Syphilis: Causes, Symptoms, and Treatment

Lues venerea – love disease – is the technical name for one of the oldest sexually transmitted diseases. While it was considered almost eradicated in the mid-1990s, the number of new cases has been increasing worldwide at an alarming rate in recent years. The pathogens are Treponema, spiral-shaped rod-shaped bacteria that only live in humans and are mainly transmitted through direct contact with the mucous membranes.

Of microbes and humans

“Pleasure epidemic is spreading”, “syphilis on the rise again”, and “syphilis outbreak in the greater Aachen area” – the reports in newspapers, on websites and in the reports of the Robert Koch Institute (RKI) paint a bleak picture. An infection that was thought to be almost forgotten is spreading again. Although the “hard chancre” tends to affect homosexuals or men who have sex with other men (“MSM”), it also occurs in a quarter of the cases in heterosexuals.

 

High risk of infection

It is worrying that syphilis is easily transmitted and is so often interpreted as an indicator of a general increase in sexually transmitted diseases or unprotected sex. It also increases the likelihood that people with HIV will transmit the AIDS virus at the same time or that people with syphilis will contract the AIDS virus.

Unlike many other sexually transmitted diseases, the majority of patients become infected in Germany. So it is not the travel fever that leads to the spread, but rather an increase in the disease in endangered milieus and from there, it is passed on to the rest of the population. Humans are the only reservoir – outside their host, the pathogens only have a short chance of survival. They are, therefore, almost only transmitted during sexual intercourse or from mother to child, more rarely without sexual contact in cramped communities with poor hygienic conditions or when sharing syringes.

Education, prevention with condoms, regular blood tests for those at risk and adequate therapies are therefore essential to minimize the risk of infection.

Hard facts and dark figures

At the end of the last millennium, the World Health Organization assumed that around 12 million people worldwide contracted syphilis every year. Since a significant increase in new cases has recently been observed in many countries, the current numbers are likely to be even higher. In Tanzania, almost 50% of stillbirths are currently due to a syphilis infection in the unborn child by the mother!

In Germany, syphilis must be reported anonymously. In 2004, the RKI was informed of an average of 4.1 new cases per 100,000 inhabitants, corresponding to an increase of 14% compared to the previous year. In addition, an unreported number of unreported cases of around 30-40% is assumed. Big cities like Frankfurt and Cologne are the sad frontrunners, but the disease incidence is also increasing in rural areas and border areas.

The fact that the infection is also increasing again among heterosexuals is attributed, among other things, to the globalization of prostitution. Drug addicts and foreign (above all from Eastern Europe and the Balkans) prostitutes are more willing to engage in unprotected sex and often have poorer access to the healthcare system. However, women make up only about 10% of those infected, and bisexual men infect some.

Experts express concern that dismantling public health structures in recent years has led to a sharp increase in the risk of infection. In many places, people from high-risk groups can no longer be reached or can only be reached with great difficulty – only passive help is offered, and the networking between public health services, drug help and substitution systems is not considered sufficient.

 

symptoms and stages

A distinction is made between an acquired form ( syphilis acquisita ) and a congenital form that is transmitted through the blood during pregnancy (syphilis connata). The latter is associated with an increased miscarriage rate and neonatal mortality, as well as congenital disabilities. If left untreated, acquired syphilis is a chronic disease that progresses through several phases:

• Early syphilis:  About three weeks after infection, a painless, reddened and weeping ulcer appears at the entry point of the pathogen, which is very contagious. Three weeks later, the lymph nodes in the area can be felt as individual, complex, mobile, painless swellings. A few weeks later, general symptoms such as fever, skin rashes, general swelling of the lymph nodes, headaches and body aches appear. After weeks to months, this primary stage changes to the secondary stage and growths in the genital and anal areas that are highly infectious appear. The symptoms usually disappear after about two years, and the disease can only be detected in the blood.
• Late syphilis: In rare cases, the pathogens spread throughout the body in untreated people, and after about five years, there are changes in the skin, mucous membrane and organs (so-called gums), which lead to the destruction of the tissue. Neurosyphilis manifests years to decades later in the brain and spinal cord and results in a wide variety of symptoms ranging from personality changes to visual, sensory and gait disorders. In addition, there can be changes in the main artery with the life-threatening risk of a rupture. In the late stages, syphilis is no longer contagious.

detection and therapy

Smears diagnose secretions from the skin lesion or a lymph node and detect the pathogen under the microscope. Various tests can be carried out in the blood, with which an illness can be detected (even years later), and the activity, i.e. the need for treatment of the infection and the success of the therapy, can be checked.

Fortunately, less toxic substances are now available for treatment than the mercury used earlier, and the arsenic-containing salvarsan was developed in 1909. Therapy is with penicillin; the duration depends on how long the disease has existed – in early syphilis up to two weeks, otherwise 3-4. It is given as an injection into the muscle or as an infusion. The co-treatment of the sexual partner is mandatory. The success of the therapy is checked with a blood test.

In a nutshell

• In principle, the pathogen can enter any body part where the skin or mucous membrane is damaged.
• Infection occurs mainly through unprotected sexual intercourse or transmission from the pregnant woman to the unborn child.
• Frequently changing, unprotected sexual intercourse, especially with men, increases the risk of infection.
• Condoms (with spermicides), urination, and washing with soap and water immediately after sex offer some protection.
• Rapid and complete healing with antibiotics is possible. Otherwise, severe complications and even death can occur years later.
• The sexual partners must also be treated.
• You can always get infected with syphilis.