Syphilis
BASICS
DESCRIPTION
- A chronic, systemic infectious disease caused by the spirochete Treponema pallidum
- Transmitted sexually by direct contact with an active lesion; also transmitted vertically (maternal–fetal) and via blood transfusions
- Untreated disease includes four overlapping stages.
- Primary: single (usually) painless chancre at point of entry; appears in 10 to 90 days; chancre heals without treatment in 3 to 6 weeks.
- Secondary: appears 2 to 8 weeks after primary chancre; nonpruritic rash on palms or soles of feet, mucous membrane lesions, headache, fever, lymphadenopathy, and alopecia
- Latent: seroreactive without evidence of disease
- Early latent: acquired within the last year
- Late latent: exposure >12 months prior to diagnosis
- Tertiary (late): Serology may be negative (fluorescent treponemal antibody absorption [FTA-ABS] test typically positive).
- Gumma, cardiovascular, and late neurosyphilis; may be fatal
- Neurosyphilis: any type of CNS involvement; can occur at any stage
- Psychosis, delirium, dementia
Pediatric Considerations
In noncongenital cases, consider child abuse.Pregnancy Considerations
- Screen all patients who are pregnant with venereal disease research laboratory (VDRL) test or rapid plasma reagin (RPR) test early in pregnancy, (i.e., first prenatal visit); if high risk, repeat at 28 weeks and at delivery (1)[ ].
- Use the same nontreponemal test for initial screening and for follow-up (1)[ ].
EPIDEMIOLOGY
Incidence
Syphilis rates decreased through 2000 and have since increased (primarily in men who have sex with men [MSM]) (2).
ETIOLOGY AND PATHOPHYSIOLOGY
T. pallidum enters through intact mucous membranes or breaks in skin. The organism quickly enters the lymphatics to cause systemic disease; highly infectious; exposure to as few as 60 spirochetes is associated with ~50% chance of infection.
RISK FACTORS
MSM, multiple sexual partners, exposure to infected body fluids, injection drug use, transplacental transmission, adult individuals in custody, high-risk sexual behavior, people living with HIV (PLWH)
GENERAL PREVENTION
COMMONLY ASSOCIATED CONDITIONS
HIV infection, hepatitis B, and other sexually transmitted infections (STIs)
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