Sexually Transmitted Infections: Syphilis

Introduction

• Description: Since antiquity, syphilis has been the prototypic venereal disease. This disease presents with an easily overlooked first stage and, if left untreated, can slowly progress to a disabling disease noted for central nervous system, cardiac, and musculoskeletal involvement.

• Prevalence: Increasing; in 2019, 129,813 cases of all stages of syphilis, were reported, including 38,992 cases of primary and secondary (P&S) syphilis reported in the United States, a rate of 3.9 cases (P&S) per 100,000 women. Men account for most cases of syphilis, with most cases occurring among men who have sex with men (56.7% of male cases). It is the second most common of genital ulcers (after herpes).

• Predominant Age: 15–30 years (85%).

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Treponema pallidum is a very small group of spirochetes that are virulent for humans. This motile anaerobic spirochete can rapidly invade even intact moist mucosa (epithelium).

• Risk Factors: It is estimated that approximately one-third of patients exposed to early syphilis acquire the disease.

Signs and Symptoms (Based On Stage)

• Primary stage—10–60 days (average 21 days) after inoculation—painless chancres (shallow, firm, punched out, with a smooth base and rolled edges; on the vulva, anus, rectum, pharynx, tongue, lips, fingers, or the skin of almost any part of the body)

• Second stage—low-grade fever; headache; malaise; sore throat; anorexia; generalized lymphadenopathy; a diffuse, symmetric,

  

  asymptomatic maculopapular rash over the palm and soles (“money palms”); mucous patches; condyloma lata, “moth-eaten” alopecia

• Tertiary stage—cardiac or ophthalmic manifestations, auditory abnormalities, or gummatous lesions

Diagnostic Approach