Lues venerea, sexual plague, French disease, British disease, venereal disease.

What is it?

It is a chronic infectious disease caused by a bacteria called Treponema pallidum , acquired, most of the times, through sexual contact with another infected person. If not treated, it becomes chronic and develops into systemic manifestations, that is, affecting many parts of the body. Overtime, its progression, according to the degree of commitment of the body, was divided into stages (primary, secondary and tertiary). The two first phases are the most markedly infectious, when more symptoms can be observed and when it is most transmissible, after which a long period of latency can be observed – when the person presents no symptoms and shows an apparent healing of the initial lesions – even in the cases of untreated individuals. After this initial phase, the capacity of transmission diminishes. After some years, manifestations of the disease can appear in the heart, in the brain and in virtually any organ of body.

How is it acquired?

Syphilis can be acquired by sexual contact; diaplacental passage (congenital syphilis, the fetus acquires it during the intrauterine life); through the kiss, or another intimate contact with an active lesion (containing the Treponema bacteria); by blood transfusion or its derivatives, or still, by accidental inoculation, for example, in healthcare workers (rare). The majority of the contagion cases occur through unprotected sexual intercourse (without condom).

What does one feel?

The first manifestations occur after a period of incubation (from the contamination until the first symptom appears) of average duration of 21 days, that can vary from 3 to 90 days. The disease presents, as mentioned before, three distinct phases, with manifestations that are characteristic to each one and a latent period (without symptoms) between the second and third phase.

During the primary phase, there is the classic lesion of the genitals, entering door to the Treponema, called chancre. It is a sore with hard and deep edges, a soft bottom and hurts very little. This lesion may not be present, or occult, in the case of women. It can also occur in multiple ways, more frequently in individuals with compromised immunity, such as HIV carriers. Such lesions are very variable and often atypical; for this reason, every lesion on the genitals should undergo a medical evaluation. It may happen what the physicians call Lymphadenopathy, a swelling of the lymph nodes in the inguinal region, simultaneously, with the primary lesion. The chancre takes an average 3 to 6 weeks to be cured and may leave no scar.

The secondary phase occurs 4 to 8 weeks from the appearing of the chancre, and this lesion may possibily still be present. During this phase, the largest quantity of circulating Treponemas occurs. The infected individual presents general symptoms such as: malaise, fever, headache, sore throat, loss of appetite and weight and, in many cases, swollen lymph nodes (lymphoadenopathy) all over the body. In 80% of the cases, lesions appear on the skin all over the body, “saving” the face, while they may occur on the lips, compromise the sole of the feet and the palm of the hands (characteristic of this phase). They are pinkish, or violet, flat little spots of 3-10mm of diameter, that do not itch nor hurt.

Because what occurs in this second phase is a dissemination of the bacterium throughout the body, the manifestations can vary according to the degree of compromise of one or other organ. The brain, the kidneys, the liver, digestive tube, the eyes, the bones, the tendons, the cartilage and the joints can be compromised. While in this phase symptoms can be mistaken for a large number of diseases, fortunately the main diagnostic testing is positive in 99% of the cases. From this phase, the individual can move on to latent syphilis, where there is no evolution to a third phase and becomes free of the symptoms, although relapse may occur with symptoms of the second phase and be potentially contagious, especially women in the case of intrauterine transmission to fetus. The individual may remain for an indefinite time in this phase, which may last a lifetime.

The tertiary phase is the slow but progressively inflaming stage (chronic), with symptoms related to the organs predominantly compromised. It is destructive and incapacitating. Therefore, in the case of the brain, we will have neurosyphilis, with symptoms of meningitis and nerve paralysis or damage to brain vessels caused by obstructions of the arteries, with symptoms of thrombosis or strokes. When the medulla is affected, there is a loss of reflexes and sensibility of the limbs, with a progressive deterioration of sphincter control and walking ability. The range of the neurological symptoms is very wide, and the scenario may include cases more related to the sensibility: abdominal pain and/or in the limbs, and even blindness. Another dominant form is vascular, in which the heart valves (failure and stenosis) and the large vessels, especially the largest one, the Aorta, become compromised, leading to its dilatation (aneurysm). Symptoms include breathlessness and fatigue with increasidngly less efforts. Today, the consequences of the tertiary syphilis still constitute serious medical problems, although the incidence of new cases has been constanly decreasing in the developed western societies.

How to we make the diagnosis?

As previously seen, this disease can be similar to many others; for this reason, the diagnosis must first go through clinical suspicion. Very often, this suspicion is brought up by the physician when evaluating the forms of exposure to contamination, especially unprotected sex, symptoms, genital lesions and skin manifestations. The diagnosis of other sexually transmitted diseases, as AIDS and gonorrhea, makes testing for syphilis virtually mandatory. After the clinical suspicion, the physician has two ways to confirm the diagnosis. Either he detects the bacterium in the lesion (less frequent), or, most frequently, he tests for the presence of antitreponema antibodies in the blood.

How is it treated?

The most frequently indicated antibiotics for the infection by Treponema pallidum is precisely the oldest and price-accessible: the penicillin. This is one of the main reasons for observing a decrease in incidence of new cases with late complications of the disease (tertiary phase) in the developed countries. In addition, of course, to the effective control of public health. To treat syphilis seems to be very easy because of the cost and the access to the treatment. The major problem, though, continues to be the diagnosis, because it can be mistaken for many other diseases.

How to prevent it?

There are no prospects for the development of any vaccine in the near future; therefore, the prevention is focussed on health education for the suspicion and early diagnosis and treatment, in addition to promoting safe sex with the use of condoms. Questions that you can ask your physician Whom from my relations should get tested or treated in the case of my being infected?