Syphilis symptoms
Only about half of all infections with T. pallidum lead to a symptomatic course. Four different stages are distinguished:Stage I of syphilis symptoms (primary stage) includes the incubation period, the occurrence of the primary effect and the time of its spontaneous regression. The incubation period from infection to the appearance of the first symptoms of syphilis is on average 3 weeks, in exceptional cases also 1 week to 3.5 months.
During this time, the pathogen multiplies at the point of entry up to a concentration of approx. 107/g tissue. The primary symptom is a coarse ulcer with a raised edge, also known as hard chancre or ulcer durum.
It is the size of a small fingernail, round, painless and produces a clear fluid. It is usually located in the genital area, but can also be located outside the genital region (extragenital) at any part of the body, e.g. on the lip, chest, fingers. In such cases the ulcer durum is easily overlooked or misinterpreted.
In addition, the ulcer can hide in body orifices, e.g. in the vagina or anus, and is then usually only discovered by chance or not at all. The primary effect of syphilis is highly infectious (highly contagious) as it contains numerous living pathogens. Approximately one week after the occurrence of the ulcer, the (regional) lymph node located near the ulcer becomes enlarged (lymphadenopathy).
The node feels hard, is easily movable and painless. This lymph node is also known as satellite bubo. The complex consisting of the primary and satellite bubo is called primary complex.
The symptoms of the primary effect heal spontaneously 3-6 weeks after they occur, but the swelling of the lymph node can last for months. Stage II of syphilis (secondary stage) includes the time of the body’s confrontation with the pathogen. It develops after about 6 – 12 weeks after infection due to the hematogenic spread (generalization) of the pathogen and consists of organ manifestations characterized by a large number of pathogens and a high risk of infection.
Mainly symptoms such as changes in the skin (skin manifestation) can be observed at this stage, but also fever, fatigue, headache, pain in the neck and limbs, swelling of the palatal tonsils with whitish coatings and hoarseness (angina syphilitica), enlargement of the spleen and general swelling of the lymph nodes can occur. The most important skin manifestations include the so-called Roseola syphilitica, condylomata lata, plaques muqueuses and alopecia. Rose lichen is a harmless skin disease that can be confused with the skin symptoms of syphilis.
Roseola syphilitica occurs in 75-100% of patients and consists of a pale, blotchy (macular) rash (exanthema) that is mainly confined to the upper part of the body (trunk). The palms of the hands and soles of the feet may also be affected (palmoplantar syphilis). Over time, the patches of exanthema turn into blisters (papules) and then heal with or without treatment, usually leaving light (hypo-) and dark (hyperpigmented) spots on the skin.
In the genital area, under the breast and between the fingers and toes, broad, soft, superficially weeping and highly infectious papules form, which are called condylomata lata. The plaques muqueuses are also highly infectious papules that are located on the mucous membrane, i.e. in the mouth, tongue, but also in the vagina. If the scalp is affected, irregular hair loss, called syphilitic alopecia, occurs.
The symptoms of the secondary stage subside 2-6 weeks after the onset. However, they can recur if the disease remains untreated. After stage II of syphilis, there may be either spontaneous healing, latency or stage III.
Latency is the period of time after healing of the primary infection, during which no clinical symptoms are present. It can last less than 1 year or even last for life. The pathogen is also present in the body during latency, so antibodies against T. pallidum can be found in the blood during this phase as well.
The latency stage is divided into the spring latency, i.e. the clinically non-appearing time in the first 4 years after the onset of the disease, and the late latency, i.e. the non-appearing time after that. During the period of spring latency, but usually only up to one year, symptoms of secondary syphilis may reappear.
The subdivision corresponds to the patient’s contagiousness (risk of infection), which is high in the first year after the onset of the disease and then drops sharply.In late latency, the patient is no longer contagious, sexual partners are no longer infected, but there is still a risk of transmission from the mother to the fetuses and through blood transmission. The latency can be interrupted at any time by the appearance of symptoms of secondary or tertiary stage disease. Stage III syphilis (tertiary stage) occurs in about 35% of untreated syphilis cases after 2-5 years.
In this stage, internal organs (liver, brain, aorta) are also affected in addition to the skin. The stage is characterized by the following symptoms: specific tissue formations (granulomas) of the skin are gums and syphilic lesions. Gums are painless tumors/tumors of elastic consistency, which tend to melt down (gumma), emptying of stringy fluid and scarring.
They develop in the subcutaneous tissue (subcutis), bulge the skin and then disintegrate into sharply defined, coarse ulcers (ulcer). Inside the gums, there are few living pathogens responsible for their development. The gums are most often found in bones, skin and mucous membranes.
In the face and mouth area they can lead to destruction (holes in the palate and nasal septum, saddle nose), in the bone to fractures, in the liver to jaundice (icterus). Syphilides consist of brown-red, coarse, lentil to bean-sized nodules that are clearly raised above the skin level. They can occur anywhere on the body, preferably on the extensor sides of the arms, but can also affect the back and face and do not cause any discomfort.
Changes in the heart and vessels (cardiovascular) are due to vascular inflammation (vasculitis) of small and medium-sized arteries and veins (endarteritis obliterans). This inflammation mainly affects the blood vessels of the aorta, which supply the aorta (vasa vasorum). The wall tissue supplied by the vasa vasorum disappears, and the elastic fibers in the aortic wall disappear.
An expansion (dilatation) of the aorta is formed, which can develop into an aneurysm. The rupture of an aneurysm is usually fatal. Often these are patients who have experienced syphilis decades before.
Neurosyphilis belongs to stage IV of syphilis symptoms or late forms. It is divided into two main forms: 1. meningovascular neurosyphilis mainly affects blood vessels in the meninges, brain tissue and spinal cord. The inflammation of the vessels (arteritis) leads to reduced blood flow and thus to damage to the nervous system.
This can result in symptoms such as back pain, sensory disturbances, cramps, failure symptoms such as hemiplegia and strokes. 2. typical symptoms of parenchymatous neurosyphilis are progressive paralysis and dorsal tabs. Progressive paralysis is based on the destruction of nerve cells (preferably in the brain) and brain atrophy (brain atrophy), whereby the frontal lobe is particularly affected.
Dementia, memory loss, megalomania, hallucinations, speech disorders, tremor, incontinence and cramps can occur. In the case of the dorsal tabes, the spinal cord is predominantly affected. Patients suffer from lightning (lancinating) pain as well as loss of temperature and vibration sensation, gait disorders, urination disorders, impotence, loss of tendon reflexes and light-fast pupils. Furthermore, changes in cerebrospinal fluid (cerebrospinal fluid) without clinical manifestations, i.e. asymptomatic neurosyphilis, may also occur. –> Continue to the topic transmission of syphilis
