Syphilis

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What is it about ?

Syphilis is a sexually transmitted infection (STI) that is caused by Treponema Pallidum, a spiral-shaped bacteria (spirochete). Syphilis can be passed through sexual contact, but it can also be passed from mother to child during pregnancy.

Unprotected sex, theHIV infection and prostitution are important risk factors. Men who have sex with men (MSM) are an important subgroup among patients with syphilis. The chance of getting syphilis after unprotected sex with an infected partner is 1 in 3.

What is its frequency?

Each year, there are 12 million new cases of syphilis worldwide. In Belgium, the number of cases of syphilis is increasing every year. Between 2011 and 2012, the increase was 4%. The average increase was 25% between 2002 and 2013. The increase in the number of reported cases of syphilis is more marked in Flanders (33%).

How to recognize it?

Syphilis is sometimes referred to as a “great imitator” because its symptoms can also manifest in other conditions.

Syphilis is characterized by different stages:

  • the incubation period: this is the interval between contamination and the appearance of the first symptoms. This stage usually lasts 3 to 4 weeks.
  • first stage (primary): initially, symptoms are limited to the site of infection: genitals, anus and oral mucosa. In about two-thirds of infected people, a hard, painless ulcer (“syphilitic chancre”) develops there on average three weeks after infection. The lesion heals without treatment in four to six weeks. Lymph nodes near the chancre (in the groin or neck area) are swollen, but not painful.
  • second stage (secondary): about three to six weeks after the syphilitic chancre has formed, more general symptoms appear: malaise, fever, muscle pain and swollen lymph nodes. The most prominent sign is a diffuse rash, especially on the trunk and limbs, including the palms of the hands and the soles of the feet. This type of rash can accompany all viral infections and is therefore not characteristic of syphilis. Pearl-gray warty lesions sometimes develop around the anus or on the genitals. Some may lose their hair and develop characteristic bald patches.
  • latent stage: there are no more symptoms or skin abnormalities. The disease appears to be cured, but syphilis is still detectable in the blood. We speak of late latent syphilis when the contamination dates back more than a year. The infection can then no longer be transmitted sexually. About a third of untreated infected people progress to the third stage, the others remaining asymptomatic until the end of their life.
  • third stage (tertiary): tertiary syphilis can develop about 2 to 30 years after infection. This stage is characterized by inflammatory foci in the form of nodules which can appear both on the skin and in all internal organs. Symptoms depend on the organs affected. The most common forms are cardiovascular syphilis and nervous system syphilis.

How is the diagnosis made?

Syphilis can be identified by taking a blood test. If you’ve had unprotected sex, your doctor will screen you for other STIs as well. One and the same person can indeed have several STIs at the same time. If the contamination is very recent, the blood test may still be negative. In this case, the doctor will scrape off some tissue from the syphilitic chancre and examine it under a special microscope. The blood test will also be repeated a little later.

What can you do ?

Get out covered. Always use a condom, including oral sex. Get tested if you’ve had unprotected sex. See your GP right away if you think you have contracted an STI. If the infection is confirmed, tell your sexual partners in the past three to 12 months (depending on the stage of syphilis). This will allow them to receive the appropriate treatment in good time. You can of course tell them about it directly, but there are also ways to notify them anonymously. You can thus use an anonymous letter, sent by the doctor, an SMS or an anonymous e-mail.

What can your doctor do?

Syphilis can be treated with antibiotic therapy. The antibiotic of choice is penicillin injection. If you are allergic to penicillin, the doctor will choose another antibiotic. Syphilis is a reportable disease. The doctor must therefore declare any new diagnosis.

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Source

Foreign clinical practice guide ‘Syphilis’ (2000), updated on 24.05.2017 and adapted to the Belgian context on 18.02.2018 – ebpracticenet