MEN'S HEALTH Sexually Transmitted Diseases • Genital warts • Chlamydia • Genital herpes • Gonorrhea • Syphilis WOMEN'S HEALTH Sexually Transmitted Diseases • Genital warts • Chlamydia • Genital herpes • Gonorrhea • Syphilis

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Syphilis is a bacterial infection usually transmitted by sexual contact. The disease affects your genitals, skin and mucous membranes, but it may also involve many other parts of your body, including your brain and your heart.

The discovery of penicillin in the 1940s and its use in treating syphilis led to a dramatic decline in the incidence of the disease. However, in the late 1980s and early 1990s, the incidence of syphilis began to rise along with the incidence of HIV/AIDS. After a brief decline in cases in the late 1990s, incidence has again been on the rise during this decade.

The incidence of syphilis is highest among young adults. Rates of the disease have remained relatively steady for women, yet syphilis is on the rise in men, particularly in men who have sex with other men. The Centers for Disease Control and Prevention (CDC) estimates that nearly two-thirds of new syphilis cases are occurring in men who have sex with men.

Left untreated, syphilis can lead to serious complications or death. But with early diagnosis and treatment, the disease can be successfully treated.

The signs and symptoms of syphilis may occur in four stages — primary, secondary, latent and tertiary.

Primary
These signs may occur from 10 days to three months after exposure:

• A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually your genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.
• Enlarged lymph nodes in your groin.

Signs and symptoms of primary syphilis typically disappear without treatment, but the underlying disease remains and may reappear in the secondary or third (tertiary) stage.

Secondary
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:

• Rash marked by red or reddish-brown, penny-sized sores over any area of your body, including your palms and soles
• Fever
• Fatigue and a vague feeling of discomfort
• Soreness and aching

These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent
In some people, a period called latent syphilis — in which no symptoms are present — may follow the secondary stage. Signs and symptoms may never return, or the disease may progress to the tertiary stage.

Tertiary
Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death years after the original infection.

Some of the signs and symptoms of tertiary syphilis include:

• Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.
• Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta — your body's major artery — and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve stenosis.

Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period. The bacterial organism that causes syphilis, Treponema pallidum, enters your body through minor cuts or abrasions in your skin or mucous membranes. The most common route of transmission is through contact with an infected person's sore during sexual activity. Other routes are through transfusion of infected blood, through direct unprotected close contact with an active lesion (such as during kissing), and through an infected mother to her unborn child during pregnancy.

Treponema pallidum is extremely sensitive to light, air and changes in temperature. Because of this, the disease is difficult to transmit except by intimate contact. You can't contract syphilis from using the same toilet, bathtub, clothing or tableware as an infected person.

High-risk sexual activity puts you at risk of syphilis and other sexually transmitted diseases (STDs). Men who have unprotected sex with other men are at greater risk, and about half the men recently diagnosed with syphilis are also infected with the human immunodeficiency virus (HIV).

Young adults between the ages of 15 and 25 years currently appear to be at highest risk of contracting syphilis. However, anyone who has unprotected sex is at risk of developing syphilis. Even if you've had syphilis and been treated for it previously, you can contract it again.

If you have painless sores in your genital area and enlarged lymph nodes in your groin area, see your doctor. These may be signs of syphilis. Treatment in the early stages of syphilis can prevent serious, long-term illness and spread of the disease.

To diagnose syphilis, your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. Blood tests can confirm the presence of antibodies to the organism that causes syphilis. These tests remain positive indefinitely unless you receive early, effective treatment. During latent syphilis, when no symptoms are evident, your doctor can use blood tests to diagnose the infection.

If your doctor suspects that you have neurosyphilis, he or she may also suggest collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture.

If you're pregnant, it's possible for you to pass syphilis to your unborn child. Blood containing the bacteria reaches the fetus through the placenta. More than half the women who are pregnant and have active, untreated syphilis may pass the disease to their unborn babies. Almost half the babies who contract syphilis from their mothers will die — either through miscarriage, stillbirth or within a few days of birth.

If your baby is born infected with syphilis, signs of the disease may be evident at birth or may develop later. Babies born with syphilis who aren't treated early may experience serious complications, including:

• Bone abnormalities and pain
• Depressed nose bridge (saddle nose)
• Swollen joints
• Vision and hearing problems
• Disfigured, screwdriver-shaped teeth (Hutchinson's teeth)
• Scarring at the site of early sores
• Death

Adults with sexually transmitted syphilis or other genital ulcers also have an increased risk of contracting HIV. A syphilis sore can provide an easy way for HIV to enter your bloodstream during sexual intercourse.

Early diagnosis and treatment with penicillin — or another antibiotic if you're allergic to penicillin — can kill the organism that causes syphilis and stop the progression of the disease. Left untreated, the disease can lead to serious complications or death.

If transmitted to a fetus, syphilis can cause deformity and death. Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.

To make sure you're responding to the usual dosage of penicillin, your doctor likely will want you to have periodic blood tests. While you're being treated, avoid sexual contact until the treatment is completed and until your blood tests indicate that the infection has been eliminated.

The first day you receive treatment you may experience what's known as the Jarisch-Herxheimer reaction. Signs and symptoms of this reaction include fever, chills, nausea, achy pain and headache. This reaction, which is probably caused by many bacteria dying at once when you begin antibiotic therapy, usually doesn't last more than one day.

To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex:

• Avoid sex, or limit sexual relations to a single, uninfected partner.
• If you don't know the STD status of your partner, use a latex condom with each sexual contact.
• Avoid excessive use of alcohol or other drugs, which can cloud judgment and lead to unsafe sexual practices.