Syphilis infection has a rich history but is still a common sexually transmitted disease that has increased in prevalence in the past decade.
Syphilis Transmission
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum, but can also occur on the lips and in the mouth.
Transmission of the organism occurs through direct contact with active lesions during vaginal, anal, or oral sex. However, syphilis sores may go unrecognized resulting in transmission by those unaware that they are infected.
Pregnant women with the disease can pass it to the babies they are carrying.
Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
Distribution and Prevalence
In 2000, the rate of primary and secondary syphilis in North America was the lowest it had been since 1941. However since 2000, the overall rate of syphilis has been steadily increasing in both men and women, but more so in men.
Syphilis cases in men outnumber those in women by more than 2:1 and many of the cases in men are among those who have sex with men, although outbreaks also occur in sex trade workers and heterosexuals.
The occurrence of infectious syphilis is highest in women aged 20 to 24 years and men aged 35 to 39 years.
Treatment
Prior to the discovery of penicillin, syphilis was treated with mercury administered orally or topically. Whether or not mercury was an effective syphilis treatment is questionable, and may have actually have killed more than it cured as the doses used were close to lethal.
Syphilis is caused by the cork-screw shaped bacterium Treponema pallidum and is relatively easy to cure in the primary, secondary and early latent stages of infection. A single injection of penicillin is generally all that is required for cure. Three injections of penicillin one week apart are used to treat individuals in the late latent and tertiary stages of infection.
Individuals who are allergic to penicillin can be treated with alternative antibiotics: doxycyline, tetracycline or erythromycin for longer periods than those required for penicillin.
Although antibiotics kill Treponema pallidum, treatment cannot repair the damage done by the organism to the body’s organs and nervous system.
At Risk Individuals
The risks for acquiring syphilis are the same as those for acquiring other sexually transmitted diseases.
Prevention of syphilis
Prevention measures have changed drastically through the years:
- Prior to 1700 women with syphilis were whipped unless they could prove that they were infected by a husband or soldier.
- Infected persons and individuals considered at high-risk (e.g. prostitutes, foreigners) were arrested and quarantined.
- Prostitution was outlawed or regulated.
- Public treatment facility tours were used to discourage children from behaviour that may result in syphilis infection.
For better or worse prevention strategies have evolved to include:
- Abstinence from sexual contact
- Long-term monogamous relationship with an uninfected partner
- Avoiding risky sexual behaviour
Condom use may reduce the risk of infection, but will not eliminate the risk (infections that are characterized by genital ulcers are more difficult to prevent by condoms).
Once infected it is important to abstain from sexual contact until sores have completely healed so that syphilis is not spread to sexual partner(s). In addition, sexual partners must be tested and treated if found to be infected.
As with the two most common sexually transmitted infections, chlamydia and gonorrhoea, infection does not protect against re-infection. Once treated, you can become re-infected.
Sources
Primary and Secondary Syphilis --- United States, 2003—2004
Frequently Asked Questions About Syphilis
