Congenital and acquired syphilis – symptoms, diagnosis and treatment. What tests for syphilis should be performed? [WE EXPLAIN]

Syphilis is a disease caused by a germ called a pale spirochete. It enters the human body through damaged skin (it can even be very small defects in the epidermis) or undamaged mucous membranes. The disease is mainly transmitted sexually.

Syphilis – characteristics

Syphilis (or syphilis) is a bacterial infectious disease transmitted mainly sexually, sometimes also from mother to fetus, and through blood transfusion or contact with infected biological material. Syphilis is caused by a pale spirochete (Treponema pallidum) belongs to gram-negative bacteria. It enters the body through undamaged mucous membranes (hence the ease of infection in the case of various forms of sexual contact), damaged skin or directly through the bloodstream.

It may take 9 to 90 days from the spirochete infection to the first symptoms of syphilis, but on average it takes three weeks to develop. Syphilis is highly contagious and its course can be latent, and sometimes self-healing or severe organ changes occur. The risk of infection with yourself or others with syphilis should not be underestimated, so prophylaxis is recommended, as well as consulting a doctor for symptoms.

Syphilis is a disease that can be divided into two forms:

1. acquired (early and late) syphilis – infection typically transmitted through sexual contact, less often directly through the blood;
2. congenital syphilis – it concerns infection of the fetus in the womb.

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Syphilis – causes

Syphilis is a sexually transmitted disease, therefore its main and immediate cause is sexual contact with an infected person. Unfortunately, the society still lacks awareness and knowledge about venereal diseases, such as syphilis. Therefore, the risk of developing syphilis is much higher among sexually active people who do not use condoms.

Check it out: Quick sex, new drugs and old venereal diseases

Acquired syphilis – course

Acquired syphilis is transmitted primarily sexually. The probability of infection with syphilis concerns various forms of sexual contact (especially without condom protection) – vaginal, rectal, oral-genital, oral-rectal. It is also possible to become infected with syphilis by kissing someone whose throat has lesions. Acquired syphilis is divided into early and late syphilis.

Early acquired syphilis indicates a disease that lasts up to two years after infection, is symptomatic and latent. The first symptom of early syphilis (period I syphilis, developing between the 3rd and 9th week after infection) is ulceration from which serous secretions with infectious properties may flow. Primary ulcers usually occur in the genitals, rectum, anus, less often in the oral cavity. After a week, another symptom appears: enlarged nearby and distant lymph nodes.

Then syphilis goes into the next phase (early stage II syphilis – lasts from the 9th week after infection to 2 years) – a rash (early rash) appears on the skin and mucous membranes in the form of papules that damage the skin. After a while, these symptoms disappear without scarring, and the syphilis goes into a latency phase, which often results in changes in the nervous system and can later trigger syphilis in the nervous system.

The next phase, that is late syphilis comes after 3–5 years (sometimes a dozen or so) from syphilis infection. This form of the disease affects people who have not been treated at the stage of early syphilis or the therapy has turned out to be insufficiently effective. Syphilis can attack the cardiovascular system (ascending aortic aneurysms), the nervous system (e.g. encephalomyelitis, progressive paralysis, spinal cord pruritus), internal organs (infiltrates), skin and bones.

Also read: Poles downplay the problem of syphilis

Acquired syphilis – diagnosis and treatment

The first step in the diagnosis of syphilis is a medical history, in which the patient should pay attention to sexual behavior that may be a source of infection. A specialist in STDs, including syphilis, is a venereologist.

The diagnosis of syphilis is indicated by serological tests (classical and spirochetal reactions). Syphilis screening tests, abbreviated as VDRL, RPR and USR, are used to identify the risk of infection. The diagnosis of syphilis is most likely made possible by the FTA-ABS test, as well as CPW and PCR tests.

Syphilis diagnosis is routinely indicated in the following groups:

1. pregnant women;
2. blood donors and organ donors;
3. people diagnosed with a new sexually transmitted infection;
4. people with HIV, hepatitis B or hepatitis C;
5. patients suspected of early nervous system syphilis;
6. people who are more likely to develop diseases from the STD group (e.g. engaging in risky sexual behavior).

Patients diagnosed with syphilis approximately 9 weeks after the infection should undergo tests for changes in the central nervous system. Syphilis treatment should be carried out by a dermatologist-venereologist. Syphilis diagnosed early is completely treatable. Therapeutic treatment of syphilis includes antibiotic therapy with penicillin. Alternatively (e.g. in the case of allergies) doxycycline, ceftriaxone or tetracyclines are also used.

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Check it out: Research on sexually transmitted diseases

Congenital syphilis – infection

Congenital syphilis can affect a child who becomes infected with spirochetes that are pale in utero through the placenta. The risk of congenital syphilis infection depends on the stage of the disease of the mother – the highest is early (70-100%), lower (40%) latent syphilis, and the lowest (10%) late syphilis.

The consequences of congenital syphilis can be drastic:

1. stillbirth;
2. giving birth to a child who is alive but unable to continue living;
3. childbirth with symptoms of early congenital syphilis, late congenital syphilis, latent congenital syphilis.

In order to prevent these tragic consequences, every pregnant woman should have blood serological tests twice during pregnancy. A mother who has syphilitic eruptions in the birth pathways and became infected in the last weeks of pregnancy may infect the baby during childbirth. What is the risk of such an infection? It depends primarily on how long the maternal infection lasted. Symptoms characteristic of congenital syphilis can only be noticed after the 4th month of pregnancy.

Symptoms of congenital syphilis in children

Congenital syphilis can be early or late. Symptoms of early congenital syphilis appear in children up to 2 years of age. The first symptoms of congenital syphilis may appear at birth, but most often they become active between the 2nd and 10th week of life.

First, there is a liquid discharge in the nose that leads to obstruction and sometimes even permanent bone deformation. Other features of congenital syphilis are raised frontal bones and low-level jaw bones. Various types of inflammatory changes appear in the area of ​​cartilage and bones, the epiphysis of the long bone is damaged.

In addition, in the early stages of congenital syphilis, we can observe:

1. enlarged lymph nodes,
2. anemia,
3. jaundice
4. enlargement of the liver and spleen,
5. Parrot scar (appears due to the cracking of lumps around the anus and mouth),
6. limitation of the upper limbs and contracture of the lower limbs may occur less frequently,
7. skin changes on the hands and feet.

Late congenital syphilis occurs when a child is left untreated for the first two years of their life. At first, it does not give any alarming symptoms, but over time (mainly between the ages of 8 and 14) it can be identified:

1. damage to the auditory nerve leading to deafness (tinnitus and dizziness are felt at first),
2. interstitial keratitis which causes eye pain, lacrimation, photosensitivity and loss of vision
3. articular exudates that are recurrent. They occur especially when the knee joints are affected,
4. deformation of permanent teeth, which may be widely spaced, upper and incisors and molars may have nodules,
5. tooth apical atrophy,
6. syphilis rarely attacks the cardiovascular and nervous systems,
7. saber-like drumsticks.

Read more: Non-obvious sexually transmitted infections

Congenital syphilis – diagnosis and treatment

A doctor can diagnose congenital syphilis only when he is sure that the newborn has pale spirochetes in the placenta samples. Blade ducts can also be found in other autopsy material.

The methods below are used to detect syphilis bacteria.

1. Light microscope examination with a capacitor for the dark field of view due to its delicate structure and poor ability to stain the spirochete with dyes – this examination allows viewing of live spirochetes, similar in appearance (under a microscope) to a corkscrew.
2. Examination by immunofluorescence – during it, the material fixed on the slide is subjected to additional staining with sera containing anti-twisted antibodies, and then the specimen is examined under a fluorescence microscope. This method may lead to false-positive results in the first year of a child’s life.
3. PCR test – is a more sensitive method that allows you to increase the genetic material from the amniotic fluid or the blood of the newborn.
4. Medical interview – is used at the stage of early diagnosis.
5. Routine examination of syphilis in pregnant women – recommended for better prophylaxis.
6. Screening repeated in the third trimester of pregnancy and at delivery – performed in the group of increased risk of syphilis.

The treatment of congenital syphilis should absolutely apply to all children born to a mother infected with pale spirochete. They are given a single dose of penicillin. Penicillin can be administered for early (two weeks) and late congenital syphilis for one month. In children who are severely allergic to penicillin, erythromycin may be given instead of it, but only in children over one month of age!

In untreated women, complications may occur, such as the death of the fetus or newborn. This is because syphilis causes inflammation of the placenta and less blood flow to the fetus.

Syphilis – indications for examination

Syphilis should be tested by people who have been told that their sexual partner has syphilis. In addition, preventive tests for syphilis should be performed by people who frequently change sexual partners and do not use condoms. Among those who should be tested for syphilis as a preventive measure, there are also pregnant women, honorary blood donors, organ donors and people in risk groups.

The risk group includes, however, people diagnosed with venereal diseases, as well as people infected with HIV, such as hepatitis B and C, and many others.

Syphilis – side effects of treatment

During the treatment of syphilis, side effects may appear in the form of:

1. anaphylactic shock – it may appear as a symptom of penicillin allergy, you must respond immediately;
2. Jarisch-Herxheimer-Łukasiewicz reaction – it manifests itself with a high temperature and chills, manifesting itself even 8 hours after taking penicillin. If they were oral anti-syphilis agents, the reaction may appear even after a day. Fever may be accompanied by skin changes;
3. Hoigné’s syndrome – occurs most often in patients who are treated with procaine penicillin. Patients may hallucinate auditory and visual hallucinations, be aggressive and have seizures while the injection is being given. High blood pressure and increased heart rate appear, these symptoms last for several minutes, during which the patient is given sedatives.

Syphilis – prophylaxis

Syphilis prevention is very simple. The cause of infection with syphilis is most often unprotected sexual contact, so the best way to prevent it is to educate the public about the need to protect themselves with, for example, a condom during intercourse. Unfortunately, many people do not remember that a condom is not only an effective method of preventing pregnancy, but also protection against various venereal diseases, including syphilis.

Public education also includes the careful selection of sexual partners and the limitation of their number. But that’s not all. Syphilis infection can also occur during contact with ulcers of patients suffering from syphilis, but contact with other lesions associated with syphilis on the patient’s tissues and skin should also be avoided.

The risk of infection with syphilis is also associated with contact with the patient’s blood or other body fluids. Medical workers and paramedics are particularly exposed to contact with them. Prophylaxis of syphilis in pregnant women increases the chance of having a healthy child despite the infection, thanks to the implementation of treatment in the first months of pregnancy.

Syphilis and syphilitic alopecia

Syphilis alopecia is one of the symptoms of early acquired syphilis in the second stage of development. It usually appears after 6 months of syphilis. This is often the only noticeable symptom of syphilis. Syphilis alopecia can be focal or diffuse, but the symptoms can also be combined.

Syphilitic alopecia has very characteristic symptoms and is easily distinguished from alopecia in another category. During syphilis infection, alopecia most often appears on the temples and the back of the head. However, attention should be paid to the fact that inflammatory changes on the skin do not appear on the skin during hair loss. Another symptom of syphilitic alopecia that occurs at the same time is syphilitic albinism, but it is alopecia that is more characteristic because it occurs quite unexpectedly. Importantly, in the case of syphilitic alopecia, there is no scarring of the hair roots, which means that there is a chance for hair to regrow.

Syphilitic alopecia occurs during a syphilis infection, therefore treatment of the infection is the mainstay of treatment. Therefore, the key is to make a good diagnosis and start treatment quickly. If left untreated, the hair follicle can be damaged and even permanent hair loss.

Syphilis – complications

Syphilis is a serious disease that, if left untreated, can lead to serious complications. In the case of late syphilis, starting antibiotic treatment does not make sense, because the symptoms are not the result of an active infection, but are the result of degeneration that the antibiotic will not reverse. In addition, although one form of late syphilis has been diagnosed, this does not mean that other organs are not damaged:

1. late syphilis of the skin, mucous membranes and bones – it is nodular-amoebic or nodular-ulcerative syphilis and nodular syphilis;
2. nodular amoebic syphilis is a benign form of syphilis – brown-red nodules several millimeters in diameter appear on the skin and mucous membranes, which may disintegrate, leaving scars. Lumps can form large lesions with ulcerative margins and a smooth and mosaic central part of the scar;
3. syphilis – it is a condition associated with the appearance of the so-called kilaki, i.e. nodules of the formed subcutaneous, bone or muscle tissue. Several are most often formed in places where the skin adheres to the bones, such as the face or collarbones. Initially, these are hard, nodular-like infiltrates. Such a lump may rupture, and then a sticky, gelatinous discharge with a blood color flows out of it. The skin then develops a large, kidney-shaped ulcer;
4. syphilis on mucous membranes leads to the appearance of similar changes as on the skin, but they are more prone to decay;
5. late syphilis of bones and joints – it causes periostitis, osteitis, and joint changes. The changes caused by syphilis in the bones lead to several destruction not only of the bones but also of the soft tissues. They develop ulcerations leading to osteonecrops;
6. internal organ syphilis – the lesions appear mainly in the liver (leading to damage to the liver parenchyma, cirrhosis), stomach (resembling ulcerations and neoplastic lesions), lungs (suggesting neoplastic lesions and tuberculosis) and testes (lesions usually include one testicle);
7. cardiovascular syphilis – lesions appear mainly in the main artery and crescent aortic valves. They can also affect the heart muscle and peripheral arteries.

Syphilis – the nervous system

Both early and late asymptomatic syphilis consists in the appearance of changes in the cerebrospinal fluid without any symptoms or neurological ailments. It can be the first stage of syphilis development if left untreated.

Meningeal syphilis, or acute syphilitic meningitis it is most common in young people when the infection lasts less than a year. Symptoms associated with this form of syphilis include headache, fever, neck stiffness, photophobia, nausea and vomiting, aphasia, seizures, delirium, confusional states, and even deafness that resolves after administration of penicillin.

Meningovascular syphilis of the brain and spine it is a form of syphilis that affects the brain, spinal cord and brainstem. Symptoms are not observed until 5-12 years after being infected with syphilis and most often appear in people aged 30-50. The disease is associated with inflammation leading to thrombotic changes in the cerebral vessels in young people who do not have hypertension. There may also be symptoms that indicate congestion related to heart problems. The most common clinical symptoms are paralysis or hemiparesis, epileptic seizures and aphasia.

In the case of progressive paralysis, the changes are slow, and clinical symptoms are observed in the elderly and middle-aged people about 15-20 years after infection. In this case, a complex of psychiatric and neurological symptoms appears. This means a slow loss of memory, personality changes, decreased intellectual performance, and over time depression or euphoria, delusions, confabulations, or epileptic seizures appear.

In turn, itching of the spinal cord occurs in elderly people and after about 20-25 years of infection. The main symptoms include bladder dysfunction, faecal incontinence, loss of vision, shooting pain, ataxia, suppression or weakening of ankle, elbow and knee reflexes, and deformities in large joints. The last form of syphilis of the nervous system are clumps of the brain and spinal cord, the symptoms of which resemble those of a brain tumor. In certain situations, surgical treatment is allowed.

Syphilis – Syphilis and HIV

People with syphilis should be tested for HIV infection, and HIV positive people should be tested for syphilis. Sexually transmitted diseases may coexist, and in the case of syphilis and HIV infection, the course of the disease may be unusual, e.g. neurological changes develop faster.

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Syphilis – classification

When it comes to congenital and acquired syphilis, we can distinguish two forms: early and late. However, their course is different.

The clinical phases of acquired syphilis are as follows.

1. Early syphilis – it is characterized by high infectivity and symptomatic and asymptomatic periods:

1. first-stage syphilis – up to the 9th week after infection,
2. second-stage early syphilis – from the 9th to the 16th week,
3. syphilis of the second recurrent period – from the 16th week,
4. Early latent syphilis – up to 2 years, characterized by no symptoms, the only suggestion of syphilis is positive serological reactions.

2. Late syphilis – arise when it is untreated or not adequately treated:

1. late latent syphilis – more than 2 years after infection, no symptoms other than positive serological reactions,
2. late symptomatic syphilis – over 5 years old,
3. late syphilis of the skin, bones, mucous membranes and internal organs,
4. cardiovascular syphilis – over 10-15 years old,
5. nervous system syphilis – over 10-15 years.

Regarding phases of congenital syphilis, are as follows:

1. Early syphilis – occurs in children up to 2 years of age.
2. Late syphilis – occurs in children after 2 years of age, may be asymptomatic for a long time.

See related topics:

1. Gonorrhea – Symptoms, Treatment, and Causes in Men and Women
2. Gonorrhea – how to recognize the symptoms? Can you heal yourself?
3. HPV (human papillomavirus) – symptoms, treatment

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