Syphilis develops in various stages, each of which is characterized by different symptoms and course. After an initial onset without obvious symptoms , the disease manifests itself with skin and genital lesions, accompanied by flu -like symptoms . In the absence of an adequate diagnosis and treatment, a progressive evolution of the infection is possible. Therefore, serious damage can occur to multiple organs and systems, such as the skin, heart and skeleton. In its final stage, syphilis damages the central nervous system causing mental confusion, dementia, and progressive paralysis.
Fortunately, thanks to the availability of valid diagnostic methods and the high efficacy of antibiotic therapy, syphilis is now a controllable and curable infection.
Syphilis is a pathology known for a very long time and also known as LUE , a term that derives from the Latin “lues” which means epidemic or pestilence.
The term “syphilis” was coined by the scholar and scientist Gerolamo Fracastoro in the first half of the 1500s. In his work “Syphilis sive de morbo gallico”, he tells of the shepherd Sìfilo who, after having offended Apollo, was punished with a terrible disfiguring disease and who it will take its name from him.
As far as popular tradition is concerned, it is said that this highly contagious disease was introduced in Europe by Christopher Columbus’ sailors, returning from the discovery of the New World. From the sailors the disease would have been transmitted to some Neapolitan prostitutes, who in turn would have infected the soldiers of Charles VIII’s army. Since then, syphilis was called, for at least two centuries, “Gallic disease” or “French disease”, while in France it was known as “Neapolitan disease”. The fact that a sex-linked disease could induce such devastating effects immediately struck the collective imagination and had important consequences on social life and sexual behavior at the time. Thus, from the abstinence prescribed to the sick,
Year after year, syphilis continued to present the characteristics of a serious epidemic, at least until the first half of the twentieth century. In those years the discovery of penicillin transformed syphilis into a curable disease. Before then, the therapeutic measures were limited to the isolation of the infected subject and the use of the mercurial ointment, then in vogue for skin diseases but burdened by important side effects. Not surprisingly, in reference to syphilis the saying “One night with Venus and a whole life with Mercury” was in vogue.
Treponema Pallidum: Characteristics Of The Causative Agent
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, with a variable length of 5-20 microns.
Treponema pallidum is able to pass through intact mucous membranes or damaged skin . The agent responsible for syphilis is more easily transmissible, therefore, 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 Is Syphilis Transmitted?
The transmission of syphilis occurs mainly through unprotected sexual intercourse , both genital, oral or anal, consumed with an infected and contagious person.
In addition to sexual fluids, the bacterium is also abundantly present in the lesions caused by syphilis, present on the skin, genitals and mucous membranes in general, including that of the mouth. Syphilis is therefore also transmitted by direct contact with wounds or ulcers present in the areas where the disease mainly occurs. Some of these lesions are often painless, so it may happen that the person is not aware that they have syphilis, thus risking infecting their partner. For this reason, it is very important that casual sexual intercourse be consummated with the correct use of the condom .
Occasionally, the disease can also be transmitted through blood transfusions . However, this method of contagion is now very rare and mostly limited to countries where the blood is not sufficiently checked before transfusion.
Syphilis can also be contracted transplacentally ( transmission from mother to child ) and accidentally (use of objects belonging to infected people such as syringes and razors or by professional contagion due to the handling of infected samples).
Indirect transmission is unlikely , i.e. through contact with objects, dishes or clothing used by a sick person. As we have seen, the Treponema pallidum , in fact, is scarcely resistant in the environment, therefore it dies rapidly outside the body.
Syphilis In Pregnancy – Congenital Syphilis
During pregnancy, syphilis can be transmitted to the fetus transplacentally , i.e. through infected maternal blood, or at the time of passage through the birth canal. In these cases we speak of congenital syphilis, while when the infection is contracted after birth we speak of acquired syphilis.
Stages Of Syphilis
The clinical history of syphilis is usually divided into 4 stages:
- Lue, or primary syphilis;
- Secondary syphilis;
- Latent syphilis (early and late);
- Tertiary syphilis.
Primary syphilis corresponds to the initial stage of the infection. About 3-4 weeks after the infection ( incubation period ), a lesion called syphiloma appears right at the entry point of the Treponema pallidum . This initial sign begins as a rounded, well-circumscribed nodule of variable size, but, above all, it is not painful. Soon, the surface of the primary syphiloma erodes and ulcerates , exposing a bright red background, from which a serous exudate , containing the bacteria responsible for syphilis, oozes.
In men, syphiloma appears more frequently at the level of the balano-preputial sulcus, i.e. between the glans and foreskin . In women, however, it can arise on the cervix , vulva or vagina. Furthermore, in both sexes, the syphiloma can also appear in the anorectal area and inside the oral cavity, therefore on the lips , gums , pharynx or tongue. After about a week from the appearance of the syphiloma, another typical sign of primary syphilis occurs, represented by the enlargement of the lymph nodes .
Symptoms of the first stage of syphilis tend to disappear after 4 to 6 weeks, even without treatment. Furthermore, these symptoms can go unnoticed, especially when the lesions are very small or hidden.
However, this regression of symptoms and lesions must not be misleading, since the disease and its transmissibility remain the same.
Secondary Or Disseminated Syphilis
The next stage of syphilis, called secondary , begins 3-6 weeks after the onset of syphiloma. This phase is characterized by systemic manifestations due to the proliferation of Treponema and its diffusion throughout the body by blood and lymphatic routes . Also for this reason, secondary syphilis is typically accompanied by flu-like symptoms such as fever , asthenia , headache and general malaise. In addition to these, the most important symptoms of secondary syphilis, however, occur at the level of the skin, mucous membranes and appendages. In particular, a rash appears generalized which can have a highly variable appearance, often asymptomatic or associated with mild itching . For example, small, diffuse, roundish spots resembling the typical rashes of measles may arise . These manifestations also disappear spontaneously after a few weeks.
From contagion to the end of the secondary phase we speak of recent syphilis which can last from 60 days to one or two years. During this time, the patient has no symptoms, but the infection and contagiousness remain. At the end of this phase, syphilis can heal spontaneously (about one third of cases), enter a latent phase or evolve towards a more serious or TERTIARY stage (about one third of cases).
Latent syphilis begins when, after the regression of the secondary phase, the patient enters an asymptomatic phase in which the disease can only be diagnosed by positive serum treponema.
The third and final stage, called late or tertiary symptomatic syphilis , is characterized by the appearance of cutaneous and/or visceral manifestations, mostly cardiovascular or nervous. These manifestations, usually limited, but rather harmful, can also affect the digestive system, bones, skin and other organs, causing, in the most serious cases, the death of the individual.
In tertiary syphilis, the most important manifestations are those affecting the central nervous system, with degenerative changes in the nervous tissue of the brain and spinal cord. In the so-called neurosyphilis , progressive degeneration can cause personality alterations up to dementia, and inability to control muscle movements up to paralysis.
The evolution of syphilis can be accelerated by a coexisting HIV infection ; in these cases, ocular involvement, meningitis and other nervous complications are more frequent and serious.