American Medical Association Family Medical Guide - American Medical Association [254]
Symptoms
Syphilis progresses through three distinct stages, each with its own symptoms. If not treated promptly, the infection can persist for years.
• First stage In the first stage, called primary syphilis, the disease is confined to one area of the body. From 10 days to 3 months after exposure to the bacteria (but usually within 2 to 6 weeks), a small, painless sore called a chancre develops. A chancre is usually red and solid and protrudes above the skin. The initial chancre usually appears in the genital area, such as on the penis or vulva or inside the vagina, but can also develop on the lips, tongue, cervix, rectum, or other parts of the body. Chancres on the penis are usually visible, but when they develop in a woman’s vagina or cervix they are not easily detected. A chancre heals in 1 to 5 weeks, leaving a thin scar. During this stage, the bacteria circulate in the bloodstream.
• Second stage During the second stage, called secondary syphilis, the bacteria spread and cause symptoms throughout the body. About 6 weeks after the chancre has healed, you may feel generally ill and have a sore throat, fever, and headache. You may have swollen glands in your neck, armpits, and groin, and a skin rash of small, red, scaly bumps that do not itch. You may experience patchy hair loss. Spots may appear on the palms of your hands and on the soles of your feet. Gray patches of skin, which are different from chancres, can develop in the mucous membranes of the mouth, vulva, and penis. A rash may also develop around the rectum. These skin conditions, which are highly infectious, usually heal within 2 to 6 weeks.
• Third stage For several years during the third stage, called tertiary syphilis, a person has no symptoms. Then, without warning, the disease flares up, producing a variety of symptoms depending on the part of the body that has been infected. For example, if the infection has spread to the brain and nervous system, it can cause paralysis, dementia, loss of equilibrium, loss of sensation in the legs, and, rarely, blindness. If the aorta (the main artery in the body) is infected, its walls may weaken and balloon out, forming an aneurysm (see page 599). The infection can interfere with the functioning of the aortic valve, causing inflammation of the aorta or aortic insufficiency (see page 593). During this stage, syphilis can also affect the liver, the stomach, the eyes, and other organs and tissues throughout the body.
Diagnosis and Treatment
A diagnosis of syphilis is based on the symptoms, a physical examination, and the results of blood tests. A doctor may remove a sample of tissue from a sore for examination under a microscope, to look for the syphilis bacteria. If the doctor suspects damage to the brain and nervous system, he or she may test a sample of cerebrospinal fluid.
Syphilis is easy to treat in the first stage (and sometimes in the second stage) with injections of antibiotics (usually penicillin). If you are allergic to penicillin, the doctor will either prescribe another antibiotic or have you undergo a desensitization procedure in the hospital so you will be able to take penicillin. Desensitization involves giving the drug in a series of small doses, which helps prevent an allergic reaction. Treatment in the third stage of syphilis can prevent the disease from progressing but cannot reverse existing damage to tissues and organs.
If you are diagnosed with syphilis, you and your sex partner will be treated at the same time. Your doctor will ask you to avoid all sexual contact until treatment is complete and you have no symptoms. Ask your doctor when you can safely resume sexual activity. Remember to practice safer sex (see page 477 can be reinfected with syphilis after the disease has been cured.
Chancroid
Chancroid, also called soft chancre