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SYPHILIS TREATMENT

Syphilis is a bacterial infection that usually spreads through sexual contact.

syphilis

Briefly

Syphilis initially begins as a painless lesion on the mouth, genitals or rectum and it is gradually progressing, affecting all people coming to direct contact with the sores on the skin and mucous membrane.

The infection’s bacteria may remain dormant for many years even decades before they are activated again. Syphilis in early stage is treatable, often with one shot of penicillin. If left untreated, syphilis may cause severe damage to the brain, heart and other organs and can also turn out as a serious threat to the patient’s life.

Symptoms

It develops gradually in stages. However, symptoms vary in each stage, while at times the later may overlap not always occurring in the same sequence. There are chances of infection that goes unnoticed as it remains asymptomatic for several years.

Primary syphilis: The first symptom is a small lesion, a chancre, at the area where the infection bacteria accessed the body. Usually, the majority of patients develop one sore, however there are cases were people developed more than one chancres. The lesion usually occurs approximately 3 weeks after being exposed to the infection. Painless as it is, the chancre is more likely to go unnoticed, & may hide within the rectum or the vagina. The sore will heal within the following six weeks on its own.

Secondary syphilis: The original sore may be healed but in the following weeks after that, the patient may develop a rash on their torso which will finally cover the whole body, soles & palms included. Sometimes following to this rash, which is not itchy, may occur wart like lesions in the genital area or the mouth. At times, patients may experience fever, swollen lymph nodes, sore throat and muscle aches. In a few weeks these symptoms and signs may either disappear or come and go repeatedly for months even a year.

Latent syphilis: If syphilis is left untreated it will move to the next stage, the latent one, which is asymptomatic, and may last for many years. In this stage syphilis may move to the next stage (tertiary) or the symptoms and signs may never come back.

Tertiary syphilis: Approximately, 15-30% of infected people who don’t get treatment will experience complications, which, in the final stages, may cause damage to the nerves, brain, blood vessels, heart, eyes, liver joints and bones, problems which may appear even years after the initial infection which was left untreated. Depending on the area where the lesion is localised, the disease gets its name. The most characteristic types include cardiovascular syphilis, neurosyphilis and syphilis of the bones.

Congenital syphilis: Pregnant women suffering from syphilis can transmit the infection to the unborn baby during birth or through the placenta. The majority of syphilis newborns infected by congenital syphilis experience no symptoms whereas there are cases where babies develop a rash on their soles of their feet or on their palms.If the disease progresses, it may cause deafness, as well as teeth and nose deformities.

When to visit a dermatologist

Arrange an appointment with the dermatologist-venereologist if you observe any unusual discharge, sores or rashes, particularly if these occur in the groin area.

Causes

Treponema pallidum is the bacterium responsible for syphilis. Sexual intercourse is the most common way of transmission is sexual intercourse. Minor cuts, mucous or skin membranes are the main routes the bacteria use to enter the body.
It is contagious during its primary and secondary stages, and sometimes in the early latent period. It cannot be transmitted by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs. Once cured, it doesn’t recur. However, you can become reinfected if you have contact with someone’s syphilis sore.

Risk factors

Factors that may increase the risk of acquiring syphilis include:
• Unprotected sexual contact
• Large number of sexual partners
• Sexual contact between men
• HIV infection, the virus that produces AIDS

Complications of syphilis

If it remains untreated, it can lead to serious problems throughout the patient’s body. The risk of HIV Infection is very high while women may experience several problems while pregnant. It’s worth noticing that treatment acts proactively in the prevention of future problems but can not reverse or repair any damage that has already happened.

Small bumps or tumours: These bumps may develop in the late stage of syphilis on the bones, the liver, on the skin, or any other organ. These bumps or tumours usually disappear after treatment with antibiotics.

Neurological problems: It can cause a number of problems with your nervous system, such as stroke, meningitis, deafness, visual problems or dementia.

Cardiovascular problems: Syphilis may lead to aneurysm and inflammation of the aorta (the major artery of the body), as well as of other blood vessels. Syphilis may also cause damage of the heart valves.

HIV Infection: It has been estimated that adults with sexually transmitted syphilis or other genital ulcers have around 2 to 5 times more chances to be infected with HIV. As syphilis lesions bleed easily, they constitute an easy route for HIV to enter your circulatory system during sexual intercourse.

Pregnancy and childbirth complications: Pregnant women may infect their unborn baby. On top of that congenital syphilis can be fatal for the baby’s life as there is the possibility of miscarriage, stillbirth or even death of the newborn few days after birth.

Tests and diagnosis

Syphilis can be diagnosed by testing samples of:

Blood: The body produces antibodies to fight the infection. Blood testing samples are able to confirm their presence. On top of that, given the fact that they do remain in the organism for years, performing a blood test can verify not only a current but also a previous infection.

Fluid from sores: Your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. This test can be done only during primary or secondary syphilis, when sores are present. The scraping can reveal the presence of bacteria that cause syphilis.

Cerebral spinal fluid: If there is any suspicion that the patient may experience complications in their nervous system, the doctor may recommend this testing to confirm or reject the suspicion. More specifically, the testing includes the taking of a sample of cerebrospinal fluid through a spinal tap (lumbar puncture).

Treatments and medications

When the infection is treated on time, that is in the early stages, then the curation process is easy. Usually, the recommended treatment is penicillin, which can destroy the bacteria that causes the infection. In cases where some patients are allergic to penicillin, then another antibiotic medication can be used.

If a patient is infected for less than 12 months, then just one injection of penicillin is able to put an end to the infection’s progress. But, this is not the case, for patients for are infected longer, where they will need more doses of penicillin.

In addition, pregnant women infected with syphilis are strongly recommended to receive treatment with penicillin, as it is the only effective antibiotic medicine. In the case where they are allergic, they should first go through a desensitization process which will make them eligible to receive penicillin. Women who have been treated for syphilis while being pregnant is of utmost importance that their newborn child will also receive an antibiotic based treatment for the infection.

On the first day of the treatment, the patient is possible to experience the Jarisch-Herxheimer reaction which will last for about 24 hours. Symptoms and signs include nausea, fever, achy pain as well as headache.

Follow-up period

Patients receiving syphilis treatment will be asked by the dermatologist-venereologist to:

• Have periodic blood tests to confirm that they are responding to the usual dosage of penicillin
• Avoid sexual intercourse until the completion of the treatment and until there is confirmation by the blood tests that syphilis has been cured.
• Inform their sex partners to be tested & receive treatment if necessary
• Be tested for HIV infection

Prevention

Transmission can be prevented if:

You abstain from sexual contacts or you are monogamous: The only certain way to avoid syphilis is to forgo having sex. The next-best option is to have mutually monogamous sex with one partner who is uninfected.

Use a latex condom in each and every sexual contact: Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.

Do the relevant exams before becoming pregnant: If you are planning to have a baby, it is advisable to have a test for syphilis and other sexually transmitted diseases before becoming pregnant.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

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