What is Syphilis from a Medical Perspective?

• Primary Syphilis: Initial infection marked by a painless ulcer (chancre).
• Secondary Syphilis: Widespread systemic infection with skin rashes and mucocutaneous lesions.
• Tertiary Syphilis: Late-stage complications affecting vital organs (heart, brain) if untreated.
• Latent Syphilis: Asymptomatic but detectable via blood tests, divided into early (≤2 years) and late (>2 years) stages.

Syphilis is a reportable disease under international health regulations and remains a significant global public health concern.

Symptoms of Syphilis

Stage-Specific Manifestations:

1. Primary Syphilis (2-4 weeks post-exposure):
   • Chancre: Single, painless ulcer at the infection site (genitals, anus, mouth).
   • Enlarged lymph nodes near the chancre.
   • Self-resolves in 3-6 weeks without treatment.
2. Secondary Syphilis (6 weeks to 6 months post-infection):
   • Generalized maculopapular rash (often on palms/soles).
   • Mucous membrane lesions, hair loss (“moth-eaten” pattern).
   • Flu-like symptoms: Fever, fatigue, muscle aches.
   • Condyloma lata (smooth, moist lesions in warm body folds).
3. Tertiary Syphilis (10-30+ years post-infection):
   • Cardiovascular Syphilis: Aortic aneurysms, aortic insufficiency.
   • Neurosyphilis: Cognitive decline, seizures, tabes dorsalis (neuropathy).
   • Gummatous Syphilis: Soft, necrotic tissue masses in bones/skin.
4. Latent Syphilis: No visible symptoms but detectable antibodies.

Syphilis Diagnostic Methods

Testing involves sequential blood assays and clinical evaluation:

1. Non-Treponemal Tests:
   • Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL).
   • Quantitative results used for monitoring treatment response.
2. Treponemal Tests:
   • Fluorescent Treponemal Antibody Absorption (FTA-ABS) or Treponema Pallidum Particle Agglutination (TPPA).
   • Confirmatory tests for specificity.
3. Darkfield Microscopy: Direct visualization of spirochetes in chancres/rash exudates.
4. Molecular Tests: PCR for early detection or neurosyphilis confirmation.

Testing Guidelines:

• Annual screening for sexually active individuals at risk.
• Pregnancy screening at first prenatal visit and delivery.
• Partner notification and testing required for confirmed cases.

Medical Management of Syphilis

• Primary/Secondary Syphilis: 2.4 million units IM as a single dose.
• Latent Syphilis (early): 2.4 million units IM weekly for 3 weeks.
• Latent Syphilis (late) or Tertiary Syphilis: 2.4 million units IM weekly for 3 weeks.
• Neurosyphilis: Daily aqueous penicillin G (10-14 days) followed by benzathine penicillin.
• Pregnancy: Benzathine penicillin G (2.4 MU weekly for 3 doses).

Important Considerations:

• Penicillin allergy management requires desensitization protocols.
• Follow-up RPR/VDRL testing for 2-3 years post-treatment.
• Sexual abstinence until serology stabilizes.

Frequently Asked Questions (FAQ)

Preventing Syphilis Transmission

Key Strategies:

• Safe Sex Practices:
  • Condoms reduce transmission risk but not 100% effective.
  • Avoid sexual contact with active chancres/rashes.
• Screening Programs:
  • Regular STI testing for high-risk groups (new partners, MSM).
  • Pregnancy-specific screening protocols.
• Partner Notification:
  • Contact tracing and treatment of sexual partners within 90 days of infection.
• Public Health Measures:
  • Sex education emphasizing abstinence and monogamy.
  • Access to clean needles for injecting drug users.