Syphilis
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Basics

Description

  • A chronic, systemic infectious disease caused by Treponema pallidum
  • Transmitted sexually, maternal–fetal, contact with an active lesion, and via blood transfusions
  • Untreated disease includes 4 overlapping stages:
    • Primary: Usually single painless chancre at point of entry; appears in 10–90 days; chancre heals without treatment in 3–6 weeks
    • Secondary: Appears 2–8 weeks after primary chancre. Nonpruritic rash on palms or soles of feet, mucous membrane lesions, headache, fever, lymphadenopathy
    • Latent: Seroreactive without evidence of disease:
      • Early latent: Acquired within the last year
      • Late latent: Exposure >12 months prior to diagnosis
    • Tertiary (late): Serology may be negative (although fluorescent treponemal antibody absorption (FTA-ABS) test is positive almost 100%):
      • Refers to gumma and cardiovascular and late neurosyphilis; may be lethal
    • Neurosyphilis: Represents any type of CNS involvement with syphilis and can occur at any stage:
      • Psychosis, delirium, dementia
  • Ability to affect nearly every organ/tissue in the body has led to it being called “the great imitator.”

Pediatric Considerations
In noncongenital cases, consider child abuse,

Pregnancy Considerations
  • All pregnant patients should have VDRL or rapid plasma reagin (RPR) test at 1st prenatal visit (1). If high exposure risk, repeat the tests at 28 weeks and at delivery.
  • The same nontreponemal test for initial diagnosis also should be used for follow-up tests.

Epidemiology


Incidence
  • Syphilis rate decreased until 2000, increasing primarily in men since then (2).
  • In 2010: 14.9/100,000 population (an increase of 2.2% from 2009) (3):
    • Highest in both men and women aged 20–24 years:
      • Men: 7.9/100,000
      • Women: 1.1/100,000
    • Congenital: 8.7 cases/100,000 live births
  • Race/Ethnicity (2):
    • Caucasian, non-Hispanic: 2.1/100,000
    • African American: 16.8/100,000
    • Hispanic: 4.6/100,000
    • Asian/Pacific Islander: 1.3/100,000
    • Native American/Alaska native: 2.5/100,000
Prevalence
  • Predominant sex: Male > Female (7:1)
  • Increasing male-to-female ratio (was 1.2:1 in 1996) suggests greatest syphilis increase in men having sex with men (MSM).

Risk Factors

MSM, multiple sexual partners, exposure to infected body fluids, IV drug use, transplacental transmission, adult inmates, high-risk sexual behavior, HIV positive

General Prevention

Education; condoms reduce, but do not eliminate transmission (4)[A].

Etiology

Treponema pallidum subspecies pallidum, spirochete

Commonly Associated Conditions

HIV infection, hepatitis B, other STIs

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