Syphilis – Secondary

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

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

What is Secondary 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.

Secondary stage: The bacterium invades tissues, cerebrospinal fluid, skin, and mucus membranes. It causes inflammatory rashes on the body (secondary lesions), within 4-12 weeks after the primary stage. This continues till a stage of dormancy is reached; after which multiple relapse or remissions take place (for the next 1-2 years).

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

Who gets Secondary 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 socioeconomic 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 Secondary Syphilis? (Predisposing Factors)

Risk factors for Syphilis may 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 one's 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 Secondary 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

After the Secondary stage, there is a latent stage, known as Asymptomatic Syphilis which may last for many years (even decades). All infections do not progress to the final (tertiary) stage.

What are the Signs and Symptoms of Secondary 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

Syphilis – Secondary: Many individuals do not report a Primary stage, since they remain unaware of such a stage.

• Formation of red skin rashes (that appear inflamed and wart-like), on the entire body including the palms and soles. The lesions are also observed around the genitals, anus, and mouth
• The rashes form blisters, which become tender and erupt, oozing pus. Itching or burning sensations are usually absent. Hair loss is observed around these blisters
• Fever, muscular pain, headaches
• Fatigue, lethargy, weight loss
• Sore throat
• Inflamed lymph nodes
• The symptoms may last a few weeks (3-6 weeks) and resolve automatically, even without any treatment. But thereafter, these recur repeatedly for about a year or two in most individuals

After the secondary stage, there is a latent stage, known as asymptomatic Syphilis which may last for many years (even decades). All infections do not progress to the final (tertiary) stage.

How is Secondary 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 Secondary Syphilis?

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

How is Secondary 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 Secondary 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 Secondary Syphilis? (Outcomes/Resolutions)

• Syphilis – Secondary (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 Secondary 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