO guidelines for the treatment of Treponema pallidum (syphilis). Available at: http://apps.who.int/iris/bitstream/10665/249572/1/9789241549806-eng.pdf?ua=1 (accessed March 2018)

Cause

  • Bacteria: Treponema Pallidum
  • Sexual contact: vaginal, anus, oral, sharing sex toys.
  • Men who have sex with men
  • Close contact to sores
  • Infected mother to child

Treatments

  • Having operations abroad using contaminated equipment
  • Blood transfusions abroad

Illicit drugs

Increased risk:

  • Unprotected sex
  • Multiple sex partners
  • H.I.V
  • Being a man who has sex with men

Symptoms (adults)

(First phase)

  • Sores on genital and/or around mouth from 2-6 weeks?

Sores then disappear and then one gets (second phase):

  • Non-itchy pink to reddish brown to violet rash (mainly on palms of hands and soles of feet) though can occur anywhere?
  • Rash on groin, armpits, inner thighs and under breast) that turn to raised white and grey raised area of skin, it may resolve in a few weeks but can reoccur?
  • Headache which is on and off or a constant headache longer than 24 hours?
  • Sore throat longer than seven days or more?
  • Swollen lymph glands and/or reoccurring mouth ulcers?
  • Mouth infection?
  • High temperature greater than 38°C (100°F) or over and/or chills and sweats longer than 72 hours?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Unexplained weight loss?
  • Patchy hair loss?
  • Joint pains and stiffness?

Symptoms above can last for six weeks or longer and then disappear for years and then develop severe warning symptoms (third phase):

  • Loss of mental function?
  • Bone pain?
  • Tumour-like swellings internal and external (appears as lumps on the skin)?
Penicillin can cure both syphilis and congenital syphilis. The antibiotic cannot reverse damage done to your organs via infection, especially if the disease has greatly progressed before treatment.

Complications /Information to beware of/General tips:

Medical Emergency Condition

Do not wait, phone for an ambulance if have or develop:


This condition can lead to:

  • Chancre
    • This is a hard sore or an ulcer that usually forms where the bacteria enters your body, most often in your genital area, but also in your mouth or anus. A chancre usually doesn’t cause pain) – it can be confused with a chancroid.
    • It can occur after 21 days after syphilis exposure and cause swelling around the surrounding area.
    • It can last from 3- 6 weeks and heal faster with treatment.
    • Multiple lesions can occur for those who have a weak immune system i.e. H.I.V 
  • Anal  tears and/or fissures and Anal fistulas
  • Hepatitis (liver disease)
  • Glomerulonephritis (kidney disease)
  • Enlarged spleen
  • Priapism
  • Gummatous syphilis (severe inflamed bacterial infection on skin, bones and internal organs) – it can be mistaken for cancer.
  • Mikulicz syndrome

If pregnant or planning to be pregnant

(Pregnant females should be screened at 28 weeks and again at delivery):

This condition can lead to:

  • Miscarriage
  • Stillbirth
  • Congenital syphilis (baby has syphilis):
    • During the first few years, some babies have no symptoms however If left untreated, the symptoms may include:
      • Liver swelling
      • Spleen enlargement
      • Petechia (purplish skin spots caused by ruptured capillaries) and/or rash
      • Profuse nasal drip (known as syphilitic “snuffles”) with highly infectious mucus discharge
      • Late stage syphilis symptoms:
        • Lung inflammation
        • Jaundice (yellowing of the skin and eyes)
        • Seizures

By age 2, the child may have characteristic facial or physical deformities and significant sensory impairment, including:

    • Blunted upper front teeth (known as Hutchinson’ teeth)
    • A collapse of the bony part of the nose (saddle nose)
    • A protruding jawbone and foreshortened upper jaw
    • A protruding frontal bone of the skull (frontal bossing)
    • Swollen knees (Clutton’s joints)
    • Bowing of the shin bones (saber shins)
    • Inflammation and scarring of the cornea (interstitial keratitis)
    • Glaucoma
    • Deafness
    • Developmental delays
    • Related death in these children is most often caused by a lung haemorrhage.

verywell Health

NORD


Eyes:

  • Argyll Robertson pupil is the most common ocular finding in patients with syphilis. It is described as pupils that constrict with accommodation but do not constrict with exposure to light.

Medscape


Contagious:

  • During  syphilis (first phase), the disease is passed by coming into contact with a mouth sore.
  • During secondary syphilis (second phase), the disease can be passed by coming into contact with the secondary rash. the rash can be puss- filled and can be highly contagious.
  • During early syphilis phase (second phase), secondary symptoms can sometimes relapse and increase the risk of transmission.
  • During late syphilis (third phase)  , the disease is considered non-contagious.

Sexual Partners:

  • With primary syphilis (first phase), notification should be sent to anyone you’ve had sex with up to 90 days before the appearance of symptoms.
  • With secondary syphilis (second phase), notification should be sent to anyone you’ve had sex with up to six months before the appearance of symptoms.
  • With early latent syphilis (third phase), notification should be sent anyone you’ve had sex with up to a year before the appearance of symptoms.

verywell Health


This condition may show similar symptoms to:

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

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