Syphilis is forever linked in my mind with Elizabethan times. It may even be responsible for them, as Henry the Eight was allegedly infected. Syphilis may have been responsible for the high incidence of miscarriage seen in his first wife, leading to his divorce, the creation of the Church of England and his infamous marriage to Anne Boylan. As the new world opened up to explorers and spread the diseases of medieval Europe across two continents, one disease moved the other way.

Making A Comeback

Treponema pallidum, a spiral shaped bacteria that under the microscope almost looks cute as it corkscrews its way across the slide. The symptoms, however, are terrible. In the year 2000 it looked as if it was on its way out, reaching the lowest incidence in the USA since reporting began in 1941. Since then however the disease has made a comeback, doubling in incidence between 2005 and 2013. Control has been less successful in the developing world with an estimated 12 million new cases in 1999 and notable recent outbreaks in Russian and China.

Symptoms

Syphilis is a disease for the long term and has three distinct stages. The first stage (primary syphilis) consists of highly infectious skin lesions. These commonly occur on or around the genitals or mouth but can appear on any part of the body. The sores usually last about 3 weeks but can be present for as long as 90 days. They are painless, sometimes go unnoticed by the patient and will resolve even without treatment.

If untreated, however, secondary syphilis may occur one to six months later with a rash around the groin and commonly on the palm of the hand. The rash is often described as a rosy “copper penny” rash and is easily identifiable as syphilis, but can occur as a nondescript rash that may be misdiagnosed. Other symptoms include possible warts around the genitals, sores in the mouth, fever and weight loss. Like primary syphilis, secondary syphilis will appear to resolve without treatment within a few months.

The bacteria can then lay dormant in your system for years, a period known as latent syphilis without causing any symptoms.

The Final Stages

Tertiary syphilis is the reason that Treponema pallidum should be feared. Following the latent period, the bacteria can then re-emerge to cause systemic disease, infecting essential organs such as the heart, nervous system and brain. Symptoms can include heart disease, blindness, deafness, arthritis and brain damage leading to dementia. If untreated the disease will eventually prove fatal.

Treatment

Treatment with penicillin once proved exceptionally effective and resulted in almost wiping out the disease. In most cases the bacteria are still highly susceptible to a single dose of intramuscular Penicillin, but there has been a rise in macrolide (erythromycin), tetracycline and rifampicin resistance in Treponema pallidum making treatment of penicillin-sensitive people difficult. Even with treatment if the syphilis bacteria have invaded the cerebral spinal area (brain and spinal column) many antibiotics struggle to reach this area and may not reach levels fatal to the bacteria. Relapse can occur and patients should be monitored following treatment.

What To Do

People diagnosed with syphilis will need to notify sexual partners. Condoms provide limited protection against the spread of syphilis as sores are often not covered so anyone with Syphilis must abstain from sex while sores are present to prevent infecting others. Incidence in of syphilis in Singapore is low compared to most countries but care should always be taken. Remember the best protection against any STD is abstinence or to be in a monogamous relationship where both partners are known to be STD free.