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Syphilis is a very common infectious disease caused by the bacterium Treponema pallidum.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Infection by Treponema Pallidum – Primary Syphilis
  • Syphilitic Chancre – Primary Syphilis
  • Treponemal Infection – Primary Syphilis

What is Primary Syphilis? (Definition/Background Information)

  • Syphilis is a very common infectious disease caused by the bacterium Treponema pallidum. Syphilis is generally transmitted through sexual contact. A pregnant woman affected by Syphilis can transmit the infection to her child through the placenta, while the baby is still in the womb
  • The disease leads to formation of lesions on the body, especially around the anus, genitalia, and mouth. Any contact with these ulcerative lesions result in a transmission of the condition
  • There are 3 stages in the progression of Syphilis; Primary, Secondary, and Tertiary. The sooner the treatment is started, better is the outcome. If treatment is delayed or is lacking; it could develop into a serious medical issue with long-term neurological complications. In rare cases, the complications can even lead to death
  • The universal treatment for this condition (at all stages) is by using the drug penicillin, which can bring about a complete recovery. However, early recognition and management of the condition is extremely important

Primary stage: After the initial infection (direct sexual contact with an affected individual), the bacterium spreads all over the body using the blood vessels and lymphatic system, and multiply rapidly. Primary lesions form within a few hours after infection, which contain large quantities of the Treponema bacteria.

Primary Syphilis is characterized by the formation of small painless sores (on the genitals) that often go unnoticed. These may appear within a week of infection, and heal within 6 weeks.

Secondary stage: Occurring between 4-12 weeks after the primary stage, with remissions taking place for about two years.

Tertiary stage: This may occur even a few decades after the secondary stage.

Who gets Primary Syphilis? (Age and Sex Distribution)

  • Sexually mature men and women who are infected by Treponema bacteria contract Syphilis. Occasionally, even teenagers (as young as 15 years) are affected by this infectious condition
  • No gender preference or racial predilection is observed. However, according to a CDC report (CDC.gov release, 2006) the male-female incidence for Syphilis - Primary & Secondary, stands at 6:1
  • In certain geographical regions with lower socio-economic standards and insufficient access to proper healthcare; it is found that the general incidence of sexually transmitted diseases (STDs), including Syphilis is higher

What are the Risk Factors for Primary Syphilis? (Predisposing Factors)

Risk factors for Syphilis include:

  • Having a new sex partner (a carrier of Syphilis)
  • Multiple sex partners
  • Not practicing safe sex
  • Having sex with individuals who have STDs
  • Having a same-sex partner(s). The incidence of Syphilis is extremely high among men (according to a CDC study, up to 72% of all new cases in 2011, were owing to this single factor)
  • Increased use of drugs (cocaine, methamphetamine, Viagra); leading to high-risk behavior, such as ‘sex for drugs’
  • Untreated pregnant women with syphilis, have a very high risk (90% chance) of passing on the infectious bacteria to the baby in the womb. This causes Congenital Syphilis
  • Transfusion of contaminated blood or blood products (contaminated by the syphilitic bacteria)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Primary Syphilis? (Etiology)

  • Syphilis is a contagious bacterial infection that is transmitted through sex with an affected individual. It is caused by the bacterium Treponema pallidum
  • An individual’s skin lesions and mucus membranes carry the pathogen, which then spreads to their partner(s) during all forms of sexual contact (even through kissing), causing an infection. It infects the mouth, anus, and genitals of males and females
  • Syphilis has three distinct stages of progression; each stage more aggressive than the previous one: Primary, Secondary, and Tertiary

What are the Signs and Symptoms of Primary Syphilis?

Each stage of Syphilis presents a different set of signs and symptoms. The progression to higher stages occurs because of non-treatment. These include:

Syphilis – Primary:

  • Formation of small, painless sores (called chancres) on the genitals or anus, that remain unnoticed sometimes
  • The sores maybe solitary or multiple, and may take anywhere from 3-90 days to appear. It then forms into a tender blister, erupts, and ulcerates (with loss of skin, tissue, and formation of pus). After this, the sores heal within 3-6 weeks
  • Lymph node inflammation around the infected region, is normally observed

How is Primary Syphilis Diagnosed?

Diagnosis of the condition may be made at any stage of the disease. A few diagnostic tests performed for Syphilis include the following:

  • Physical exam with evaluation of medical history
  • Blood test, for detecting antibodies against Syphilis
  • Exam of cerebrospinal fluid (lumbar puncture); in case of Neurosyphilis
  • Analysis of lesion fluids in the laboratory, under a microscope (dark field microscopy)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Primary Syphilis?

At the Primary stage level, complications due to Syphilis are uncommon. However, other underlying diseases such as AIDS/HIV infections may worsen the condition.

How is Primary Syphilis Treated?

Prompt, early diagnosis and appropriate treatment is the key to speedy recovery from Syphilis. The later the stage, the more difficult it becomes to treat the condition and avoid permanent injury (physical or neurological):

  • All manifestations of syphilis are treated using the antibiotic drug penicillin. This is given as an intramuscular injection (for a couple of weeks), or intravenously. Worldwide, penicillin is a cheap and easily available drug that is also simple to administer
  • If the individual is allergic to penicillin, then it is given in very small dosages and in a controlled manner, until the body gets sensitized (accustomed) to the drug

How can Primary Syphilis be Prevented?

  • Syphilis is classified as a venereal disease (VD) transmitted from one individual to another. This occurs during sexual contact with the infected lesions. It is a preventable and curable disease

The onus is on all sexually mature individuals to ensure that they are generally well-informed (either by their healthcare providers or public health authorities) of the sexually transmitted syphilitic infection. They have to be also aware of the preventive measures and precautions to be taken, which include:

  • Avoidance of multiple sex partners
  • Practice of safe sex (use of condoms that prevent entry of the syphilis bacteria)
  • Excessive craving for drugs and alcohol, may lead to unsafe practices, such as ‘sex for drugs’
  • If you are frequently sexually active with multiple partners; then regular screening for sexually transmitted diseases is essential

What is the Prognosis of Primary Syphilis? (Outcomes/Resolutions)

  • Syphilis – Primary (stage) can be completely treated and cured, if an early diagnosis and proper management is rendered. A full recovery is possible and the outcome is excellent in such cases
  • The condition of infected individuals without treatment will progressively worsen over many years. Death under such circumstances is a possibility; especially if the disease has progressed into the advanced stages
  • The outcomes are poorer in individuals diagnosed with AIDS/HIV infection, or other opportunistic infections

Additional and Relevant Useful Information for Primary Syphilis:

  • If you are diagnosed with Syphilis (or other VDs), then inform of the condition to your sex partner(s). Abstain completely from sex until you are certified cured
  • Given the fact that there may be many years of symptom-free (latent) period; it is particularly important that regular screening and blood tests for Syphilis are undertaken
  • Pregnant women with untreated Syphilis can infect the baby in the womb. Hence, it is recommended that all pregnant women should undergo screening tests for Syphilis
  • Syphilis does not spread by non-human contact such as spas, hot tubs, toilet seats, and swimming pools
  • Syphilitic sores (oral, anal, penile, or vaginal) can increase the risk for acquiring HIV infections. CDC reports that such a risk of acquiring an HIV infection, is increased 2-5 times
  • There are no home remedies to treat Syphilis
  • The treatment provided, even if it is during the later stages, helps prevent the infection from causing further damage. The damage to organs already occurred, cannot be reversed
  • It is important to note that Syphilis can reinfect a person even after successful treatment for a prior infection. Infection by Syphilis does not confer a lifelong immunity

What are some Useful Resources for Additional Information?

Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
Email: cdcinfo@cdc.gov
Website: http://www.cdc.gov

References and Information Sources used for the Article:

http://www.mayoclinic.com/health/syphilis/DS00374 (accessed on 1/15/13)

http://www.cdc.gov/std/treatment/2006/congenital-syphilis.htm (accessed on 1/15/13)

Helpful Peer-Reviewed Medical Articles:

Eccleston, K., Collins, L., & Higgins, S. P. (2008). Primary syphilis. Int J STD AIDS, 19(3), 145-151. doi: 10.1258/ijsa.2007.007258

Omura, G., Fukuoka, O., & Suzuki, M. (2010). [Primary syphilis with initial lower-lip sclerosis--a case report]. Nihon Jibiinkoka Gakkai Kaiho, 113(9), 758-761.

Moskovitz, B. L., Klimek, J. J., & Quintiliani, R. (1982). Primary Syphilis. Arch Intern Med, 142, 139-140.

Martin, I. E., Gu, W., Yang, Y., & Tsang, R. S. (2009). Macrolide resistance and molecular types of Treponema pallidum causing primary syphilis in Shanghai, China. Clinical infectious diseases, 49(4), 515-521.

Wong, T., Singh, A. E., & De, P. (2008). Primary syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin. The American journal of medicine, 121(10), 903-908.

Fiumara, N. J., & Berg, M. O. N. I. C. A. (1974). Primary syphilis in the oral cavity. British Journal of Venereal Diseases, 50(6), 463.

Fiumara, N. J. (1977). Treatment of seropositive primary syphilis: an evaluation of 196 patients. Sexually transmitted diseases, 4(3), 92-95.

Alam, F., Argiriadou, A. S., Hodgson, T. A., Kumar, N., & Porter, S. R. (2000). Medical matters: Primary syphilis remains a cause of oral ulceration. British dental journal, 189(7), 352.