The stage of syphilis determines the symptoms observed in the patients. Symptoms of syphilis vary greatly with the stage of the disease. In some cases, the patient may be infected but never noticed the symptoms for years [5].

Primary syphilis: Chancre is the first sign of syphilis. It appears as a small sore on the skin and is the point from where the bacterium has entered the body. It develops after 3-4 weeks after exposure and is painful, so often goes unnoticed. The chancre heals within six weeks, on its own.

Secondary syphilis: There can be a rash on the trunk or sometimes the entire body, even within a few weeks after the original chancre healing. The rash is not itchy or may be accompanied by wart-like sores in the mouth as well as the genital areas.

Latent syphilis: If syphilis is not treated, the disease moves from secondary to latent stages. This stage can last for several years.

Tertiary (late) syphilis: The complications of the tertiary (late) syphilis can develop if the disease is not treated on time. About 15-30% of the patients not treated for syphilis may graduate to this stage. Damage to the brain, nerves, eyes, brain, blood vessels, liver, joints, and bones is observed in such patients.

Congenital syphilis: Babies born to infected mothers gets the infection through the placenta or even during birth. These children may be asymptomatic or show symptoms that often go unnoticed such as a rash on the palms of the hands and soles of feet. As the disease progresses, congenital syphilis manifests as deafness, teeth deformities, and saddle nose.

• Generalized Lymphadenopathy

  Among 139 infants with symptomatic congenital syphilis in 3 series, the most common early signs were hepatosplenomegaly (71%), rash (68%), fever (42%), neurosyphylis (23%), pneumonitis (17%), rhinitis ( snuffles ; 14%), generalized lymphadenopathy (14% [doi.org]

  Due to being mediated by bacteremia, these patients not only have non-specific constitutional symptoms such as low-grade fever, malaise, headache, and generalized lymphadenopathy, but there may also be multi-organ involvement 1,2: dermatological syphilis [radiopaedia.org]

  Some patients are asymptomatic while others have constitutional symptoms including fever, malaise, and generalized lymphadenopathy. [health.am]

• Cervical Lymphadenopathy

  Inguinal lymphadenopathy arises in men with ulcers on the genitals and cervical lymphadenopathy in patients with ulcers in the mouth. [dermnetnz.org]

  Syphilis presenting as isolated cervical lymphadenopathy: two related cases. J Infect. 2009;58:76–8. PubMed CrossRef Google Scholar 57. Cummings MC, Lukehart SA, Marra C, et al. [doi.org]

• Inguinal Lymphadenopathy

  Inguinal lymphadenopathy arises in men with ulcers on the genitals and cervical lymphadenopathy in patients with ulcers in the mouth. [dermnetnz.org]

• Fever

  A 37 year old man with a 2 year history of progressive cognitive decline, unilateral tinnitus and deafness presented with complex partial seizures and a fever. [ncbi.nlm.nih.gov]

  This response is characterized by low-grade fever, myalgias, headache and malaise that begin within a few hours after initiation of therapy and last for 12–24 h. [cmaj.ca]

• Pain

  We present a 53-year-old woman with an unusual truncal rash with painful anogenital lesions, accompanied by patchy alopecia, oral lesions, photophobia and hoarseness. [ncbi.nlm.nih.gov]

  Vaginal discharge Burning or pain during urination Abdominal and/or low back pain Nausea Fever Pain with intercourse Vaginal bleeding between periods Symptoms in men include: Burning or pain during urination Penile discharge Burning and itching around [verywellhealth.com]

  However, iodide salts were recommended for several other conditions, including angina, which might have been blamed for his chest pains. [news.bbc.co.uk]

• Fatigue

  Fever, enlarged lymph nodes, fatigue, weight loss, hair loss, headaches, and muscle aches have all been reported in the secondary stage of syphilis. [medicinenet.com]

  Other, less common signs and symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. [beforeplay.org]

  Other symptoms of secondary stage syphilis include: fever swollen lymph glands sore throat patchy hair loss headaches weight loss muscle aches fatigue Latent syphilis: Latent syphilis causes no symptoms. [southernnevadahealthdistrict.org]

  Syphilis About 2 to 10 weeks after the first sore appears, you may develop the following: A skin rash that causes small, reddish-brown sores Sores in your mouth, vagina, or anus Fever Swollen glands Weight loss Hair loss Headache Extreme tiredness (fatigue [webmd.com]

• Malaise

  It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest. [sti.guidelines.org.au]

  This response is characterized by low-grade fever, myalgias, headache and malaise that begin within a few hours after initiation of therapy and last for 12–24 h. [cmaj.ca]

• Unsafe Sexual Practices

  “The increasing incidence of syphilis in military members is of significant public health concern because this finding suggests that some servicemembers have been engaging in unsafe sexual practices that increase the likelihood of acquisition of other [stripes.com]

  Excessive use of alcohol or other drugs can cloud your judgment and lead to unsafe sexual practices. Screening for pregnant women People can be infected with syphilis and not know it. [mayoclinic.org]

  These are available for purchase online. not sharing sex toys avoiding alcohol and drugs that could potentially lead to unsafe sexual practices Having syphilis once does not mean a person is protected from it. [medicalnewstoday.com]

• Saddle Nose

  Later manifestations of congenital syphilis include bone and teeth deformities, such as “saddle nose” (due to destruction of the nasal septum), “saber shins” (due to inflammation and bowing of the tibia), “Clutton’s joints” (due to inflammation of the [emedicine.medscape.com]

  nose A50.59 Other late congenital syphilis, symptomatic A50.6 Late congenital syphilis, latent A50.7 Late congenital syphilis, unspecified A50.9 Congenital syphilis, unspecified A51 Early syphilis A51.0 Primary genital syphilis A51.1 Primary anal syphilis [icd10data.com]

  Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses. [mayoclinic.org]

• Hoarseness

  We present a 53-year-old woman with an unusual truncal rash with painful anogenital lesions, accompanied by patchy alopecia, oral lesions, photophobia and hoarseness. [ncbi.nlm.nih.gov]

  Other symptoms may also occur which include tiredness, fever, sore throat, headaches, hoarseness, loss of appetite, and swollen glands. These signs and symptoms last 2 to 6 weeks, and will disappear even if no treatment is received. [vdh.virginia.gov]

  Other symptoms may occur such as tiredness, fever, sore throat, headaches, hoarseness, loss of appetite, patchy hair loss and swollen glands. [health.ny.gov]

  Cardiovascular syphilis is suggested by symptoms and signs of aneurysmal compression of adjacent structures, particularly stridor or hoarseness. [msdmanuals.com]

• Nasal Discharge

  About half the time, however, he may have signs and symptoms such as a yellow-mucous nasal discharge (snuffles), rashes, skin ulcers, fluid retention, bone infection, fever, swollen spleen and liver, low red blood cell count (anemia), and jaundice (yellowing [healthychildren.org]

  Placenta, neonatal nasal discharge or skin lesions may be examined by dark-field microscopy or DFA/IFA or PCR for T. pallidum. It is unknown if the DFA/IFA cross-reacts with non-pathogenic treponemes from these specimen types. [canada.ca]

  discharge, placenta, umbilical cord, cerebrospinal fluid (CSF), amniotic fluid or autopsy material or etection of Treponema pallidum specific IgM in the child or The child’s serum non-treponemal3 serology titre at birth is at least fourfold greater than [health.nsw.gov.au]

  Infants should not be discharged from the hospital unless the syphilis serologic status of the mother has been determined at least one time during pregnancy and preferably again at delivery. [glowm.com]

• Nausea

  Symptoms and signs of this reaction include: Chills Fever General ill feeling (malaise) Headache Muscle and joint pain Nausea Rash These symptoms usually disappear within 24 hours. [medlineplus.gov]

  Symptoms and signs of this reaction include: Chills Fever General ill feeling ( malaise ) Headache Muscle and joint pain Nausea Rash These symptoms usually disappear within 24 hours. [nlm.nih.gov]

  Signs and symptoms include a fever, chills, nausea, achy pain and a headache. This reaction usually doesn't last more than one day. [mayoclinic.org]

  Meningeal syphilis usually occurs during the first year of infection and is characterized by headache, stiff neck, nausea, and vomiting. Cranial nerve involvement can result in hearing loss, facial weakness, or visual disturbances. [health.am]

• Rectal Discharge

  If women have symptoms they include: Pain or burning with urination Vaginal discharge Vaginal bleeding between periods Both men and women can get a rectal gonorrhea infection. [verywellhealth.com]

• Rectal Pain

  He described the presence of inguinal adenopathy and non-painful ulcer with indurated edges on his penis that heal spontaneously after 3 months. In the same period of time the patient presented: tenesmus, bleeding and rectal pain. [scielo.org.pe]

• Lesion of the Tongue

  A 2-year-old infant boy presented with a large ulcerative lesion on his tongue. The grandmother who cared for the boy was in the habit of chewing food before giving it to the boy and had active syphilis. [ncbi.nlm.nih.gov]

• Hepatosplenomegaly

  Among 139 infants with symptomatic congenital syphilis in 3 series, the most common early signs were hepatosplenomegaly (71%), rash (68%), fever (42%), neurosyphylis (23%), pneumonitis (17%), rhinitis ( snuffles ; 14%), generalized lymphadenopathy (14% [doi.org]

  There was no hepatosplenomegaly. Fig. 1: Papulosquamous lesions on the patient's trunk. Fig. 2: Mucous patches involving the lips. Fig. 3: Involvement of the palm. Blood samples were taken for HIV antibody and VDRL testing. [cmaj.ca]

• Tinnitus

  Two weeks after treatment, the tinnitus alleviated and vertigo disappeared. [ncbi.nlm.nih.gov]

  Signs and symptoms of otosyphilis may include: hearing loss; ringing, buzzing, roaring, or hissing in the ears (“tinnitus”); and dizziness or vertigo (feeling like you or your surroundings are moving or spinning). [cdc.gov]

  If the ears are affected, people may have a ringing in their ears (tinnitus) or lose their hearing, or they may have vertigo and nystagmus (a rapid jerking movement of the eyes in one direction alternating with a slower drift back to the original position [merckmanuals.com]

• Hearing Impairment

  impairment) (03) 9347 8619 Partner Notification Officers can help you anonymously notify your partners. [betterhealth.vic.gov.au]

• Arthralgia

  Systemic manifestations include malaise, fever, myalgias, arthralgias, lymphadenopathy, and rash. Widespread mucocutaneous lesions are observed over the entire body and may involve the palms, soles, and oral mucosae. [emedicine.medscape.com]

• Saber Shin

  Later manifestations of congenital syphilis include bone and teeth deformities, such as “saddle nose” (due to destruction of the nasal septum), “saber shins” (due to inflammation and bowing of the tibia), “Clutton’s joints” (due to inflammation of the [emedicine.medscape.com]

• Bone Pain

  KEYWORDS: Bone pain; Dolor óseo; Infección de la sífilis; Periosteitis; Syphilis infection; Tenosinovitis; Tenosynovitis [ncbi.nlm.nih.gov]

  pain vision loss hearing loss joint swelling saber shins, a bone problem in the lower legs scarring of the skin around the genitals, anus, and mouth gray patches around the outer vagina and anus In 2015, the WHO confirmed Cuba as the first country in [medicalnewstoday.com]

  Muscles and bones became painful, especially at night. The sores became ulcers that could eat into bones and destroy the nose, lips and eyes. They often extended into the mouth and throat, and sometimes early death occurred. [jmvh.org]

• Anterior Uveitis

  Although any structure of the eye can be involved in syphilis, isolated unilateral anterior uveitis as an initial sign of the disease is rare. [ncbi.nlm.nih.gov]

  Less common presentations include patchy alopecia, anterior uveitis, meningitis, cranial nerve palsies, hepatitis, splenomegaly, periostitis and glomerulonephritis. [patient.info]

• Pupillary Abnormality

  Tremors of the mouth, tongue, outstretched hands, and whole body may occur; other signs include pupillary abnormalities, dysarthria, hyperreflexia, and, in some patients, extensor plantar responses. Handwriting is usually shaky and illegible. [msdmanuals.com]

• Skin Rash

  These wart-like lesions, as well as the skin rash, are highly contagious. The rash can occur on the palms of the hands, and the infection can be transmitted by casual contact. [medicinenet.com]

  The diagnosis of secondary syphilis can be determined by the presence of the typical skin rash and positive serologic tests for syphilis. [cmaj.ca]

  The Case: A 34-year-old homosexual man was referred to a dermatologist for evaluation of a nonpruritic skin rash. The rash had appeared on his abdomen 3 weeks earlier and, over 1 week, had spread to his entire body. [ncbi.nlm.nih.gov]

• Alopecia

  Alopecia is an uncommon manifestation of syphilis, simulating other common forms of hair-loss, but representing a crucial complaint for the patient, who might by converse have not noticed other signs and symptoms of the disease. [ncbi.nlm.nih.gov]

  Other skin findings of secondary syphilis are condylomata lata and patchy alopecia. Condylomata lata are painless, highly infectious gray-white lesions that develop in warm, moist sites. [emedicine.medscape.com]

  Secondary syphilis of other viscera convert 091.69 to ICD-10-CM 091.7 Secondary syphilis, relapse convert 091.7 to ICD-10-CM 091.8 Other forms of secondary syphilis 091.81 Acute syphilitic meningitis (secondary) convert 091.81 to ICD-10-CM 091.82 Syphilitic alopecia [icd9data.com]

• Blister

  Large blisters or a flat copper-colored rash may develop on palms and soles. Raised bumps may develop around the nose and mouth and in the diaper area. Newborns may not grow well. [merckmanuals.com]

  — Erika Edwards, NBC News, "Why SNL's Pete Davidson is wrong about STDs," 14 Oct. 2019 People recoiled from his blisters and oozing sores and chalked up Marat’s painful condition to everything from syphilis to a dangerous temperament. — Erin Blakemore [merriam-webster.com]

  These may include a red rash on the palms of the hands and the soles of the feet, small blisters filled with pus, or thick grey or pink patches. [irishhealth.com]

  […] rash, which may look like rough "copper penny" spots or fine red dots on the palms of the hands and soles of the feet A skin rash on the arms, legs, and trunk — The rash can take a variety of forms, such as small blotches or indented circles; small blisters [drugs.com]

• Skin Ulcer

  […] of the skin). [healthychildren.org]

  Primary symptoms include: Appearance of a single, firm, usually painless, non-itchy skin ulceration called a “chancre.” The chancre typically appears three to 90 days after exposure to the bacterium. Appearance of multiple chancres. [soc.ucsb.edu]

  "Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy". International Journal of STD & AIDS. 21 (8): 537–45. doi:10.1258/ijsa.2010.010243. PMID 20975084. [en.wikipedia.org]

  Molecular differentiation of Treponema pallidum subspecies in skin ulceration clinically suspected as yaws in Vanuatu using real-time multiplex PCR and serological methods. Am. J. Trop. Med. Hyg. 92, 134–138 (2014). 128 Liu, H., Rodes, B., Chen, C. [nature.com]

  Unusual skin ulceration in an HIV-positive patient who had cutaneous syphilis and neurosyphilis. Br J Dermatol 1997; 136:946-8. 20. [hivinsite.ucsf.edu]

• Foot Ulcer

  Spinal cord disease results in unsteady gait, bladder disturbance, impotence and sensory changes (tabes dorsalis) resulting in collapsed joints (Charcot's joints) and foot ulcers. [dermnetnz.org]

  As a result, deep foot ulcers can occur. Syphilis in pregnancy and congenital syphilis Syphilis infection can be passed from a pregnant mother to her unborn baby (fetus), via the placenta. [patient.info]

• Syphilitic Chancre

  Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients. [ncbi.nlm.nih.gov]

  From Wikidata Jump to navigation Jump to search sexually transmitted infection syphilitic chancre great pox edit Language Label Description Also known as English syphilis sexually transmitted infection syphilitic chancre great pox Statements instance [wikidata.org]

• Genital Lesions

  lesions or rashes Primary syphilis classically presents as a single, painless, indurated genital ulcer (chancre), but this presentation is only 31% sensitive; lesions can be painful, multiple, and extra-genital Diagnosis is usually based on serology, [bmj.com]

  Syphilis Prevention Any person who discovers that they have a genital lesion should regard it as potentially syphilitic, should be examined by a physician as soon as possible, and should stop all sexual activity. [healthcommunities.com]

  Syphilitic ulcers should be differentiated from other sexually transmitted genital lesions (see table Differentiating Common Sexually Transmitted Genital Lesions). [msdmanuals.com]

• Headache

  Some people never develop symptoms, however others experience the following symptoms: Seizures Headache, stiff neck, and fever brought on from an inflammation of the lining of the brain. [southernnevadahealthdistrict.org]

  Nervous system problems.Syphilis can cause problems like headaches, meningitis, brain damage, paralysis, or hearing and vision loss. Cardiovascular problems. [webmd.com]

  Early symptoms can include genital sores, rash and headache. Untreated, syphilis can eventually affect the brain and nervous system. Prenatal testing and condom use can reduce risk of spread. You have successfully created a MyPHO account! [publichealthontario.ca]

  A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). [ncbi.nlm.nih.gov]

• Hyperreflexia

  Tremors of the mouth, tongue, outstretched hands, and whole body may occur; other signs include pupillary abnormalities, dysarthria, hyperreflexia, and, in some patients, extensor plantar responses. Handwriting is usually shaky and illegible. [msdmanuals.com]

• Abnormal Gait

  Symptoms include : dementia or altered mental status abnormal gait numbness in the extremities problems with concentration confusion headache or seizures vision problems or vision loss weakness Congenital syphilis Congenital syphilis is severe and frequently [medicalnewstoday.com]

Diagnosis of syphilis can be done by performing the tests on the samples of blood, fluids from the sore and the cerebral spinal fluid.

Performing the blood tests confirm the presence of antibodies in the body. Antibodies are produced when the body is exposed to an infection. A positive result of the test indicates that the person is infected with syphilis. Antibodies remain in the body for many years, even if the disease has been treated. A negative result, however, does not necessarily mean the patient is not infected with syphilis as the antibodies are not detected for up to three months after the infection. In that case, the patient is advised to take the test again after 3 months.

The sores that form the hallmark of syphilis are scraped and a small sample of the cells from this sore is analyzed under the microscope in the laboratory. This test is performed only in the primary and secondary syphilis when the sores are present. When analyzed in the laboratory, it can show the presence of bacteria in the scrapings, thus confirming syphilis [7].

Analysis of the cerebrospinal fluid is performed to diagnose CNS involvement. For this, the sample of cerebrospinal fluid is collected through a lumbar puncture, and the fluid is tested in the laboratory.

• Treponema Pallidum

  Syphilis is a sexually transmitted infection caused by the spirochaetal bacterium Treponema pallidum, subspecies pallidum. It is found only in human hosts. [bestpractice.bmj.com]

  NAS, Sifilide non specificata, Infezione da treponema pallidum, Lue, Sifilide Portuguese Sífilis NE, Infecção por Treponema pallidum, Sifílis, Sífilis Spanish Lúes, Sífilis NEOM, Sífilis no especificada, Infección por Treponema pallidum, sífilis, SAI [fpnotebook.com]

  It belongs to the sexually transmissible diseases. 2 Pathogen Treponema pallidum is a bacterium belonging to the spirochete family, with a length of 6-30 µm. Humans are the natural host of treponema pallidum. [flexikon.doccheck.com]

  Complete genome sequence of Treponema pallidum, the syphilis spirochaete. Science 1998 ; 281: 375 – 88. Google Scholar | Crossref | Medline | ISI 26. Cumberland, MC, Turner, TB. [doi.org]

• Colitis

  CM Diagnosis Code A09 Infectious gastroenteritis and colitis, unspecified 2016 2017 2018 2019 2020 Billable/Specific Code Applicable To Infectious colitis NOS Infectious enteritis NOS Infectious gastroenteritis NOS Type 1 Excludes colitis NOS (K52.9) [icd10data.com]

  There are few reported cases of radiation recall colitis [1-2, 16]. [cureus.com]

Penicillin is the preferred drug for the management of syphilis. Guidelines for the dosage regimen of the penicillin for different stages of syphilis are present, with later stages requiring a long course of treatment because of the slow rate of replication of bacteria. Penicillin is the only drug used widely for managing neurosyphilis, and congenital syphilis. The common penicillin used to manage syphilis is Benzathine penicillin G. In patients with syphilis, penicillin allergy skin test must be performed [6].

In patients who are allergic to penicillin, tetracyclines, erythromycin, ceftriaxone have shown anti-treponemal activity. Doxycycline and azithromycin are also good options to manage syphilis. Studies have shown the efficacy of these two drugs [8].

Monitoring syphilis in patients ensures that the treatment is done adequately. Inpatient care is reserved for late-stage patients with syphilis. For patients who were successfully treated for must perform the follow-up visits at 3, 6 and 12-month interval. HIV patients who are treated with non-penicillin regimen must be monitored for life. After 24 months of therapy, patients with neurosyphilis must be reevaluated.

Treatment is said to have failed if the symptoms of syphilis return. The reappearance of symptoms is called “relapse”. Adequate treatment must be initiated in cases of relapse. Pregnant patients with syphilis should go for venereal disease research laboratory (VDRL) testing every month for the duration of pregnancy.

Though the cure of syphilis at the early stages is easy (penicillin), in the later stages damage done to the organs cannot be reversed. Secondary syphilis is cured, if detected early, and is completely treated.

Treatment can last from within weeks to almost a year, in some cases. In the absence of treatment, up to one-third of the patients will develop complications of syphilis. Late syphilis can cause permanent disability and can also lead to death in some cases.

Complications

• If not treated properly, syphilis can cause damage to the entire body. It also increases the risk of HIV by several-fold. A syphilis lesion can bleed easily allowing easy passage of the virus.
• Gummas are small bumps that develop on the patient’s skin, liver and bones. This generally occurs in the later stages of syphilis. Administration of antibiotics can cause these gummas to disappear.
• Neurological problems such as stroke, deafness, meningitis, dementia and visual problems are common among patients with syphilis.
• Cardiovascular problems in syphilis can occur when there is bulging and inflammation of the large vessel, aorta, and other blood vessels.
• Pregnancy: Syphilis can pass from the infected mother to her baby. Congenital syphilis increases the chances of miscarriage and stillbirth in this group of the population.

The pathogen that causes the syphilis infection is the spirochete, T pallidum. This is a human pathogen and does not occur naturally in any other species. Transmission of this spirochete occurs when it penetrates the mucosal membranes or abrasions on the epithelial surfaces. The most common mode of spread of the disease is through sexual contact [2]. T palladium cannot survive dryness or exposure to disinfectant.

Risk factors for transmission of syphilis:

1. Unprotected sex
2. Intravenous drug use
3. Promiscuous sex
4. Healthcare providers or workers are at the occupational risk

Region

The prevalence of syphilis varies from region to region. Developing countries and some areas of America, and Eastern Europe have a greater prevalence of syphilis. The highest reports of the occurrence of syphilis are from South and Southeast Asia. In 1999, Siberia reported a prevalence of syphilis as 1300 per 100,000 populations [3].

Age distribution

The highest frequency of syphilis is observed in years of peak sexual activity. Syphilis is more common in men and women in the age group of 15-40 years.

Sex distribution

Men are more frequently affected by syphilis (primary and secondary) than women.

Ethnicity

Non-Hispanic Blacks are at a greater risk of syphilis than non-Hispanic whites. Since 2005, the incidence of both primary and secondary syphilis has increased in all the races and ethnicities.

Primary syphilis is characterized by ulceration due to the migration of mononuclear leukocyte infiltration, lymphocytes, and macrophages. It generally heals spontaneously. Secondary syphilis, however, is caused by the spread of infection and causes widespread vasculitis. The lesions of secondary syphilis contain treponemes. Though the reasons for the secondary syphilis are still not clear, it is believed to be related to cell-mediated immunity.

The progression of latent syphilis to late syphilis occurs in only about 40% of the patients. Neurosyphilis is seen in about 10% of the patients with untreated syphilis, and it can occur at any stage. It is characterized by inflammation (chronic) of the meninges, caused by the invasion of the bacteria in the CNS by treponemes. When the treponemes cause occlusion of the aorta, the condition is called cardiovascular syphilis [4]. When there is a long-term inflammation of the walls of the vessel, it can cause an aneurysm and weakening of the aortic walls.

Till date there has been no vaccine developed to prevent syphilis. However, safe sex practices, including use of condoms can help reduce the chances of syphilis several-fold [10]. It is advisable to wash or douche the genitals after the sexual act. Treating the infected mother early in the pregnancy can prevent neonatal syphilis [9].

Syphilis is an infectious disease which is caused by the spirochete Treponema pallidum. It is contracted by sexual contact with the infectious lesions, from the mother to the fetus through the blood transfusion and sometimes through the breaks of the skin, which comes in contact with the infected lesions.

Syphilis mimic the presentation of several other infections and immune-mediated processes in advanced stages, hence also called,” the great imposter”.

The disease starts off as a painless sore in and around the genitals, rectum, and mouth, and spread from one person to another via the skin or mucous membrane. The bacteria remain dormant after initial infection for decades, before it becomes active again.

Early detection of the disease can help treat the condition even with a single injection of penicillin [1]. If not treated early, syphilis can damage the heart, brain or other organs and emerge as a life-threatening disease. There are four stages of syphilis: Primary, secondary, latent and tertiary.

The first presentation of syphilis is a small and painless sore or ulcer, which is known as chancre on the skin, rectum, and genitals. The lymph nodes are also enlarged around the sore area. These symptoms characterize primary syphilis. Skin rash, patches around the vagina, penis, and mouth, general ill feeling, loss of appetite, joint and muscle pain, changes in the vision and hair loss are some of the other presentations of syphilis observed in patients.

1. Dismukes WE, Delgado DG, Mallernee SV, Myers TC. Destructive bone disease in early syphilis. JAMA. Dec 6 1976;236(23):2646-8.
2. CDC. Summary of notifiable diseases, United States, 1997. MMWR Morb Mortal Wkly Rep. Nov 20 1998;46(54):ii-vii, 3-87
3. Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941--1993. Sex Transm Dis. Jan-Feb 1996;23(1):16-23
4. Harrison LW. The Oslo study of untreated syphilis, review and commentary. Br J Vener Dis. Jun 1956;32(2):70-8
5. CDC. Primary and secondary syphilis--United States, 2003-2004. MMWR Morb Mortal Wkly Rep. Mar 17 2006;55(10):269-73.
6. Fiumara NJ. Treatment of primary and secondary syphilis. Serological response. JAMA. Jun 27 1980;243(24):2500-2
7. Young H. Syphilis. Serology. Dermatol Clin. Oct 1998;16(4):691-8
8. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006.MMWR Recomm Rep. Aug 4 2006;55:1-94
9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. 33 2008.;Atlanta, Georgia
10. Golden MR, Wasserheit JN. Prevention of viral sexually transmitted infections--foreskin at the forefront. N Engl J Med. Mar 26 2009;360(13):1349-51