March 27, 2023 Author : Saraiva da Cunha Syphilis is a sexually transmitted infection . It is caused by a bacterium named Treponema pallidum . The main form of contagion is vaginal, oral or anal intercourse, through contact with lesions of syphilis (hard chancre) in skin or mucous, which may or may not be visible. Syphilis can also be transmitted from mothers to children during pregnancy, giving rise to congenital syphilis; After becoming infected, the disease can go through several stages with symptoms of different severity and also have periods without symptoms. Contagion can occur at any stage of the disease. Syphilis symptoms and diagnosis Primary syphilis is the stage of the disease in which symptoms begin to appear 2-3 weeks after infection. A reddish lump usually appears on the penis, around the vaginal opening or anus, that is, in the region of the body that was the entryway for Treponema pallidum ; This lump, which is painless, can evolve into an ulcer (a sore known as a hard chancre) with raised edges; There may also be sores in the vaginal cavity, rectum or throat that are not immediately visible; Even without treatment, these lesions can heal in a few weeks, which means that many people do not seek medical care, allowing the disease to worsen and spread to others. Thus, when no importance is given to symptoms of primary syphilis and, therefore, the disease is not diagnosed or treated correctly, new episodes may follow, in this case of secondary syphilis , with more severe and varied symptoms, including: Generalized rash (red spots); Large and raised, gray or whitish patches in warm and moist areas of the body, for example the mouth and genitals; Flu-like symptoms: fever, muscle aches, headache and sore throat, among others; Swollen lymph nodes in the neck, armpits and groin. Tertiary or late syphilis is the disease that occurs a long time after the infection, often many years, sometimes after other episodes of the disease that have not been treated. The symptoms and lesions of late syphilis are much more severe, involving the heart, among other tissues and organs. In any of the stages of syphilis - primary, secondary or late - there may be involvement of the central nervous system (brain and spinal cord), which is referred to as neurosyphilis . In these cases there are often symptoms such as: Nausea and vomiting; Neck stiffness; Confusion. Latent syphilis is the name given to the stage of the disease in which there are no symptoms, regardless of the time elapsed since the infection and whether or not the disease is known. The diagnosis of syphilis is made based on the symptoms, the history reported by the patients, the results of the physical exam and is confirmed by blood tests and eventually by analysis of cerebrospinal fluid obtained by lumbar puncture when there is suspicion of neurosyphilis. Treatment and prevention The treatment of syphilis is simple and effective, as long as it is done early using antibiotics . Penicillin and its derivatives play an important role in the treatment of the disease, but other options are available when there are contraindications to penicillin treatment; The earlier the diagnosis of syphilis and its treatment, the greater the probability of successfully treating it in a short period of time; It is usually necessary to monitor the results of the treatment by carrying out blood tests; In more advanced and severe cases of syphilis, it may be necessary to maintain follow up and carry out monitoring tests lifelong As with other sexually transmitted infections, there are measures to prevent syphilis : Using a condom during sexual intercourse is the best way to prevent contagion. Avoid sexual intercourse when there us a known infection or even when there is a suspicion that it may be present. Avoiding risky behaviors, such as changing sexual partners frequently, helps prevent the spread of syphilis and prevents it from spreading. When in doubt, medical attention should be sought whenever: There are nonspecific or suggestive symptoms of syphilis; There has been sexual intercourse with someone diagnosed or suspected of having syphilis, even if no symptoms are known in any of the people involved. Syphilis screening Routine medical follow-up includes annual screening for syphilis , carried out through a blood test - VDRL (venereal disease research laboratory) or RPR (rapid plasma reagin) -, for the following groups: Women during pregnancy; Men and women who have unprotected sex with multiple partners; Men who have sex with men, particularly those involved in sex with drugs (chemsex); All those infected with the human immunodeficiency virus (HIV); All those diagnosed with another sexually transmitted infection. There are numerous cases of syphilis diagnosed in these routine analyses. Syphilis in Portugal Syphilis is a mandatory reporting disease , and the number of cases has been increasing. In 2018, the last year for which data for this disease in Portugal are published: 908 cases of syphilis were diagnosed and reported, 7 of which were congenital syphilis, that is, transmitted from mother to fetus during pregnancy; 77% of syphilis cases occurred in men; The regions of the country where the most cases were diagnosed were the metropolitan area of Lisbon, with 41%, and the metropolitan area of and Porto, with 14%. Sources : Centers for Disease Control and Prevention (CDC). Syphilis . Arando Lasagabaster M, Otero Guerra L. Sífilis . Enferm Infecc Microbiol Clin 2019; 37:398-404. Meet the infectious diseases clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
