Syphilis

Tertiary syphilis

Approximately one-third of people who have had secondary syphilis go on to
develop the complications of late, or tertiary, syphilis, in which the bacteria
damage the heart, eyes, brain, nervous system, bones, joints, or almost any
other part of the body. This stage can last for years, or even for decades. Late
syphilis can result in mental illness, blindness, other neurologic problems,
heart disease, and death.

HOW IS SYPHILIS DIAGNOSED?

Syphilis is sometimes called “the great imitator” because its early symptoms
are similar to those of many other diseases. Sexually active people should
consult a doctor or other health care worker about any rash or sore in the
genital area. Those who have been treated for another STI, such as gonorrhea,
should be tested to be sure they do not also have syphilis.

There are three ways to diagnose syphilis.

• Recognizing the signs and symptoms
• Examining blood samples
• Identifying syphilis bacteria under a microscope

The doctor usually uses all these approaches to diagnose syphilis and decide
upon the stage of infection.

Blood tests also provide evidence of infection, although they may give
false-negative results (not show signs of an infection despite its presence) for
up to 3 months after infection. False-positive tests (showing signs of an
infection when it is not present) also can occur. Therefore, two blood tests are
usually used. Interpretation of blood tests for syphilis can be difficult, and
repeated tests are sometimes necessary to confirm the diagnosis.

HOW IS SYPHILIS TREATED?

Unfortunately, the early symptoms of syphilis can be very mild, and many
people do not seek treatment when they first become infected.

Doctors usually treat patients with syphilis with penicillin, given by
injection. They use other antibiotics for patients allergic to penicillin. A
person usually can no longer transmit syphilis 24 hours after starting
treatment. Some people, however, do not respond to the usual doses of
penicillin. Therefore, it is important that people being treated for syphilis
have periodic blood tests to check that the infectious agent has been completely
destroyed.

People with neurosyphilis may need to be retested for up to 2 years after
treatment. In all stages of syphilis, proper treatment will cure the disease.
But in late syphilis, damage already done to body organs cannot be reversed.

WHAT ARE THE EFFECTS OF SYPHILIS IN PREGNANT WOMEN?

A pregnant woman with untreated, active syphilis is likely to pass the
infection to her unborn child. In addition, miscarriage may occur in as many as
25 to 50 percent of women acutely infected with syphilis during pregnancy.
Between 40 to 70 percent of women with active syphilis will give birth to a
syphilis-infected infant.

Some infants with congenital syphilis may have symptoms at birth, but most
develop symptoms between 2 weeks and 3 months later. These symptoms may include

• Skin ulcers
• Rashes
• Fever
• Weakened or hoarse crying sounds
• Swollen liver and spleen
• Yellowish skin (jaundice)
• Anemia (low red blood cell count)
• Various deformities

People who care for infants with congenital syphilis must use special
cautions because the moist sores are infectious.

Rarely, the symptoms of syphilis go undetected in infants. As infected
infants become older children and teenagers, they may develop the symptoms of
late-stage syphilis, including damage to their bones, teeth, eyes, ears, and
brains.

CAN SYPHILIS CAUSE OTHER COMPLICATIONS?

Syphilis bacteria frequently invade the nervous system during the early
stages of infection. Approximately 3 to 7 percent of persons with untreated
syphilis develop neurosyph