What is Syphilis?
Syphilis is a sexually transmitted infection (STI) caused by a bacteria called Treponema Pallidum. This bacteria enters into the body through epithelial breaks or abrasions in the skin or through mucous membranes by invading the walls of blood vessels. Syphilis is spread through contact with a sore during sexual activities and sometimes kissing.
The exact origin of syphilis is unknown, but the first well known outbreak was in 1495 among French troops while they were in Naples, Italy.
Syphilis is a sexually transmitted infection (STI) caused by a bacteria called Treponema Pallidum. This bacteria enters into the body through epithelial breaks or abrasions in the skin or through mucous membranes by invading the walls of blood vessels. Syphilis is spread through contact with a sore during sexual activities and sometimes kissing.
The exact origin of syphilis is unknown, but the first well known outbreak was in 1495 among French troops while they were in Naples, Italy.
Symptoms
There are four stages of syphilis:
There are four stages of syphilis:
Primary syphilis
During this stage, a small sore appears called a chancre, usually a few weeks after the exposure where bacteria entered the body. The chancre heals on its own.
Secondary syphilis
During this stage and after the chancre heals, a rash begins to appear that sometimes covers the whole body. Some symptoms begin to appear as well, such as hair loss, fever, and sore throat. Typically these symptoms disappear after a few weeks, but sometimes they remain on and off for a year. The primary and secondary stages of syphilis are the most infectious.
Latent syphilis
The latent stage is called the hidden stage. This is because symptoms are not visible anymore, but they may or may not return. This stage happens if syphilis has not been detected or treated, and can last for years.
Tertiary syphilis
The latent and tertiary stages are no longer contagious, although the tertiary stage is the most destructive. About 15-30% of untreated people will develop this stage. Damages to the body may include the brain, nerves, heart, blood vessels, eyes, bones, joints, and liver. Some symptoms include hearing loss, visual problems, strokes, delirium, psychosis, and dementia. There are three main types of tertiary syphilis, which include gummatous syphilis, cardiovascular syphilis, and neurosyphilis. I will be focusing on neurosyphilis on the next topic.
During this stage, a small sore appears called a chancre, usually a few weeks after the exposure where bacteria entered the body. The chancre heals on its own.
Secondary syphilis
During this stage and after the chancre heals, a rash begins to appear that sometimes covers the whole body. Some symptoms begin to appear as well, such as hair loss, fever, and sore throat. Typically these symptoms disappear after a few weeks, but sometimes they remain on and off for a year. The primary and secondary stages of syphilis are the most infectious.
Latent syphilis
The latent stage is called the hidden stage. This is because symptoms are not visible anymore, but they may or may not return. This stage happens if syphilis has not been detected or treated, and can last for years.
Tertiary syphilis
The latent and tertiary stages are no longer contagious, although the tertiary stage is the most destructive. About 15-30% of untreated people will develop this stage. Damages to the body may include the brain, nerves, heart, blood vessels, eyes, bones, joints, and liver. Some symptoms include hearing loss, visual problems, strokes, delirium, psychosis, and dementia. There are three main types of tertiary syphilis, which include gummatous syphilis, cardiovascular syphilis, and neurosyphilis. I will be focusing on neurosyphilis on the next topic.
Neurosyphilis
Neurosyphilis is an infection of the brain and spinal cord, which in turn can lead to the destruction of many areas of the nervous system. Because the front and back of the spinal cord are being deprived of oxygen and nutrients due to the bacteria, different symptoms occur. Some include the loss of function to the arms and legs, loss of vision, and altered mental abilities. Infections that disrupt the brain or spine damage the flow of important information between the brain and body, therefore disrupting the nervous system as a whole. Neurosyphilis can occur at any stage, although it most commonly occurs during the tertiary stage.
Neurosyphilis is an infection of the brain and spinal cord, which in turn can lead to the destruction of many areas of the nervous system. Because the front and back of the spinal cord are being deprived of oxygen and nutrients due to the bacteria, different symptoms occur. Some include the loss of function to the arms and legs, loss of vision, and altered mental abilities. Infections that disrupt the brain or spine damage the flow of important information between the brain and body, therefore disrupting the nervous system as a whole. Neurosyphilis can occur at any stage, although it most commonly occurs during the tertiary stage.
This is a cast of a man with tertiary syphilis in the Musee de l’Homme in Paris, France.
Other Neurological Problems Associated with Neurosyphilis
- Syphilitic meningitis involves inflammation of tissues surrounding the brain and spinal cord.
- Ocular syphilis. The most common form is uveitis, which involves inflammation of the eyes resulting in pain and blurred vision.
- Meningovascular syphilis accounts for two-fifths of all the cases of neurosyphilis. It is caused by inflammation of blood vessels that supply the nervous system. The middle cerebral artery is most affected. This may result in a stroke or spinal cord infarct.
- General paresis involves damage to the cerebral cortex, hypothalamus, and meninges. Some serious symptoms include memory problems, decreased mental function, and mood and personality changes. General paresis doesn’t occur until years to decades since the first initial infection.
- Tabes dorsalis. This is a disorder of the posterior column and roots of the spinal cord. It’s caused by inflammatory changes and demyelination which causes degeneration of nerve cells and fibers. Nerve cells are what carry information around the body.
A MRI of a normal brain on the left, versus hyperintensities in different regions of the brain due to neurosyphilis.
A little bit of unethical history involving syphilis…
The Tuskegee Study
From 1932 to 1972, approximately 400 African-American men that had untreated syphilis, and 200 men without syphilis were used in an unethical human experiment. They were told that they were receiving free treatment because of their “bad blood” by the US government. In reality, the purpose of this experiment was to study untreated syphilis, and they did not receive any treatment at all. In fact, they were given ineffective medicines to truly make them believe they were receiving treatment. They weren’t notified and were withheld treatment as the researchers knew that penicillin was an effective cure. The men were told that it would only last six months, but instead it lasted forty years. So, this was performed without their consent in a cruel way.
The four year follow up indicated that 26.1% of the men developed neurosyphilis versus the controls at 2.5%.
In 1972, there was a mass outrage and a lawsuit had been made against them. This was settled two years later for ten million dollars.
Diagnosis
The most common way to diagnose syphilis is by taking blood samples. By doing this, it can confirm the presence of antibodies which the body produces to fight the infection.
Another way is by obtaining cerebrospinal fluid (CSF) through a lumbar puncture if the person is suspected of having nervous system issues that are prone to syphilis. The cerebrospinal fluid is then analyzed for evidence of syphilis.
The most common way to diagnose syphilis is by taking blood samples. By doing this, it can confirm the presence of antibodies which the body produces to fight the infection.
Another way is by obtaining cerebrospinal fluid (CSF) through a lumbar puncture if the person is suspected of having nervous system issues that are prone to syphilis. The cerebrospinal fluid is then analyzed for evidence of syphilis.
Treatment
Early stages of syphilis can be treated with an antibiotic called penicillin. If someone is allergic to penicillin, an alternative is used such as ceftriaxone, doxycycline, or azithromycin. Because of the use of penicillin, it can be cured in early stages, but can remain inactive in the body. Treatment during later stages will only limit further progression and has limited effect on damage that has already been done.
Early stages of syphilis can be treated with an antibiotic called penicillin. If someone is allergic to penicillin, an alternative is used such as ceftriaxone, doxycycline, or azithromycin. Because of the use of penicillin, it can be cured in early stages, but can remain inactive in the body. Treatment during later stages will only limit further progression and has limited effect on damage that has already been done.
Prevention
There are ways you can prevent obtaining syphilis, such as:
There are ways you can prevent obtaining syphilis, such as:
- having safe sex
- using condoms
- avoiding multiple sexual partners
- getting screened regularly for STI’s.
Bibliography
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Wikipedia. Neurosyphilis. December 21, 2021. https://en.wikipedia.org/wiki/Neurosyphilis. Accessed May 4, 2022.
Khan Academy. “What is Tertiary Syphilis?” YouTube, Uploaded by Khan Academy Medicine, June 15, 2015. https://www.youtube.com/watch?v=CvO0a7suxmY
MedBoard. “What is Syphilis?” YouTube, uploaded by MedBoard, May 27, 2021. https://www.youtube.com/watch?v=IxPv4wX7Tbo
Wikipedia. History of Syphilis. February 23, 2022. https://en.wikipedia.org/wiki/History_of_syphilis. Accessed May 4, 2022.
Healthwise Staff. “Neurosyphilis.” HealthLinkBC, February 26, 2020. https://www.healthlinkbc.ca/illnesses-conditions/sexual-reproductive-health/neurosyphilis
“Tabes Dorsalis.” NIH, April 1, 2022. https://www.ninds.nih.gov/health-information/disorders/tabes-dorsalis
Medline Plus. “General paresis.” April 4, 2020. https://medlineplus.gov/ency/article/000748.htm
Pardington, Fiona. “Cast of a Man With Tertiary Syphilis.” Blogspot, May 22, 2011. http://fionapardington.blogspot.com/2011/05/cast-of-man-with-severe-tertiary.html
SpeeDx. “Stages of Syphilis.” Twitter. Accessed May 4, 2022. https://twitter.com/speedx/status/1396736621677096962?lang=zh-Hant
Scarlett Alliance. “Syphilis Stages.” https://redbook.scarletalliance.org.au/syphilis/ . Accessed May 4, 2022.
Macdonald, Cheyenne. “Safe Sex Emoji.” Daily Mail, December 1, 2016. https://www.dailymail.co.uk/sciencetech/article-3987900/The-unofficial-safe-sex-emojis-revealed-Researchers-umbrella-raindrops-best-represents-condom-s-no-official-symbol.html
Xiang, Tao. “Neuroimaging of Six Neurosyphilis Cases.” Journal of the Neurological Sciences, September 5, 2013. https://www.jns-journal.com/article/S0022-510X(13)02868-2/fulltext
Radiopedia. “Normal Brain (MRI).” https://radiopaedia.org/cases/normal-brain-mri-6. Accessed May 4, 2022.
“Syphilis.” iStock, Getty Images. https://www.istockphoto.com/illustrations/syphilis. Accessed May 4, 2022.