Syphilis The Great Mimic What is Syphilis Caused

Syphilis The Great Mimic

What is Syphilis? • Caused by the bacterium Treponema pallidum • Time between infection and start of first symptom is 10 -90 days • Diagnosed by – Dark field microscopy of material taken from a lesion or lymph node – Serologic tests (RPR & VDRL)1 1. CDC. 2014. STD treatment guidelines.

Stages of Syphilis • Disease has 4 distinct phases: – Primary – Secondary – Latent (early & late) – Tertiary

How Do I Get Syphilis? • Bacteria enter body through minute abrasions in skin • Transmitted through contact with moist lesions, especially during sexual activity • Rate of transmission from infected sexual partner is about 30%-60%1 • Primary, secondary, and early latent stage account for nearly all transmission • Syphilis may also be acquired congenitally (at birth) 1. Augenbraun M. 2003. In: Dale DC.

Syphilis • Syphilis has been around since at least the 15 th century. • National public reporting of syphilis cases began in 1941. • In the year 2000, the rate of primary and secondary (P&S) syphilis hit an all time low. • In 2013, the total case counts (all stages) were the highest recorded since 1996. • From 2012 to 2013, there was a 13. 1% increase in overall cases. .

Syphilis and MSM • 75% of primary and secondary syphilis in 2013 was associated with men having sex with men (MSM). • Syphilis cases among MSM are characterized by high rates of HIV co-infection and high-risk sexual behaviors. • In 2006, the rate was highest among men ages 35 – 39 years. • In 2013 the rate was highest in men 20 -29 years old. CDC, “ 2013 STD Surveillance Syphilis”

Syphilis and Youth • 20% of all newly diagnosed cases are in young people, ages 15 – 24. 1 • Racial disparities in young people ages 15 – 19 – Rates among black males were 11. 7 times higher than white males in the same age group. – Rates among black females were 18. 2 times higher than white females in the same age group. CDC, “Sexuallly Transmitted Infections Among Young Americans”

Reported Cases of Syphilis Source: CDC. 2010. STD Surveillance.

What is Primary Syphilis? • Single or multiple sores (chancres) • Firm, round, painless; indicates point of bacterial entry • Typically occurs on genital skin and mucosa • May also occur in mouth, hands, or other parts of the body • Chancre heals by itself in 3 -6 weeks • Neurosyphilis can occur during any stage of syphilis, including primary and secondary syphilis. 1

Vaginal opening Syphilis chancre

Syphilitic Chancre, Mouth

Syphilitic Chancre, Female Abdomen

Syphilitic Chancre, Male Syphilis chancre

What is Secondary Syphilis? • Symptoms are caused by the spread of the bacteria • Fever, sore throat, rash, lymph gland swelling, loss of hair 1 • External genital lesions called condyloma lata • Lesions resolve in 3 -12 weeks 2 1. Augenbraun M. 2003. In: Dale DC. 2. Sparling PF. 2008. In: Holmes KK, et al.

What is Latent Syphilis? • • Latent stage can be divided into early and late stages Mostly asymptomatic and contagious Early latent stage usually during first year of infection One-fourth of patients in early latent stage have a relapse (ie, become symptomatic again) • Relapse is rare in latent syphilis • May resolve by itself or advance to the tertiary stage 1 1. Sparling, PF. 2008. In: Holmes KK, et al.

What is Tertiary Syphilis? • Occurs in 1/3 of the cases, months or years after latency 1 • Causes walls of major arteries to weaken and balloon out; these aneurysms can rupture and may be fatal • Affects the brain and its coverings to cause paralysis, mental confusion, insomnia, and headaches • Gummas - destructive lesions in skin, bones, and other organs 2 1. Augenbraun M. 2003. In: Dale DC. 2. Sparling PF. 2008. In: Holmes KK, et al.

Stages of Syphilis (approximate duration) 1 -3 wks Incubation 3 -6 wks Primary 3 -12 wks Secondary < 1 yr Early latent 1 -5 yrs Late latent many years Tertiary Infectious & symptomatic Noninfectious & symptomatic Infectious & asymptomatic Noninfectious & asymptomatic

How is Syphilis Treated? • Effectively treated with antibiotics (penicillin) • Repeated tests are important to confirm cure • 2 -to-5 fold increased risk of HIV infection with syphilis 1 • Syphilis is on the increase in HIV positive homosexual males 2 • All patients with syphilis should be tested for HIV 1. CDC. 2010. Fact Sheet. 2. CDC. 2010. STD Surveillance.

Reducing Syphilis Risk • Syphilis is a dangerous STI • 100% consistent use of condoms may reduce the risk of transmission, but does not eliminate the risk. 1 • Screening of all pregnant females is recommended 2 • All infants born to infected mothers should be treated 2 1. Koss. 2009. Sexually Trans. Diseases 2. CDC. 2010. STD Treatment Guidelines.

Avoiding Syphilis • For unmarried individuals, sexual abstinence is the only practical and certain way to avoid syphilis • For those who choose to be sexually active, a marriage (mutually faithful, life-long relationship with an uninfected sexual partner) is the healthiest choice