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DESCRIPTION
Syphilis is a highly contagious sexually-transmitted disease caused by a corkscrew or spiral-shaped spirochete bacterium called Treponema pallidum. Syphilis causes widespread tissue destruction. Syphilis is known by many names throughout history, including the "French disease" and the "Great Pox". It is also known as the "great mimic" or "the great imitator," because its symptoms resemble or are indistinguishable from those of many other diseases. It involves the genitals, skin, and central nervous system.
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores can also occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing or eating utensils.
There are two types:
- Congenital form is found in newborns (0 to 2 weeks) born to mothers with syphilis.
- Contagious form is the type that affects persons of all ages and both sexes who acquire it through sexual contact.
In the United States, syphilis is the third most commonly reported infectious disease, and is most common in urban areas and in southern states. U.S. health officials reported over 32,000 cases of syphilis in 2002, including 6,862 cases of primary and secondary (P & S) syphilis. In 2002, half of all P & S syphilis cases were reported from 16 counties and 1 city; and most P & S syphilis cases occurred in persons 20 to 39 years of age. The incidence of infectious syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns decreased from 2001 to 2002, with 492 new cases reported in 2001 compared to 412 cases in 2002.
Between 2001 and 2002, the number of reported P & S syphilis cases increased 12.4 percent. Rates in women continued to decrease, and overall, the rate in men was 3.5 times that in women. This, in conjunction with reports of syphilis outbreaks in men who have sex with men (MSM), suggests that rates of syphilis in MSM are increasing.
HISTORY (From Wikipedia.org)
The first well-recorded outbreak of what we know as syphilis occurred in circa 1494 when it broke out among German troops besieging Naples. From this center, the disease swept across Europe. As Jared Diamond describes it, "when syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." In addition, the disease was more frequently fatal than it is today. Diamond concludes that "by 1546, the disease had evolved into the disease with the symptoms so well known to us today." The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease. Some famous historical personages, including Charles VIII, Hernando Cortez of Spain, Adolf Hitler, Benito Mussolini, Vladimir Lenin, and Ivan the Terrible, have been alleged to have had syphilis. Guy de Maupassant and possibly Friedrich Nietzsche are thought to have been driven insane and ultimately killed by the disease. Al Capone contracted syphilis as a young man. By the time he was incarcerated at Alcatraz, it reached its third stage, neurosyphilis, making him confused and disoriented. Syphilis led to the death of artist Edouard Manet and artist Paul Gauguin is also said to have suffered from syphilis. Composers who succumbed to syphilis include Hugo Wolf, Frederick Delius, Scott Joplin, and possibly Franz Schubert.
The insanity caused by late-stage syphilis was once one of the more common forms of dementia; this was known as the general paresis of the insane.
While working at the Rockefeller Institute in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, proving that the spirochete was the cause of the disease.
Tuskegee Syphilis Study - One of the worst (and best-documented) cases of unethical human medical experimentation in the twentieth century was the Tuskegee syphilis study. The study took place in Macon, Alabama and was supported by the Tuskegee Institute. This study began in 1932, a group of 600 poor, uneducated African American sharecroppers were examined to determine the natural course of the disease if left untreated. It was documented that 399 men were infected with the disease and 201 were uninfected control patients. The government stated at first that treatment was supposed to be a part of the study, but they were unable to produce any useful data. It was then discovered that the government had decided to leave the men untreated and follow the course of the disease to these men's eventual deaths. They thought they were receiving experimental treatment for "bad blood" in exchange for free meals and a $50.00 death benefit. However, the study was designed to measure the progression of untreated syphilis and to determine whether syphilis caused cardiovascular damage more often than neurological damage, and to determine if the natural course of the disease was different in black men versus white men. By 1947 penicillin had become the standard treatment of syphilis. The men were never advised that they had syphilis, nor were they ever offered a treatment, not even Salvarsan or the other arsenical drugs that were in use at the beginning of the study. The original study was meant to last six to nine months, but continued for 40 years, ending in 1972, long after many wives and children had been infected, and many of the men had died of syphilis. It was estimated that more than one hundred men and women died for this study. The study only ended because of a story printed in the Washington Star. A class-action lawsuit was then filed against the federal government for the study. This lawsuit was settled out of court and the living subjects and their descendants were awarded a total of ten million dollars. After the settlement was awarded, the government passed the National Research Act, which required the government to review and approve all medical studies involving human studies. (http://www.pbs.org/wnet/aaworld/reference/articles/tuskegee_syphilis_study.html)
ORIGINS OF SYPHILIS
There are 3 theories on the origin of syphilis, which form an ongoing debate in anthropological and historical fields.
The pre-Columbian theory holds that syphilis symptoms are described by Hippocrates in Classical Greece in its venereal/tertiary form. There are other suspected syphilis findings for pre-contact Europe, including at a 13-14th century Augustinian friary in the northeastern English port of Kingston upon Hull. Skeletons in pre-Columbus Pompeii demonstrating symptoms of congenital syphilis have also been found.
The Columbian Exchange theory holds that syphilis was a New World disease brought back by Columbus. The transmission of infections generally went from Europe to the Indies, with disastrous consequences for the indigenous Americans. Supporters of the Columbian theory find syphilis lesions on pre-contact Native Americans and cite documentary evidence linking crewmen of Columbus's voyages to the Naples outbreak of the 1490s.
Evidence for the pre-Columbian and Columbian Exchange theories are each disputed by the opposing school of thought, but Alfred Crosby suggests both are correct. Syphilis is a form of Yaws, similar to tuberculosis which has existed in both Old and New Worlds since time immemorial. According to Crosby: "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases".
In other words, a common ancestor of the syphilis bacterium existed on both the Old and New Worlds, easily spread by the poor hygiene of primitive cultures. As hygiene standards improved in Europe the bacterium was forced to evolve into a more aggressive version to survive and reproduce, which also resulted in it becoming deadly to Humans. The European strain was carried to the New World, where the native population's exposure to the less deadly version of syphilis vaccinated them against the lethal variety. As fewer Native Americans than Europeans succumbed to the deadly syphilis, it appeared to contemporary thinkers that the New World was to blame for the disease.
FREQUENT SIGNS & SYMPTOMS
Syphilis has three stages: primary, secondary and tertiary.
PRIMARY (FIRST STAGE)
The first sign of Primary Syphilis (First Stage) is contagious. It appears 3 to 6 days (some resources state 10 days to 6 weeks or 10 days to 90 days with an average of 21 days) after contact / exposure to the bacterium:
- A painless, red sore (chancre) on the genitals, mouth or rectum (the spot where syphilis entered the body. The sore usually affects the penis in males and vagina or cervix in females. The chancre is firm and has clearly defined borders that are slightly raised. A chancre on the penis is easily visible. However, those that occur on the labia, cervix, anal area, or mouth are frequently unnoticed because they are usually (but not always) painless. There may also be swollen lymph glands.
If adequate treatment is not administered, the infection progresses to the secondary stage.
SECONDARY (SECOND STAGE)
Second Stage or Secondary Syphilis is contagious and begins 6 or more weeks after the chancre appears. Even without treatment, the chancre usually heals spontaneously within 2 months. This is not a sign that the disease is overcome, however, but rather that it has entered the secondary stage:
- Lesions that look like the original chancre are usually prominent on the palms of the hands and soles of the feet. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. A generalized rash in one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Rashes appear on skin and mucous membranes of the penis, vagina or mouth. The rash has small, red, scaly bumps (wart-like patches). Sometimes the rashes associated with secondary syphilis are so faint that the are not noticed.
- Enlarged lymph glands in the neck, armpit or groin.
- Headache, achy muscles and joints.
- Sore throat, patchy hair loss, weight loss, fatigue.
- Fever (sometimes).
Like the chancre, these symptoms also go away. Throughout primary and secondary syphilis the infection continues to be highly contagious. Without treatment, the infection will progress to the latent and late stages of the disease.
TERTIARY (THIRD STAGE)
Latent syphilis: Latent (hidden) syphilis is defined as having serologic proof of infection without signs or symptoms of disease. This is a dormant period that can last for many years. Latent syphilis is further described as either early or late. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk for transmission. In the real-world, the timing of infection is often not known and should be presumed to be late for the purpose of therapy. Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. For infectiousness, however, late latent syphilis is not considered as contagious as early latent syphilis.
Tertiary Syphilis: In Tertiary Syphilis (Third Stage), the infection may flare up after being dormant for many years. Tertiary syphilis usually occurs 1-10 years after the initial infection, though in some cases it can take up to 50 years. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms. At this stage it is no longer contagious.
The disease may damage the cardiovascular or nervous system. It may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include:
- Mental deterioration and dementia.
- Sexual impotence.
- Loss of balance. Paralysis, numbness, difficulty coordinating muscle movements.
- Loss of feeling or shooting pains in the legs.
- Gradual blindness.
- Death may occur if damage is serious enough.
This stage is characterized by the formation of soft tumor-like balls of inflammation called gummas that may form anywhere in the body including the skeleton. Gummas were once readily seen in the skin and mucous membranes although they tend to occur internally in recent history. These are known as granulomas. the granulomas are chronic and represent an inability of the immune system to completely clear the organism. The gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy.
Other characteristics of untreated tertiary syphilis include Charcot's joints which are a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). Clutton's joints are bilateral knee effusions.
The more severe manifestations include neurosyphilis and cardiovascular syphilis. In a study of untreated syphilis, 10% of patients developed cardiovascular syphilis, 16% had gumma formation, and 7% had neurosyphilis.
Neurological complications at this stage can be diverse. In some patients, manifestations include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupils. These are a diagnostic sign in which the small and irregular pupils constrict in response to focusing the eyes, but not to light. Tabes dorsalis, also known as locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait. See below for more information about neurosyphilis.
Cardiovascular complications include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. The course can be insidious, and heart failure may be the presenting sign after years of disease. The infection can also occur in the coronary arteries and cause narrowing of the vessels. Syphilitic aortitis can cause de Musset's sign (a bobbing of the head that de Musset first noted in Parisian prostitutes).
NEUROSYPHILIS
Neurosyphilis refers to a site of infection involving the central nervous system (CNS). Neurosyphilis may occur at any stage of syphilis. Before the advent of antibiotics, it was typically seen in 25-35% of patients with syphilis. Neurosyphilis is now most common in patients with HIV infection. Reports of neurosyphilis in HIV-infected persons are similar to cases reported before the HIV pandemic. The precise extent and significance of neurologic involvement in HIV-infected patients with syphilis, reflected by either laboratory or clinical criteria, have not been well characterized. Furthermore, the alteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization.
Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement, as demonstrated by any of these on cerebrospinal fluid (CSF) examination:
- An abnormal leukocyte cell count, protein level, or glucose level.
- Demonstrated reactivity to Venereal Disease Research Laboratory (VDRL) antibody test.
There are four clinical types of neurosyphilis:
- Asymptomatic neurosyphilis.
- Meningovascular syphilis.
- General paresis.
- Tabes dorsalis.
The late forms of neurosyphilis (tabes dorsalis and general paresis) are seen much less frequently since the advent of antibiotics. The most common manifestations today are asymptomatic or symptomatic meningitis. Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash. Patients present with headache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve. Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.
Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary syphilis infection. Meningovascular syphilis can be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable. Prodromal symptoms include unilateral numbness, paresthesias, upper or lower extremity weakness, headache, vertigo, insomnia, and psychiatric abnormalities such as personality changes. The focal deficits initially are intermittent or progress slowly over a few days. However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients. Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.
General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis. It is a chronic dementia which ultimately results in death in as little as 2-3 years. Patients generally have progressive personality changes, memory loss, and poor judgment. More rarely, they can have psychosis, depression, or mania. Imaging of the brain usually shows atrophy.
Tabes dorsalis is a rare syndrome seen late in neurosyphilis. It can take as few as 3 years to manifest but averages occurs after 20 years. The symptoms are due to disease in the posterior columns of the spinal cord which are responsible for carrying sensory information to the brain from the body. Symptoms include sudden severe stabbing pains, loss of sensation, loss of reflexes, and Argyll-Robertson pupils. The Argyll-Robertson pupils account for half of the cases of tabes dorsalis and are manifested by a small pupil that does not constrict in response to light but does contract with accommodation.
CAUSES
The infecting microorganism for both forms is Treponema pallidum.
The congenital form is spread to the fetus through the bloodstream.
The contagious form is spread by intimate sexual contact with someone who has syphilis in the first or second stages.
RISK INCREASES WITH
Multiple sexual partners.
Sexual activity between homosexual males.
PREVENTIVE MEASURES
Obtain blood serum test for syphilis early in pregnancy. If infected, get immediate treatment.
Use latex condoms during intercourse. See STDs & Condoms for more information. Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Based on findings from several research studies, N-9 may itself cause genital lesions, providing a point of entry for HIV and other STDs. In June 2001, the CDC recommended that N-9 not be used as a microbicide or lubricant during anal intercourse. Transmission of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a health care provider immediately.
Avoid any sexual contact if you suspect or know a person is infected. The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. While abstinence from any sexual activity is very effective at helping prevent syphilis, it should be noted that T. pallidum readily crosses intact mucosa and cut skin.
Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.
All patients with syphilis should be tested for HIV. Individuals sexually exposed to a person with primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be treated, even if he/she is currently seronegative. If the exposure was more than 90 days before the diagnosis, presumptive treatment is recommended if serologic testing is not immediately available or if follow-up is uncertain. Patients with syphilis of unknown duration and nontreponemal serologic titers ≥1:32 may be considered as having early syphilis for purposes of partner notification and presumptive treatment of sex partners. Long-term sex partners of patients with late syphilis should be evaluated clinically and serologically and treat appropriately. Patient education is important as well.
EXPECTED OUTCOME
Usually curable in 3 months with treatment. In spite of treatment, syphilis returns within 1 year in 10% of persons. If this happens, re-treatment is necessary.
POSSIBLE COMPLICATIONS
Widespread tissue destruction and death without treatment.
The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present. Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnostic tests may include laboratory studies, such as a blood serum test for syphilis, a microscopic exam of discharge from the chancre, and a study of spinal fluid. Tests are repeated after treatment.
Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.
A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
WASSERMAN TEST: In 1906, the first effective test for syphilis, the Wasserman test, was developed. Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wasserman test. Both of these early tests have been superseded by newer analytical methods.
DARK FIELD MICROSCOPIC STUDY: It was only in the 20th century that effective tests and treatments for syphilis were developed. Microscopy of fluid from the primary or secondary lesion using darkfield illumination can diagnose treponemal disease with high accuracy. As there are other treponemes that may be confused with T. pallidum, care must be taken in evaluating with microscopy to correlate symptoms with the correct disease.
VDRL & RPR TESTS: Present-day syphilis screening tests, such as the Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests are cheap and fast but not completely specific, as many other conditions can cause a positive result. False positives can be seen in viral infections (Epstein-Barr, hepatitis, varicella, measles), lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy, intravenous drug abuse, or contamination.
OTHER TESTING AS FOLLOW-UP
As a result, these two screening tests (VDRL & RPR) should always be followed up by a more specific treponemal test. Tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum hemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific and more expensive. Unfortunately, false positives can still occur in related treponomal infections such as yaws and pinta. Tests based on enzyme-linked immunoassays are also used to confirm the results of simpler screening tests for syphilis.
Neurosyphilis is diagnosed by finding high numbers of leukocytes in the CSF or abnormally high protein concentration in the setting of syphilis infection.[7] In addition, CSF should be tested with the VDRL test although some advocate using the FTA-ABS test to improve sensitivity. There is anecdotal evidence that the incidence of neurosyphilis is higher in HIV patients, and some have recommended that all HIV-positive patients with syphilis should have a lumbar puncture to look for asymptomatic neurosyphilis.
It is important that you ensure that all your sexual partners obtain treatment. The public health department will work with you to notify contacts confidentially and help them obtain treatment.
HISTORICAL TREATMENT FOR SYPHILIS
There were originally no effective treatments for syphilis. The Spanish priest Francisco Delicado wrote El modo de adoperare el legno de India (Rome, 1525) about the use of Guaiacum in the treatment of syphilis. He himself suffered syphilis. Another common remedy was mercury: the use of which gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury". It was administered multiple ways including by mouth and by rubbing it on the skin. One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box which caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body.
As the disease became better understood, more effective treatments were found. The first antibiotic to be used for treating disease was the arsenic-containing drug Salvarsan, developed in 1908 by Sahachiro Hata while working in the laboratory of Nobel prize winner Paul Ehrlich. This was later modified into Neosalvarsan. Unfortunately, these drugs were not 100% effective, especially in late disease. It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time malaria was used as treatment because it produced prolonged and high fevers. This was considered an acceptable risk because the malaria could later be treated with quinine which was available at that time. This discovery was championed by Julius Wagner-Jauregg, who won the 1927 Nobel Prize for Medicine for his work in this area. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured.
CURRENT TREATMENT FOR SYPHILIS
Syphilis is easy to cure in its early stages. Syphilis can be easily treated with antibiotics including penicillin. The oldest, and still most effective, method is an intramuscular injection of benzathine penicillin ( Penicillin G Benzathine). A single deep intramuscular injection of penicillin or other antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.
The effect of penicillin on syphilis was widely known before randomized clinical trials were used; as a result, treatment with penicillin is largely based on case series, expert opinion, and years of clinical experience. Parenteral penicillin G is the only therapy with documented effect during pregnancy.
Nonpregnant individuals who have severe allergic reactions to penicillin (e.g., anaphylaxis) may be effectively treated with oral tetracycline or doxycycline although data to support this is limited. Ceftriaxone may be considered as an alternative therapy, although the optimal dose is not yet defined. However, cross-reactions in penicillin-allergic patients with cephalosporins such as ceftriaxone are possible. Azithromycin was suggested as an alternative. However, there have been reports of treatment failure due to resistance in some areas. If compliance and follow-up cannot be ensured, the CDC recommends desensitization with penicillin followed by penicillin treatment. All pregnant women with syphilis should be desensitized and treated with penicillin. Follow-up includes clinical evaluation at 1 to 2 weeks followed by clinical and serologic evaluation at 3, 6, 9, 12, and 24 months after treatment.
Late latent and infections of unknown duration (late latent syphilis is defined as latency for greater than one year) - if CSF examination yields no evidence of neurosyphilis, then penicillin G is recommended as weekly doses for 3 weeks. If allergic, then tetracycline or doxycycline may be used for this stage also, but for 28 days instead of the normal 14. As with before, the data to support use of tetracycline and ceftriaxone are limited.
For patients diagnosed with neurosyphilis including ocular or auditory syphilis with or without positive CSF results, aqueous crystalline penicillin G is the treatment of choice. The recommended regimen is intravenous treatment every 4 hours or continuously for 10-14 days. If intravenous administration is not possible, then procaine penicillin is an alternative (administered daily with probenecid for two weeks). Procaine injections are painful, however, and patient compliance may be difficult to ensure. To approximate the 21-day course of therapy for late latent disease and to address concerns about slowly dividing treponemes, most experts now recommend 3 weekly doses of benzathine penicillin G after the completion of a 14-day course of aqueous crystalline or aqueous procaine penicillin G for neurosyphilis. No oral antibiotic alternatives are recommended for the treatment of neurosyphilis. The only alternative that has been studied and shown to be effective is intramuscular ceftriaxone daily for 14 days.
Alternative regimens (eg, tetracyclines) are not well studied in HIV infection and a careful follow-up is recommended. Tetracyclines are contraindicated in pregnancy.
HIV-infected patients with early syphilis may have a higher risk of neurologic complications and a higher rate of treatment failure with currently recommended regimens. The magnitude of these risks, however, although not precisely defined, is probably small. Skin testing or desensitization is recommended in latent syphilis and neurosyphilis in other patients with HIV infection.
Before administering any treatment, clinicians should warn all patients about the possibility of a Jarisch-Herxheimer reaction, which occurs most often in secondary syphilis and with penicillin therapy, and may be more common in HIV-infected patients. This reaction is characterized by fever, fatigue, and transient worsening of any mucocutaneous symptoms, and usually subsides within 24 hours. These symptoms can be alleviated with acetaminophen and should not be mistaken for drug allergy. In addition, clinicians should inform HIV-infected patients that currently recommended regimens may be less effective for them than for patients without HIV infection and that close serologic follow-up is therefore essential.
Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
FOLLOW-UP CARE
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after treatment has been received.
After treatment, have blood studies done each month for 6 months to check for recurrence. Then repeat blood studies every 3 months for 2 years.
Additional information is available from the Sexually Transmitted Diseases Hotline (800) 227-8922.
MEDICATION
Penicillin by injection unless you are allergic to it. If penicillin cannot be used, other antibiotics will be equally as effective. Always take the full course of any prescribed antibiotic medication. Taking only part of the prescribed medication wipes out the weakest bacteria but leaves the stronger bacteria resistant to the antibiotic to multiply.
Topical medications as needed for skin symptoms.
Use a latex condom with Nonoxynol-9 lubricant for sexual activity of any kind until the infection is gone completely, as syphilis is highly contagious. Be aware, though that using a condom does not guarantee complete protection. The only form of complete protection is abstinence.
ACTIVITY
Avoid sexual intercourse until cure is complete. Then use condoms during sexual intercourse.
DIET
No special diet. However, it is very important that you follow a healthy dietary plan for a strong immune system to fight infections.
To protect the helpful bacteria in your digestive tract, take antibiotics with a probiotic supplement such as Lactobacillus acidophilous or Bifidobacterium bifidus and for two weeks after the antibiotic prescription runs out. Take the probiotic as far apart from the antibiotic as possible.
Avoid 5-HTP Supplements. Syphilis alters the body's use of the amino acid tryptophan and related chemicals such as 5-HTP so that they form nerve toxins.
Herbs or other nutritional supplements recommended are used to help relieve the severity of the symptoms but do not cure the disease. You will have to be treated with antibiotics to cure the disease.
Beneficial Herbs Supplement Suggested Dosage Comments Astragalus capsules or tincture. Take as directed on the label. Protects the immune system. Butcher's Broom Ruscogenin tablets. Take 100 mg once daily. Shrinks the swollen lymph glands. Copaiba Oil. Apply to lesions daily. Soothes inflammation; accelerates healing. Rooibos Tea Bags. Prepare and take as directed on the label. Stops generalized inflammation and pain.
Helpful Products
Astragalus Root, Nature's Way, 470 mg, 180 Vcaps
Astragalus root from Nature's Way is considered to have a normalizing effect on the body's functions. Astragalus is an important herb in Chinese medicine and is commonly included in Chinese cuisine. Recommendation: Take 3 capsules three times daily with food or water.
Butchers Broom Tincture, 100% Organic, 2 fl. oz.
Butchers Broom is a laxative and diuretic and it is also used to improve circulation problems, hemorrhoids, varicose veins, arteriosclerosis, and blood clots. Also strengthens the blood vessels. Properties of Butcher's Broom included anti-inflammatory and vasoconstrictive. Suggested Dosage or Use: Use 6-12 drops in juice, water, under the tongue or as desired. May be taken 3 times daily. Shake well. Store in cool dark place. Keep out of reach of children.
Acidophilus Powder, Non Dairy, 4 oz. Bulk
Acidophilus Powder taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora. Suggested Dosage or Use: It should be taken on an empty stomach and/or one hour prior to meals. 1/4 teaspoon 1/2 hour before eating. Normally, acidophilus is refrigerated.
Sassafras Tincture, 100% Organic, 2 fl. oz.
Sassafras has been used as a stimulant, diaphoretic, and alterative. When combined with guaiacum or sarsaparilla it helps treat chronic rheumatism, syphilis, and skin diseases such as eczema and acne. The oil is said to relieve the pain caused by menstrual obstructions. As a topical it can be used for rheumatic pains and has even been used as a dental disinfectant. Suggested Dosage or Use: Take 6-12 drops in liquid or under the tongue, 1-3 times/day. Warning: Sassafras could induce abortion; therefore, not to be used by pregnant women.
Sarsaparilla Tincture, 100% Organic, 2 fl. oz.
Sarsaparilla is used for sexual impotence, rheumatism, and skin disorders such as acne, dermatitis, eczema, and psoriasis. As a tonic, Sarsaparilla is used for physical weakness, for enhancing the male reproductive system, and it aids in relieving low mood and debility associated with menopause. Sarsaparilla is also a cleansing remedy for skin and joint problems. Suggested Dosage Use: Take 6-12 drops in liquid or under the tongue, 1-3 times/day.
Rooibos Organic & Caffeine Free Herb Tea, 25 Tea Bags
Rooibos is a red tea indigenous to South Africa. Research has found Rooibos provides numerous health benefits including relief from insomnia, stomach cramps and constipation, as well as allergic symptoms such as hay fever and asthma. Rooibos is a caffeine-free tea recommended for individuals suffering from nervous tension, mild depression or hypertension. Scientists note Rooibos contains a mimic of the enzyme SOD (superoxide dismutase), an antioxidant that scavenges for free radicals, thus limiting their damaging effect. Serving Suggestion: Use one tea bag per cup of boiling water. Steep for 2 - 3 minutes. Serve hot or cold. Rooibos tea will keep refrigerator for up to two weeks without cloudiness or loss of flavor. It can also be reheated without flavor loss.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
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NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of syphilis or you feel you may have been exposed to syphilis and you need to be tested.
The following occur during or after treatment:
- Fever.
- Skin rash, sore throat or swelling in any joint, such as the ankle or knee.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
- You once had syphilis and have not had a medical check-up in the past year.
- You have had sexual contact with someone who has syphilis.
MoonDragon's Obgyn Information: Sexually Transmitted Diseases (STDs)
