Syphilis or lues is a well-known and widespread venereal disease. In most cases, it occurs chronically. The cure or treatment has been favorable since the invention of penicillin if diagnosed in time. Syphilis is reportable and should be treated promptly by a physician.
What is syphilis?
Syphilis or lues is a venereal disease that is very common in the world. However, since the invention of penicillin, this chronic disease is largely curable. The main trigger for syphilis is a bacterium (Treponema pallidum pallidum), which is mostly transmitted from one person to another during unprotected sexual intercourse. Unborn babies can also be infected in this way. Since the successful treatment of syphilis with penicillin, the venereal disease has become less common in Germany and Europe. Nevertheless, since 2001 it has been compulsory for doctors to report cases, even if there is only a suspicion of syphilis. Syphilis occurs in Germany increasingly in large cities. About 3% of the German population are infected with syphilis and have already contracted it. Thereby, men are statistically more likely to be affected by syphilis than women and younger people more likely than older people.
Causes
The cause of syphilis is bacterial infection with Treponema pallidum pallidum. This bacterium can only infect humans. In this case, it is transmitted during sexual intercourse through the mucous membranes and small tears or injuries in the skin. In pregnant women, the unborn child can also become infected with syphilis in this case. If left untreated, the syphilis bacteria spread throughout the body and can also infect other organs. Outside of a host, the syphilis pathogens can only survive for a short time. Since up to two or three weeks can pass before the first symptoms appear, other people can be infected during this time through unprotected sexual intercourse. The chance of contracting syphilis from someone with the disease is 30 percent on average.
Symptoms, complaints and signs
Syphilis can manifest itself in many ways and goes through different stages. Depending on the specific stage, different symptoms may appear. In between, there are symptom-free latency phases. Characteristic symptoms are a prominent swelling of the lymph nodes as well as skin changes. About two to four weeks after infection, small reddened skin nodules form at the entry sites of the bacterium. At first, these are often painless, but later they can cause severe pain. After about a week, they grow to the size of a coin and secrete a colorless, highly infectious fluid. Usually, these ulcers, called hard chancres, occur on the penis (often on the glans) in men and on the vagina and labia in women. However, the anus or oral mucosa may also be affected. If left untreated, they regress after about four to six weeks. The next stage of syphilis is flu-like symptoms such as fever, headache, pain in the limbs and swelling of the lymph nodes. In addition, there is typically a skin rash that initially manifests itself only as pink spots, which then develop into copper-colored nodules (papules) and heal on their own. Often, after this stage, there is a standstill. After three to five years, however, the pathogens have spread throughout the body and affect internal organs such as the bloodstream, lungs, liver, stomach, esophagus, or muscles, bones, and other parts of the body.
Course of the disease
The course of syphilis can be divided into four stages. In the first three weeks after infection, hard but painless ulcers form at the site of infection (mostly penis or vagina). This so-called ulcus durum (hard chancre) is usually not noticed by the affected person. In the second part of the syphilis disease, massive rashes, reddening of the skin and mucosal changes occur. At this point, at the latest, the affected person should consult a doctor. Often the symptoms disappear again for a few years, but then break out again particularly strong and dangerous. This is also called latent syphilis. The internal organs, such as the heart, can then be particularly damaged. Neurological disorders and bone changes are also possible. If syphilis is treated in time, the prognosis for recovery is very favorable nowadays. Especially when antibiotics (penicillin) are used, the chances of recovery are good.However, if the syphilis is already more advanced and has reached the stage of neurosyphilis, the disease can very likely end fatally. But also permanent damage such as lifelong paralysis can make the affected person a nursing case. Only rarely does spontaneous recovery occur.
Complications
If treated early, syphilis usually heals without consequences; if left untreated, the disease can cause serious complications and even death. Especially in the early stages, the disease is highly contagious and can be further spread through unprotected sexual intercourse. During pregnancy, the pathogen can pass to the child and lead to congenital syphilis. Miscarriage or premature birth is also possible. A syphilis infection increases the risk of infection with HIV; in addition, the two diseases have an unfavorable influence on each other’s course. In the advanced stage of syphilis, the pathogens affect the central nervous system: this so-called neurolues is characterized by chronic inflammation of the spinal cord and brain, which can lead to mental impairment, depression or dementia. Motor disturbances, pain in the extremities, personality changes, and urinary and fecal continence are also typical signs of neurosyphilis. Other complications may include numbness, eye muscle paralysis and dizziness. Nodule formation on the aorta as a late consequence can lead to dilatation of the aorta decades after infection (aortic aneurysm). If this aneurysm bursts, the affected person bleeds to death within a short time. Tissue growths can also damage the skin, mucous membranes and bones, and an infestation of the liver triggers liver inflammation. During treatment of syphilis, a Jarisch-Herxheimer reaction with high fever, headache, and skin rashes may develop as a complication.
When should you see a doctor?
If the affected person develops various irregularities and symptoms after unprotected sexual contact with another person, a doctor should be consulted. Swelling of the lymph and skin changes are considered signs of impaired health. They should be clarified, as venereal disease is a highly contagious disease. Pain, redness or discomfort in the area of the mucous membranes, the anus or the vaginal entrance are considered unusual and should be examined more closely. If flu-like symptoms occur in the further course, this is also to be understood as a warning signal of the organism. In case of fever, headache or a general feeling of indisposition, a doctor is needed. Dysfunctions of the organism, swellings or ulcers are further signs of a present disease. In an advanced stage of the disease, mobility restrictions or hair loss may occur. Since syphilis can lead to premature death of the affected person if the disease progresses unfavorably, or there is a possibility of developing lifelong damage such as paralysis, a doctor should be consulted at the first signs. A general feeling of illness or suspicion of infection should be discussed with a physician. In addition, when practicing unprotected sexual activities, it is recommended to have check-ups at regular intervals.
Treatment, therapy, and prevention
If syphilis is suspected, a physician should be consulted immediately. If the venereal disease is actually present, it is usually treated with the antibiotic penicillin. The dosage prescribed by a doctor should be strictly adhered to by the patient in order to exclude permanent damage. The duration of treatment depends on the severity and advanced stage of syphilis. As a rule, two to three weeks are sufficient for therapy. Side effects are usually headache, muscle pain (similar to sore muscles) and fever. A vaccination against syphilis is not yet available. Therefore, for prevention, protected sexual intercourse, e.g. by condoms, should be preferred. Likewise, when donating blood, syphilis errger should be watched out for.
Aftercare
In the vast majority of cases, medication – especially antibiotics – must continue to be taken even after the symptoms have subsided. This is to ensure that the symptoms are completely alleviated in the long term. In children, parents in particular are urged to ensure that the medication is taken continuously and correctly.During follow-up care, it is always important to include the partner – even if no infection has been detected in him or her. During this time, even protected sexual intercourse should be taboo – this way, smear infection can be ruled out. Syphilis does not usually heal spontaneously. In the case of a long period of persistence, malignant degeneration cannot be ruled out. Regular follow-up examinations over many years seem unavoidable because of the high risk of recurrence. After syphilis therapy, antibodies in the blood are determined again at certain intervals. This is to prevent a recurrence of the infection. If the venereal disease was already in an advanced stage before treatment, six-monthly testing of both serum and cerebrospinal fluid values is mandatory over a total period of three years. Further measures are usually not necessary, and the life expectancy of the affected person is not reduced – always assuming very rapid diagnosis and correspondingly timely treatment.
What you can do yourself
In the case of the notifiable disease, cooperation with a physician is mandatory. In the context of self-help, a cautious approach should be taken, especially in the case of sexual contact with another person. The sexual partner must be informed of the presence of the disease. In addition, sufficient protective measures must be taken in the event of sexual contact. Since in many cases the disease is only noticed at an advanced stage, previous sexual partners should be informed of the diagnosis. They themselves must also submit to medical tests and in turn contact former sexual partners. Unprotected sexual intercourse it to avoid under all circumstances. Since the disease usually shows a chronic course, the immune system must be supported. A healthy lifestyle is advised via a diet rich in vitamins and the avoidance of harmful substances. The consumption of nicotine, drugs, non-prescribed medication or alcohol can have a significant impact on further development. On the other hand, a weight in the normal range, sufficient exercise, restful sleep and mental strength are helpful. Stressors of everyday life should be reduced to a minimum. Dealing with the disease is particularly difficult if the unborn child has also been infected. Nevertheless, calmness should be maintained and a confident approach is necessary. Precautions should be taken to prevent further transmission.
