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C. A. V. Nogueira, M.D. |
Syphilis, a sexually transmitted infection caused by Treponema pallidum bacteria, was once a leading cause of death and serious disability. Today it is rare because we have all kinds of antibiotics but it is far from being destroyed.

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There are three stages of syphilis during which symptoms appear but not every patient will have all three stages. Between these stages, there are periods without any symptom.

Syphilis appears as an acute infection and then goes away without a treatment. It then reemerge again and then - goes away again. When it comes back it may be a chronic condition which is non-contagious.

All that means that there are two groups of patients: the first is infectious but may recover spontaneously, and the second is not infectious but won't be healed without a treatment.

As a rule of thumb, syphilis is transmitted by sexual contact but it can't be transmitted by oral and anal sex, kissing, or through an infected mother to her baby during pregnancy or childbirth.

When it develops, syphilis produces an ulcer on the body part that came in contact with an infected person and that ulcer is painful. It leaks a clear liquid which contains syphilis bacteria.

If that body part touches another person's damaged skin or a mucous membrane it will pass the infection. The bad news: those initial sores are not painful and are located in hidden areas.

That means that patients can transmit the disease while they don't know that they have it.

The first stage is called primary syphilis.

There is just one ulcer which appears 10 to 100 days after the infection. It appears as a red dome, that's the place where the bacteria multiply. It erodes to become a painless ulcer (chancre). That heals in a month or two with or without a treatment. Our patient is contagious during that first stage.

If the patient is not treated bacteria will enter the blood and spread to other parts of the body. Rash typically appears six weeks to three months after the chancre forms. Round red or brown spots then appear on the chest, arms, and legs. It can also be found on the palms soles.

Now, there are also symptoms such as headache, fatigue, and a mild fever - very similar to flu.

If the bacteria enters the brain then we have a big problem called meningitis. This second stage is called secondary syphilis and it can present for a year or two, going away and coming back. As long as there is rash, our patient is contagious.

The good news is that in many cases syphilis will stop in the second stage, with or without treatment. We call that latent syphilis and it can be inactive forever.

Patients with no treatment have 30% chance to develop chronic tertiary syphilis. This is a very dangerous condition.

The bacteria penetrates deep in the body and then syphilis is a very serious threat to the brain, heart, blood vessels, and bones. That can lead to death if left untreated. It is important to say that this stage can appear decades after the second stage rash.

What can tertiary syphilis do? Well, a lot of bad things.

Brain damage is one of them. Symptoms could range from tremors to mood disorders and delusions. Then there are muscle weakness, pain, weak coordination, and loss of movement of the limbs. Heart and blood vessel are next on syphilis' list. It damages the walls of the aorta very easily and that can lead to an aneurysm.

That syndrome appears 10 to 25 years after the initial infection.

Syphilis then attacks both eyes and without a treatment it will cause permanent eye damage and even blindness may develop. That too can happen years and years after the original infection.

And now the good news: penicillin treats all stages of syphilis.

It has been used for more than 60 years, but syphilis bacteria doesn't know how to adapt to it, luckily. Just one injection is enough to permanently cure syphilis. That's it.

An injection can cure the disease that can cause irreparable damages just like that. A patient must wait a few days after the injection before having sex again.

What if the person is allergic to penicillin? Another antibiotic is used and the disease is cured.

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