The first symptoms occur after three to four weeks: these are ulcers or rounded wounds at the entry point of the pathogen (i.e. in areas that have come into contact with the other person’s infected areas). In women, these lesions appear more frequently in the genital area, particularly at the level of the labia minora, vaginal orifice and perineum . Furthermore, in females, the infection can lead to various complications during pregnancy .
Without an adequate and timely diagnosis and therapy, a progressive evolution of the disease is possible, which can cause serious damage to multiple organs and systems, such as skin , heartand skeleton . In its final stage, syphilis damages the central nervous system causing mental confusion , dementia , and progressive paralysis.
Fortunately, thanks to the availability of adequate diagnostic methods and the efficacy of antibiotic therapy, syphilis is a controllable and curable infection.
- The causative agent of syphilis is a bacterium , Treponema pallidum . When observed with a dark field microscope, this microorganism appears as a small spiral-shaped filament, mobile and flexible, of variable length between 5 and 20 microns.
- Treponema pallidum is able to pass through intact mucous membranes or damaged skin . The agent responsible for syphilis in women is therefore more easily transmitted through oral contact and unprotected vaginal and anal sex .
- The most frequent sites of entry are, in fact, the mucous membranes of the genitals and mouth , where Treponema pallidum finds its ideal habitat to reproduce easily. Subsequently, this microorganism migrates through the skin capillaries , and then spreads to the lymph nodes , where it multiplies until it reaches levels sufficient to cause clinical disease. Typically, incubation times for syphilis range from 2 to 12 weeks.
- In people with the disease, Treponema Pallidum is found in all body fluids , such as semen and vaginal secretions . Furthermore, the bacterium is found in skin, genital and mucous membrane lesions , including those of the mouth, which occur during the course of the disease.
How Can A Woman Get Syphilis?
Women contract syphilis mainly through unprotected sexual intercourse – either genital (vaginal or anal) or oral – with an infected person.
The infection can be transmitted through direct contact with wounds or skin and mucous ulcers , which form in the areas where the disease mainly occurs (vagina, anus , mouth, throat or damaged skin surface). Sometimes, some of these manifestations are painless and can go unnoticed, so it may happen that the person is not aware that they are affected, thus risking infecting their partner.
During pregnancy , syphilis can be transmitted transplacentally to the fetus (through infected maternal blood) or at the time of passage through the birth canal . This, however, allows you to distinguish between acquired syphilis (when the disease occurs late in life) and congenital (if the infection is contracted even before birth or during childbirth).
Occasionally, the disease can be transmitted through blood transfusions . This method of contagion is now very rare in the world and is limited to countries where blood is not checked before it is transfused. Another risk factor is intravenous drug use .
Syphilis is NOT usually transmitted indirectly, for example through contact with objects, dishes or clothing used by a sick person, as Treponema pallidum is poorly resistant in the environment.
Syphilis does not confer immunity against subsequent reinfection.
What Are The Symptoms Of Syphilis In Women?
The course of syphilis in women is divided into several phases, each of which is characterized by variable symptoms. In any case, the disease is complex and – if not properly treated – can lead to various complications, such as heart disease and neurological disorders .
1) Primary Syphilis In Women
The initial stage of the infection occurs about 3-4 weeks after the infection, with the appearance of a lesion ( syphiloma ) at the injection site of the Treponema pallidum .
This initial sign is a round, well-circumscribed papule of variable size, usually painless and firm based. Soon the surface of this formation erodes and undergoes ulceration, exposing a bright red background, from which a serous exudate containing the treponemas comes out.
In women, syphiloma most frequently appears on the genitals or sexual contact area , especially the cervix, vulva , vagina, and perineum . This lesion can also occur in the anal- rectal area and inside the oral cavitylips , gums , pharynx , or tongue.
After about a week from the appearance of syphiloma, another typical sign of primary syphilis occurs, namely the lymph nodes increase in volume .
The symptoms of the first stage of syphilis in women tend to disappear 4-6 weeks after their onset, even without treatment, but the bacterium will remain in the body. In the meantime, these lesions may have gone unnoticed, especially if they are very small or not easily visible (as in the case, for example, of syphilomas located on the neck of the uterus ).
2) Secondary Syphilis In Women
Secondary syphilis begins 3 to 6 weeks after syphiloma onset. This phase is characterized by systemic manifestations, due to the proliferation and blood and lymphatic diffusion of Treponema pallidum . In women with syphilis, therefore, flu-like symptoms such as fever , asthenia , headache , muscle pain and general malaise occur .
However, the most obvious manifestation of secondary syphilis is a mucocutaneous eruption in one or more areas of the body surface, which can be transient or recurring and can have a highly variable appearance. For example, there may be roundish cracks on the palms of the hands and soles of the feet , and clusters of pink speckles spread all over the trunk and limbs, resembling the rash of measles . The rash is accompanied by enlarged lymph nodes .
Secondary syphilis in a woman with a history of unprotected sex. Involvement of the sole of the foot
Without treatment, the lesions may disappear within days or weeks, persist for months, or recur recurrently; all, however, eventually remit, usually without scarring.
Syphilis in women can also lead to sore throat , lack of appetite , weight loss , vision disturbances, hearing and balance alterations, bone pain , hair loss in strands and the appearance of thickened, gray or pink patches ( warts ). in moist areas of the skin. During the secondary stage, then, meningitis can occur .
3) Latency Period
After the regression of the secondary stage, a long latency period begins, which can last for months or even years. At this stage, the woman with syphilis has no symptoms, yet the infection persists.
4) Tertiary Syphilis In Women
In women, syphilis progresses to the tertiary stage when the Treponema pallidum “reactivates” at the end of the latency period, usually after about 10-25 years from the moment of infection. In this stage, the disease can cause various effects and permanent damage to the heart, liver , bones , joints , blood vessels , skin and other organs.
In tertiary syphilis, the most important manifestations are, however, in the central nervous system , with degenerative changes in the tissues of the brain and spinal cord . In the so-called neurosyphilisProgressive degeneration can cause personality changes, gradual blindness, memory loss up to dementia, inability to control muscle movements, progressive paralysis and, in the most severe cases, death of the patient.
Syphilis In Pregnancy
Syphilis can be transmitted hematogenously (across the placenta ) from mother to child during gestation, with serious consequences.
In fact, if contracted during pregnancy, the disease can cause fetal malformations and other problems , including:
- Premature birth ;
- Mortality births;
- spontaneous abortions ;
- Bullous eruption on the skin of the newborn;
- deafness ;
- Serious damage to bones, brain, lungs , liver and other organs.
To avoid these complications, it is essential for the woman to contact her doctor, who will be able to give the correct indications regarding the best measures to take.
Usually, in pregnant women, the prevention of congenital syphilis is implemented by promptly instituting penicillin therapy . Furthermore, in Italy, all women at the beginning of pregnancy are screened for the infection .
The diagnosis of syphilis in women is formulated starting from the evaluation of the set of symptoms reported by the patient during an accurate medical examination ; it follows, the observation under the microscope of the material taken from possible lesions and specific blood tests .
The diagnosis can be confirmed by the search for treponemas in the exudate and by the positivity of serological tests , aimed at detecting the possible presence of antibodies against the bacterium already in the early stages of the infection. Through these analyzes it will be possible to understand if syphilis has been contracted and in what degree of activity the infection is in the patient, so as to start the most appropriate treatment.
Because of its “aggressiveness,” syphilis is a notifiable disease . This means that healthcare professionals are required to notify public health authorities if they become aware of an infected patient.
Treatment And Prevention
Treatment of syphilis in women consists of parenteral administration of penicillin . Only in patients allergic to this active ingredient are other drugs used, such as doxycycline and tetracycline .
To establish the correct dosage and duration of antibiotic therapy , the doctor will be based on the stage of the disease defined during the diagnostic procedure.
Treatment is most effective when started in the early stages of syphilis. In fact, it does not allow to remedy any damage that has already occurred to the various organs. Of course, diagnostic tests and treatment should also be performed on all of the woman’s previous partners, up to three months before the onset of symptoms. During drug treatment, in order to avoid infecting one’s partner, the woman
must abstain from any type of sexual intercourse, until the complete healing of the lesions caused by syphilis. In fact, it must always be kept in mind that wounds and skin ulcers can also transmit the infection during oral sex or any other skin contact with infected areas.
Finally, it should be remembered that, once healed, one does not become immune to the pathogen, but it can happen to become infected over and over again in the course of life; this means that the woman can contract syphilis again .
As with other sexually transmitted diseases , a good measure of prevention is the use of a condom , which must be used from the beginning to the end of sexual intercourse, whether it isvaginal , anal or oral. Any sex toys used for this purpose must also be adequately covered in case of promiscuous use.
Finally, it should be noted that the correct use of a condom does not guarantee absolute protection, given that the infection can be transmitted by contact with lesions in genital areas not covered by a condom.