DATE: Sept. 7, 2008

TOPIC: Syphillis

Just to make you aware that in the past week we have diagnosed 3 cases of early syphilis (two unrelated).  This is quite unusual and there is no recent travel history to Indy or Chicago.  This is always a worry as it can be a harbinger of an increase in other STDs like gonorrhea or HIV.  Below is a quick review of syphilis.

Agent:  The bacterium Treponema pallidum.

Transmission: Syphilis is passed from person to person through direct contact with a syphilis sore, which occur mainly on the external genital, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Most new cases occur in both men and women aged 15-39 years, with the highest infection rates in persons aged 20-29 years

Incubation Period: 10 to 90 days (average 21 days).

Signs and Symptoms:  It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

Primary: The initial lesion of primary syphilis develops at the site of transmission after an incubation period of 10-90 days, with a mean of about 21-28 days, and then heals spontaneously in 3-7 weeks.

 Secondary: develops about 4-10 weeks after the appearance of the primary lesion and has a wide range of presentations. The most common systemic manifestations include malaise, fever, myalgias, and arthralgias with a generalized body rash and lymphadenopathy. These manifestations are termed the dermatitis-arthritis syndrome. Symptomatic secondary syphilis usually resolves without treatment.

 Tertiary: The latent stage that may be divided into early and late latent phases.

Early latent syphilis is: acquired syphilis within the preceding year, that is, (1) documented seroconversion; (2) unequivocal symptoms of primary or secondary syphilis; or (3) partner documented with primary, secondary, or early latent syphilis.

Occasional relapses of active secondary lesions can occur.

Late latent syphilis is seroreactivity, in the absence of symptoms, greater than 2 years after inoculation. During the late latent stage, patients typically do not have infectious lesions. Tertiary syphilis is defined as seroreactivity greater than 2 years with symptoms. This can include all organ systems and, as alluded to earlier, manifests in many ways. As many as 40% of untreated infections can develop into tertiary disease.

Diagnosis: A positive darkfield examination is the only means of making an absolute diagnosis of syphilis.  Patients with a reactive VDRL or RPR should have the result confirmed by specific treponemal testing ( fluorescent treponemal antibody absorption (FTA-ABS) and the microhemagglutination assay for T pallidum (MHA-TP).

Treatment: Primary, secondary, and early latent syphilis ( <1 y duration):Single dose of benzathine penicillin G, 2.4 million U IM

Late latent syphilis (>1 y duration), syphilis of undetermined duration, and late syphilis: Benzathine penicillin G, 2.4 million U IM once weekly for 3 consecutive weeks

Feel Free to refer to us for treatment and this is a reportable diseases (449-7504)

To view pictures of syphilitic lesions:  http://www.lib.uiowa.edu/hardin/Md/cdc/syphilis.html