Lues venerea – love disease – is the technical name for one of the oldest venereal diseases. Considered almost eradicated in the mid-1990s, the number of new cases has been rising alarmingly worldwide in recent years. Pathogens are treponemes, spiral-shaped rod-shaped bacteria that live only on humans and are transmitted predominantly through direct mucosal contact.
Of microbes and humans
“Lues epidemic spreading,” “Lues on the rise again,” “Syphilis outbreak in the greater Aachen area” – the reports in newspapers, on Internet sites, and in Robert Koch Institute (RKI) notifications paint a bleak picture. An infection that was almost thought to have been forgotten is spreading again. Although the “hard chancre” rather affects homosexuals or men who have sex with other men (“MSM”), it also occurs in a quarter of cases in heterosexuals.
High risk of infection
Of concern is that syphilis is easily transmitted and so is often interpreted as an indicator of a general increase in STDs or unprotected sex. It also increases the likelihood that people with HIV will also transmit the AIDS virus at the same time, or that syphilis sufferers will become infected with the AIDS virus. Unlike many other STDs, the majority of patients become infected in Germany. So it is not the travel fever that leads to the spread of the disease, but rather an increase of the disease in endangered environments and from there its transmission to the rest of the population. Humans are the only reservoir – outside their human host, the pathogens have only short chances of survival. They are therefore transmitted almost exclusively during sexual intercourse or from mother to child, and less frequently without sexual contact in confined communities with poor hygienic conditions or when syringes are shared. Education, prevention with condoms, regular blood testing of those at risk, and adequate therapies are therefore essential to minimize the risk of infection.
Hard facts and dark numbers
At the end of the last millennium, the World Health Organization estimated that about 12 million people worldwide become infected with syphilis each year. With a marked increase in new cases in many countries in recent years, the current numbers are likely to be even higher. In Tanzania, almost 50% of stillbirths are currently due to a lues infection of the unborn child by the mother! Syphilis is anonymously notifiable in Germany. In 2004, the RKI was informed of an average of 4.1 new cases per 100,000 inhabitants, which corresponds to an increase rate of 14 % compared to the previous year. In addition, it is assumed that the number of unreported cases is around 30-40%. Sad front-runners are large cities such as Frankfurt and Cologne, but also in rural areas and border regions the disease frequency increases. The fact that the infection is also on the rise again among heterosexuals is attributed, among other things, to a globalization of prostitution. Drug-addicted and foreign (especially from Eastern Europe and the Balkan countries) prostitutes in particular are more likely to engage in unprotected intercourse and often have poorer access to the health care system. However, women make up only about 10% of those infected, and are in part infected by bisexual men. Experts express concern that the dismantling of public health structures in recent years is leading to a sharp increase in infection risks. In many places, people from high-risk groups can no longer be reached or are very difficult to reach – only passive help is offered, and networking between public health services, drug assistance and substitution systems is considered inadequate.
Symptoms and stages
A distinction is made between an acquired form (syphilis acquisita) and a congenital form transmitted through the bloodstream during pregnancy (syphilis connata). The latter is associated with an increased miscarriage rate and neonatal mortality as well as malformations. Acquired syphilis, if untreated, is a chronic disease that progresses in several phases:
- Early syphilis: about 3 weeks after infection, a painless, red, and weeping ulcer appears at the site of entry of the pathogen and is highly contagious. 3 weeks afterward, the surrounding lymph nodes can be palpated as single, hard, mobile, painless swellings.A few weeks later, general symptoms such as fever, skin rashes, general swelling of the lymph nodes, headache and pain in the limbs appear. After weeks to months, this primary stage changes to the secondary stage and growths appear in the genital and anal areas, which are highly infectious. After about 2 years, the symptoms usually disappear and the disease is only detectable in the blood.
- Late syphilis: In rare cases, the pathogens spread throughout the body in untreated individuals and after about 5 years there are changes in the skin, mucous membrane and organs (so-called gummata), which lead to the destruction of the tissue. Neurosyphilis manifests itself years to decades later in the brain and spinal cord and results in a variety of symptoms ranging from changes in character to visual, sensory and gait disturbances. In addition, there may be changes in the aorta with the life-threatening risk of rupture. In the late stage, syphilis is no longer contagious.
Detection and therapy
Diagnosis is made by smears of secretions from the skin lesion or a lymph node and the detection of pathogens under the microscope. Various tests can be performed in the blood to detect disease (even years later) and to verify the activity, or need for treatment, of the infection and the success of therapy. Fortunately, less toxic substances are available for treatment today than the mercury used in the past and the arsenical salvarsan developed in 1909. The therapy is carried out with penicillin, the duration depends on how long the disease has existed – in early syphilis up to two weeks, otherwise 3-4. The administration is carried out as an injection into the muscle or as an infusion. Co-treatment of the sexual partner is mandatory. The success of therapy is checked with a blood test.
To the point
- In principle, the pathogen can enter the body at any point where the skin or mucous membrane is damaged.
- Infection occurs predominantly through unprotected sexual intercourse or transmission from the pregnant woman to the unborn child.
- Frequently changing, unprotected sexual intercourse v.a. with men increases the risk of infection.
- Some protection is provided by condoms (with spermicides), urination and washing with soap and water immediately after the sexual act.
- A rapid and complete cure with antibiotics is possible, otherwise it may be years later severe complications and even death.
- The sexual partners must also be treated.
- You can always get infected with syphilis again.
