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, 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
Epidemiology
Incidence
- Syphilis rate decreased through 2000 and have since increased (primarily in men who have sex with men [MSM]) (2).
- All stages: 41 per 100,000
- Congenital: 57/100,000 live births (2)
Prevalence
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 inmates, high-risk sexual behavior, people living with HIV (PLWH)
General Prevention
Commonly Associated Conditions
HIV infection, hepatitis B, other sexually transmitted infections (STIs)
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