Syphilis, also called lues or “hard chancre” (synonyms: Gumma; Hard chancre; Connatal syphilis; Lues; Neurosyphilis; Progressive paresis; Schaudinn’s disease; Late syphilis; Syphilis (lues); Treponema pallidum; Treponema infection; Ulcus durum; ICD-10 A52.-: Late syphilis; A51.-: Early syphilis; A53.9: Syphilis, unspecified; A50.-: Syphilis connata) is a sexually transmitted disease (STD or STI). It is caused by the bacterium Treponema pallidum (spirochete species). Humans are currently the only relevant reservoir of the pathogen. Occurrence: The infection occurs worldwide. Transmission of the pathogen (route of infection) occurs through contact of genitoanal or oral mucous membranes (rarely the skin) of infected patients (sexual contacts) as well as through blood. Syphilis connata is a special form of transmission of the pathogen. This is the transmission of the infection from the mother to the unborn child (intrauterine), which usually occurs from the 4th month of pregnancy. This can lead to early stillbirth of the child (in about 40%) or to syphilis connata in case of early syphilis of the mother. The pathogen enters parenterally (the pathogen does not penetrate through the intestine), i.e. in this case, it can enter the body through the smallest injuries in apparently healthy skin, especially in the area of the genital and anal mucosa. Human-to-human transmission: Yes. The incubation period (time from infection to onset of disease) is usually 10 days to 3 months. Acquired syphilis is divided into four stages according to the course of the disease:
- Primary stage – about three weeks after infection, the ulcus durum (a painless induration that ulcerates) develops at the site of entry (so-called primary effect); the local lymph nodes also swell painlessly (so-called primary complex); these symptoms regress after 4-6 weeks weeks even without therapy.
- Secondary stage – if the primary stage was not treated, the infection progresses and makes a variety of symptoms (general symptoms and skin symptoms/small spotted exanthema on the trunk of the body and on the proximal parts of the extremities; enanthem: on the mucous membranes are infectious reddish papules (vesicles / nodules; plaques muqueses); in the area of the back of the tongue are found plaques lisses); untreated, these symptoms also subside again and then culminate after months or years (= latency) in the subsequent stage.
- Tertiary stage (years after the initial infection) – at this stage, the pathogen has manifested itself in all organs, a danger exists especially in the involvement of the central nervous system
- Quaternary stage – progressive (progressive) paralysis (manifestation of neurosyphilis, which proceeds as psychosis with neurological deficits) and the tabes dorsalis (demyelination process of the posterior cord and dorsal nerve roots of the spinal nerves; this leads to disturbances of the sense of position, sense of movement and sense of vibration)
Symptom-free periods are called latency. Depending on the time elapsed since infection, a distinction is made between early and late latency. Sex ratio: men are more often affected than women. Peak incidence: the disease occurs predominantly between the ages of 20 and 50, with women more likely to become infected at a younger age (25-29 years) and men mostly between the ages of 30-39 years. Syphilis is the third most common sexually transmitted disease (STI) worldwide. The incidence (frequency of new cases) in men, after a significant decline in the 1990s, is 11.5-13.5 per 100,000 inhabitants per year, similar to the level before the beginning of the AIDS era. Among women, incidence has remained below 1 per 100,000 since the 1990s. Infectivity (contagiousness) exists in the primary and secondary stages and during early latency (until about one year after infection). Course and prognosis: For the course of the disease, see above under “Course of the disease in four stages”. With timely and adequate therapy (antibiotics), the disease heals successfully. Sexual partners should be diagnosed and, if necessary, treated. Note: Approximately half of syphilis patients also have an HIV co-infection (double infection).A protective vaccination against syphilis is not yet available. In Germany, direct or indirect detection of the pathogen is reportable by name according to the Infection Protection Act (IfSG) if the evidence indicates an acute infection.
