Information on Syphilis
Syphilis is a complex disease caused by the Treponema pallidum bacterium (pale yellow or spirochete). The incubation time of the syphilis bacterium varies from 10-90 days but the average is 21 days and can affect various body parts and organs.

Syphilis has been a scourge for centuries that has affected the lives of people at a social, political and cultural level. The metaphysical punishment dimension, the stigmatization of the patients, the agonizing effort for healing, the heredity, and the incurability of the illness strengthened the fear that accompanied syphilis. Syphilis was also a timeless challenge for the health authorities of all countries, which were trying to limit its scope.
For many years, there has been a controversy among scientists about whether Christopher Columbus and his sailors, when they returned to Europe, actually transferred syphilis to the old continent. It is a fact that after the discovery of America, the reputation of the great seafarer was blurred because they accused him of carrying the terrible venereal disease in Europe with his ships.

Some researchers showed evidence that syphilis existed in Europe before Columbus returned to Spain in 1493 and was therefore unfairly accused. But a recent study by American scientists has come to confirm that Columbus actually brought syphilis to Europe.

In 1928, Fleming discovered the penicillin, which in 1943 began to be manufactured and used to fight various diseases, including syphilis. With the use of penicillin, cases of syphilis worldwide have been drastically reduced. In recent years, there has been an outbreak of syphilis in developing regions, as there are almost no precautions during sexual intercourse, and the diagnosis of the condition by doctors is lagging behind in the absence of recent experiences.

Syphilis is transmitted by direct contact with skin or mucosal lesions and secretions (saliva, semen, vaginal fluid) of an infected person during sexual intercourse, when there are scratches on the skin or mucosa of the healthy person. Transmission is also possible through blood transfusion, if the donor is in the early stages of the disease. Transmission through infected objects is extremely rare due to very low bacterial resistance to the environment. Embryos of women with infection are infected through the placenta during labor.

Syphilis begins with a painless sore on the genitals, the rectum or the mouth, and progresses in stages. The disease has three active stages and an inactive stage called latent syphilis. Symptoms vary at each stage.

Primary Syphilis
Primary syphilis is typically transmitted by direct sexual intercourse with the injuries of another person. At this stage, wounds appear at the point where the bacterium penetrated, usually in the genitals and the perinatal area, in the rectum or in the mouth. These wounds are not particularly painful and the patient may not realize anything, yet they are extremely infectious. In some cases, the patient may have swollen lymph nodes mainly in the groin. In the majority of cases, when syphilis is at this first stage, it recedes alone within about a month. If treatment is needed, it is usually sufficient to inject penicillin.

Secondary Syphilis
The second stage of syphilis begins within a week to six months after the first appearance of the ulcers of the disease. At this stage, the symptoms affect the skin, the mucosa and the lymph nodes. A red rash may occur on any surface of the body, usually initially in the trunk and then throughout the body, even in the palms of the hands or the soles of the feet. This rash usually does not cause itching and may be accompanied by warts that resemble warts in the mouth or genital area. Some patients still have muscular pains, fever, sore throat and swollen lymph nodes. These symptoms may fall completely within a few weeks and recur several times over a year. According to surveys, 30% of those who did not treat the syphilis will develop secondary syphilis in the future.

Latent Syphilis
If the patient is not treated with syphilis or at the secondary stage, then the disease goes into the latent phase during which, for some strange reason, symptoms cease to occur. Thus, a patient may be asymptomatic and syphilis without progression for up to 25 years. Symptoms may never reappear, but the disease may also pass to the tertiary stage, which is characterized as the most dangerous and painful stage of this disease.

Tertiary Syphilis
Tertiary syphilis is the final stage of the disease and occurs in 25% of patients who did not receive treatment in the previous stages. It may occur in 3-15 years after the initial infection. It is characterized by invasion of distant organs such as the cardiovascular system, the nervous system, the liver, the bones, etc. Tertiary syphilis is distinguished in three different forms:
  • Symphytum syphilis: This stage is characterized by the formation of gums, which are soft pellets as inflammation tumors that can vary greatly in size. Typically they affect the skin, bones and liver, but can appear anywhere.
  • Neurosyphilis: The infection affects the central nervous system. It usually presents apathy and epilepsy, and generalized paralysis with dementia and spinal dilation.
  • Cardiovascular syphilis: It directly affects the cardiovascular system. The most common complication is syphilisal aortitis, which can lead to aneurysm.
Congenital Syphilis
If a pregnant woman suffers from syphilis, it is possible to transmit the bacterium to the fetus. Transmission is through the blood after the 9th week of pregnancy, after the placenta is formed. The likelihood of the embryo becoming infected depends on how early the pregnancy syphilis was diagnosed during the pregnancy (and hence the treatment was applied) and from the time the pregnant woman showed the syphilis. The older the syphilis of the pregnant woman, the less transmissible it is, although it is never considered completely non-transmissible. Some infected embryos die endometrially, some are born dead and others are born alive, but then show the symptoms of congenital syphilis, which are similar in pathogenicity to the second stage of the acquired. Congenital syphilis often has no symptoms, although some babies have a rash on the palms of the hands or the soles of their feet. If the disease develops, it can cause deafness, as well as malformations in the teeth and nose.

How Is Syphilis Diagnosed?
The diagnosis of syphilis is clinically performed by a dermatologist at a laboratory by blood test. The blood tests that help in the diagnosis are VDRL, FTA-Abs. Since syphilis is a sexually transmitted disease, it is necessary to consider the sexual partner of the patient. Tests are usually positive 2-5 weeks after the initial infection. The differential diagnosis of syphilis should be made from a variety of skin diseases, such as genital herpes, traumatic ulcers, warts, psoriasis and viral or medicinal rashes.

How Is Syphilis Treated?
Prevention of syphilis, which is particularly contagious especially in the first and second stages, mainly refers to the fact that it is a sexually transmitted disease and includes information, use of condom, early diagnosis, careful handling blood transfusions. It is important for women planning to become pregnant to be screened.

Syphilis can be fully cured if the infection is diagnosed promptly and treated properly. But if not properly treated, it can lead to death. Drugs, such as penicillin and tetracicline, are usually administered at the primary and secondary stages of syphilis. In particular, penicillin is very effective in treating syphilis and does not allow relapses to occur. A simple penicillin injection may stop the progression of the disease if the patient had been infected within the last year, otherwise, more doses of the drug may be needed. If patients are susceptible or allergic to penicillin, antibiotics such as azithromycin and doxicicline are currently administered.
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