An entire field of scientific study centered around the disease, and skin diseases were classified as being syphilis-related or not. Over time, as a result of the pathogen adapting to humans, the disease has evolved into a chronic illness with well-defined stages. In Hungary, since the mid-90’s and the turn of the century, the number of cases of early infectious syphilis has been on the rise. Numerous factors play a role in the spread of the disease, not the least of which is the lack of sufficient information about this sexually transmitted disease among sexually active individuals. Patients frequently ask, “Is syphilis still a problem?”
Author: dr Viktória Várkonyi, internationally recognized expert.
Syphilis is caused by a characteristically corkscrew-shaped, extremely sensitive bacteria (Treponema pallidum), which perishes very quickly outside of the host body. The transmission of the infection, therefore, is dependent on intimate body contact which allows the infected secretions (semen, vaginal secretions, saliva) to pass directly into the partner’s system. An infected pregnant woman can infect her child, the most serious result of which is necrosis of the fetus. Direct blood contact can also play a role in the transmission of the disease; intravenous drug users contaminated needles and syringes are also possible transmitters of the disease.
Without treatment, the course of the disease is chronic, with well-defined stages which affect the entire body.
In the classical case, a painless, well-defined firm skin lesion appears at the point of initial exposure – genitals, mouth, anus, or other areas of the body involved in sexual foreplay (e.g., biting of the nipples, manipulation with fingers that have microscopic lesions on the skin) – in three weeks on average, the surface of which ulcerates within a short a period of time. This is the primary ulcer, which swarms with treponemes and is extremely contagious. Soon after, the lymph nodes in the vicinity become swollen and painful. In men, the appearance of the ulcer is frequently followed by swelling of the penis, causing pain, as well as constriction. The screening test is negative when the ulcer appears, but a positive result can be reliably obtained when the swelling sets in.
Symptoms of the primary stage of the disease are more difficult to detect in women, because they are often hidden due to the anatomic structure of the female genitalia. The clinical symptoms can disappear by themselves, while the infected blood and all of the secretions involved in the sexual act (semen, vaginal, saliva) are severely contagious. The patients are therefore asymptomatic, but extraordinarily contagious; they can infect their partners through unprotected sex, who can then spread the disease to other individuals.
If the affected individuals remain unaware of the disease in the earliest stages, the clinical symptoms of secondary syphilis appear approximately 9 weeks following the date of infection. Typically, these are light pink, non-itchy spots, which later develop into a reddish-brown, palpable rash, frequently with collars of peeling edges. In many cases, however, there is a deviation from this classical manifestation. Oozing, foul-smelling nodes can be observed in the folds of the skin and on the genitals. The oozing lesions are particularly infectious. Often typical symptoms can only be found on the palms of the hands and soles of the foot. The secondary stage of syphilis may be preceded by or accompanied by general symptoms, like malaise, despondency, weakness and, frequently, symptoms which indicate involvement of the central nervous system (headache, disorders of vision and hearing).
Patients are frequently diagnosed with a positive blood test, in spite of being asymptomatic. Syphilis has been called “the Great Imitator” because of the many variations in its manifestation, for which reason it is important to consider the syphilitic infection which may be the underlying cause of certain symptoms.
Syphilis is a curable disease. Its diagnosis and treatment is the task of the venerologist (specialist in sexually transmitted diseases).
Establishment of the diagnosis: clinical and serological (screening) examination following the taking of a patient history, direct isolation of the pathogen in the case of oozing lesions.
It is important to be aware that the course of syphilis can be modified by the unjustified use of antibiotics, and the use of disinfectant on the painless sores can prevent the direct demonstration of the pathogen.
The infection can be transmitted in both directions via oral and anal sex, in addition to genital sex.
Syphilis and HIV infection are frequently transmitted together. The two, primarily sexually transmitted diseases have many common characteristics:
- Both diseases are primarily transmitted through sexual contact;
- The risk factors associated with acquiring the disease are the same in both diseases: unprotected sexual contact, frequent change of sexual partners, relationships that are limited to sex only!! The incidence of both diseases is facilitated through promiscuity!
- The joint occurrence of HIV and syphilis is detrimental to the system’s immune response and they mutually influence the course of the diseases. There is a predilection for syphilis to appear in atypical forms in HIV patients; lues maligna is frequently observed, as is the speedy development of syphilitic symptoms within just a few weeks or months, reactivated infections and the unusually aggressive appearance of neural syphilis.