Syphilis is a bacterial infection that can be cured by antibiotics, usually penicillin, but that can cause serious problems if left untreated. The disease is much less common today than before the development of penicillin, and safer sex practices to curb HIV transmission also helped reduce the incidence of syphilis. Congenital (from birth) syphilis, which occurs in babies born to mothers with syphilis, is very rare today.

The spiral-shaped bacterium Treponema pallidum, which causes syphilis, enters the body through broken skin or through mucous membranes in the genitals, rectum, or mouth during sex. One intimate contact with someone who is infected—even if it's only kissing—can increase your chances of becoming infected by as much as 30 percent.

Left untreated, syphilis usually passes through four stages: Primary stage. The first sign of the disease—a small, smooth, painless sore called a chancre—usually appears within 3 to 4 weeks of contact with an infected person. The sore grows on the penis but also may appear on the anus,

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190 rectum, mouth, or fingers. The sore does not bleed, but it may leak a clear fluid

The that is highly infectious. The surrounding lymph nodes may become enlarged and rubbery but are not tender. Since no pain is involved, about one third of infected men are not aware of the sore, which usually heals in 4 to 8 weeks.

Secondary stage. A skin rash usually introduces the secondary stage of syphilis, which begins 6 to 12 weeks after infection and may last up to a year. The rash may be short-lived, last for months, or disappear and then recur. Usually the lymph nodes are greatly enlarged at the same time, and the infected person may have one or more of the following symptoms:

  • headaches
  • bone aches
  • loss of appetite
  • anemia
  • fever
  • fatigue
  • inflammation of the eyes, which can cause blurred vision
  • inflammation of the kidneys, which can cause protein to leak into the urine
  • inflammation of the liver, which may cause jaundice (a yellowing of the skin and the whites of the eyes)
  • meningitis, which can cause headaches, neck stiffness, and sometimes deafness
  • hair loss
  • thick gray or pink patches on the skin (condylomata latum), which are highly infectious

Latent stage. During this stage, there are no symptoms, even though the infection is present. In some people, syphilis remains latent for the rest of their lives. But about one third of people who are untreated will enter the last (tertiary) stage.

Tertiary stage. There is no predicting when the tertiary stage will begin. It can be as early as 3 years into the infection or as long as 25 years later. Similarly, the effects are varied, from mild to severe. A process called gumma formation destroys tissues and organs—bones, brain, heart, blood vessels, liver, or skin. One consequence, called cardiovascular syphilis, affects the aorta and can lead to the formation of aneurysms (ballooning of an artery caused by blood pressing against a weakened area) and damage to the heart valve.

The active bacteria in the fluid from a chancre make primary syphilis easy to detect under a microscope. Blood tests can confirm the diagnosis at any stage.

Caught early, syphilis can be cured with a single high-dose injection (called a depot injection) of penicillin; later, a longer course of treatment is needed. However, more than half of those treated have an adverse reaction to the antibiotic within hours. In response to the sudden, massive death of bacteria, the body may produce a fever, headache, sweating, shaking, chills, or temporary worsening of the sores.

While organ damage caused by syphilis cannot be reversed, the prognoses for primary-, secondary-, and latent-stage syphilis are good. It is important to note, however, that infection does not confer immunity; once cured, you can become infected again.

Syphilis is infectious only during the primary and secondary stages, during which even practicing safer sex cannot provide complete protection. For this reason, abstinence is the best course early in the disease.

Neurosyphilis, syphilis of the nervous system, can occur during the tertiary stage of the disease but is rare in developed countries. Diagnosis may require testing a sample of cerebrospinal fluid. The outlook for recovery is poor. There are three major types of neurosyphilis:

  • Meningovascular neurosyphilis is a chronic form of meningitis in which the linings of the brain and the spinal cord are inflamed.
  • Paretic neurosyphilis causes behavioral changes and, ultimately, dementia.
  • Tabetic neurosyphilis (tabes dorsalis) is a progressive disease of the spinal cord that begins with intense, stabbing pains in the legs and eventually affects walking and bladder control, among other symptoms. The person may develop tremors and spasms of pain in various organs.

Hepatitis B

Hepatitis is inflammation of the liver. Hepatitis is an umbrella term for infection with one of five different viruses—hepatitis A, B, C, D, or E—all of which cause different diseases but have one symptom in common: inflammation of the liver. Since the viruses are different, they cause different symptoms.

Hepatitis B, also called serum hepatitis, is spread by contact with infected blood, semen, and vaginal secretions, as well as by contaminated hypodermic needles and tools used for tattooing and body piercing. Newborns can acquire hepatitis B from their infected mother during delivery. Those at risk for hepatitis B infection include:

  • people who participate in any kind of sexual activity (anal, oral, or vaginal) with an infected partner
  • people who have sex with multiple partners
  • intravenous drug users
  • emergency care personnel who are exposed to blood
  • nurses and other healthcare workers
  • people who are receiving hemodialysis

The pattern of infection for hepatitis B changed during the 1990s. Children in rural areas used to have the highest incidence. Today, young adults in urban settings are the most affected group.

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192 Many people with the virus have no symptoms. Others may have mild to

The severe flulike symptoms, dark urine, light-colored stool, jaundice (a yellowing of the skin and the whites of the eyes), fatigue, and fever. If the disease goes untreated, the virus can cause liver damage, leading to cirrhosis or liver cancer.

More than 90 percent of those infected with hepatitis B get over their symptoms without lasting complications. A vaccine is now available for people such as healthcare workers who are at significant risk of being exposed to contaminated blood and other body fluids. The vaccine provides protection for up to 18 years. All American children are now vaccinated against hepatitis B during their first 18 months.

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