Syphilis – causes, complaints & therapy

Syphilis, also known as lues or hard chancre, is a chronic infectious disease that proceeds in three stages and can be fatal if left untreated. Syphilis is one of the sexually transmitted diseases.

In the Middle Ages, syphilis also played a major role in this country as a “French disease”, nowadays the infection is on the rise again, especially among homosexual men.

Causes

Syphilis is caused by the bacterium Treponema pallidum, which can be transmitted from mother to child via direct sexual intercourse, rarely via blood transfusions or during birth via the uterus.The Treponema bacterium can be transmitted via the smallest damage and injuries to the skin (wound) but also via the mucous membrane (vaginal, oral, anal).

However, transmission through skin contact is also possible. This applies in particular to the highly contagious secretion that escapes from the ulcers.

After infection, the bacterium remains in the body for life without adequate therapy, causing the typical course of syphilitic disease.

Symptoms and course

If syphilis is not treated, various symptoms occur, which proceed in four different stages of the disease. Early syphilis is called the first two stages, while the last two stages are called late syphilis.

First stage of the disease (primary stage)

It takes about two to three weeks for the first symptoms of the disease to appear. First, it comes to the so-called “hard chancre” (ulcer durum), a painless, single, reddened and weeping ulcer on the external genitalia. This primary affect is highly contagious and is to blame for a possible transmission of the disease. In addition to the hard chancre, there are also swollen inguinal lymph nodes. The primary affect usually disappears after a few weeks, but the primary stage of the disease can last up to a year.

Second stage of the disease (secondary stage)

In the secondary stage of syphilis, the bacteria then spread through the bloodstream throughout the body. 2 to 3 months after infection, very diverse symptoms can occur. In the foreground are often reddish rashes of the skin, wide condylomas, hair loss and plaques on the oral mucosa.

Furthermore, involvement of the eye or liver is possible. Lymph node swelling all over the body can occur. The secondary stage lasts up to 5 years with strongly changing or temporarily absent symptoms. In 30% of cases, spontaneous healing also occurs here.

Third stage of the disease (tertiary stage)

The remaining 70% eventually pass into the third stage of neurolues, in which neurological symptoms can still come to the fore up to 50 years after infection. It comes to cerebral infarctions, various deficits, loss of sensation and pain, mental and intellectual disorders up to progressive dementia.

Fourth stage of the disease (Quaternary stage)

In the tertiary stage of syphilis, there is an infestation of skin, bones and muscles with the typical “gums”, which can easily be misinterpreted as tumors. Syphilis also affects the heart at this stage, leads to sagging of the aorta with a risk of bleeding and disorders of heart valve function.

When to see a doctor?

A doctor should always be consulted if syphilis is suspected. Untreated syphilis can cause serious complications and, in the worst case, be fatal. As already described, this highly contagious infectious disease usually progresses through different phases. Syphilis can be treated well with antibiotics in the early stages (primary and secondary stages).

Complications can increase during the late stages of syphilis (tertiary and quaternary stages). Here, intensive penicillin therapy under inpatient observation in the hospital is usually necessary.

Pregnant women in particular should take the suspicion of syphilis seriously and talk to their gynecologist about it, because from the 20th week of pregnancy there is a risk of infection for the unborn child. This would then lead to a case of syphilis connata, which could result in severe damage to the child and would have to be treated while still in the womb. If such a case is present, the child must also be medically monitored after birth in order to be able to treat it in good time if symptoms develop.

Diagnosis

First, the family doctor collects the medical history, whereby the sexual life of the patient has a high priority. If there is a suspicion of syphilis infection during the physical examination, the diagnosis is made by sophisticated serological examinations.

Direct detection of the pathogen is possible in the first two stages of infection. For this purpose, a smear is taken from the oral mucosa or the secretion of the weeping skin lesion and examined under the microscope (in the dark field) for syphilis pathogens. If the result is positive, the diagnosis is considered secure.

In addition, a blood test is used to check whether the immune system has already formed antibodies against the pathogen. The test for non-specific antibodies is positive from about the third week after infection. However, infections that have healed for a long time also leave behind antibodies, so if the result is positive or doubtful, the serum sample is examined using a syphilis confirmation test (e.g. FTA-ABS, IgG-FTA-ABS, IgGWestern Blot or the IgG-ELISA). The diagnosis is considered serologically confirmed if both the search reaction and the confirmation test are positive.

An examination of the cerebrospinal fluid (liquor) shows whether the central nervous system is already affected. For this purpose, liquor is taken from the spinal cord canal with a fine needle under local anesthesia and examined for signs of inflammation and antibodies to the pathogen.

In the case of syphilis, other sexually transmitted diseases should always be ruled out and an AIDS test is strongly recommended.

Complications

Syphilis is a highly treatable sexually transmitted disease today, the complications of which are well illustrated in cases from before antibiotics existed. Today, serious complications rarely occur with syphilis treated early. The disease is usually recognized quickly in the industrialized world and can be completely treated within a short time by administering antibiotics.

In rare cases, the antibiotics administered can trigger allergic reactions or side effects such as nausea, headaches or diarrhea in the patient.

On the other hand, if syphilis is not treated, the patient can still die many years later. The disease progresses in several stages, in the course of which the central nervous system suffers more and more damage. The progressive severity of the disease is often accompanied by significant limitations in the everyday life of those affected.

Even an advanced stage can be treated, although permanent damage to the nervous system cannot be ruled out.

In developing countries, without adequate medical care, severe complications and even death from syphilis are still common.

treatment and therapy

Timely detection of syphilis disease is very important in two ways. Firstly, further spread of the disease in the often unrecognized stage of the primary affection should be prevented as far as possible. Secondly, the chances of recovery are best at the beginning.If syphilis is proven, drug treatment is given with Penicillin injections , in later stages the dose may need to be increased, but the antibiotic therapy remains the same.

In the case of sexual contacts within a period of 90 days before the diagnosis is made, the partner should always be treated prophylactically. The success of the therapy must be closely monitored by means of blood tests, external appearance and technical examinations.

Prevention

As with all other sexually transmitted diseases, only the use of condoms can be recommended here. This is particularly important with changing sex partners. However, a syphilis infection cannot be ruled out with certainty using condoms. In the case of ulcers in the oral cavity, syphilis can also be transmitted through kissing or touching. It is also important that nowadays all pregnant women are examined for syphilis (screening) in order to prevent possible transmission to the newborn with the very serious consequences here.