What is an Acquired Syphilis?

March 22 23:19 2019 Print This Article

It is defined as a condition in which there is a sexual transmission of disease which is caused by the spirochetal bacteria known as Treponema Pallidium. The route is mainly sexual but it can occur by other methods also like the congenital syphllis in which the transmission of bacteria from the mother to child occurs via utero.They have multiple signs and symptoms. As the serological testing came into the market it make the precise diagnosis a difficult thing. It is also known as the great imitator as it is confused with the other diseases and mainly in the tertiary stages. They re mainly treated with the help of antibiotics which includes the penicillin. If it is not treated properly it can lead to the injury to heart, brain, eyes and bones. It can be life threatening also. In the year 1998 there was a complete publication of the T.Pallidium which helped in the understanding of the pathogenesis of disease.

What are the alternative names of Acquired syphilis?

The name syphilis was coined by the physician of Italy and by a poet in his epic noted poem. It was written in the Latin and the name was given as The French Disease. It was done in the year 1530. The poem is protagonist by a shepherd known as syphilis. It was the first man who got this disease and was considered to be a punishment send by God Apollo for their defiance. This is also known as the contagious disease as it spread to the Syphilus and his followers. It was also known as the Italian disease in France. The Dutch called this disease as a Spanish disease. The Russian called this disease as a Polish disease. The Turks called this disease as a Frank or Christian disease.

The Tahitians called this disease as a British disease. They were given the national names as the disease was spared by the sailors and soldiers due to their unprotected sexual contact with the local prostitutes. Until the 16th century it was also known as the great pox as it was difficult to separate it from small pox. In the early stages of great pox one can see the rashes similar to small pox which are also known as the variola. The name was a misnomer as a small pox is more a deadly disease. The syphilis is also known as the lues and cupids disease. They refer to syphilis. It was also known as the Grand gore in Scotland. The ulcers which were seen in the British soldiers were known as the Black Lion.

What are the signs and symptoms of Acquired syphilis?

There are different signs and symptoms seen in this disorder.

1. In the case of primary syphilis the infection occurs by a direct contact with the already infected person. After the initial exposure about 10 to 90 days one can see the skin lesion at the genital organs. It can occur anywhere on the body. The lesion is known as chancre which is a firm and painless skin ulceration located at the point of exposure to the spirochete. It includes the penis, vagina and rectum. In very few cases the lesions can be multiple and but in most of the cases a single lesion is seen. The lesion persists for 4 to 6 weeks and heals its own. One can see the local lymph node swelling also. In the initial incubation period the condition is asymptomatic. So, the patients do not go for medical care. It does not occur through the toilet seats and daily activities like sharing the utensils or clothes.

2. In the case of secondary syphilis the infection occurs in between 1 to 6 months. It occurs after the primary infection. It shows different secondary manifestations. One sees a symmetrical reddish pink, non itchy rash which is present on the trunk and extremities. The rash can occur on the palms of hand and may also involve the sole of feet. The rash can become flat in the moist areas of body such as vulva or scrotum. It is broad, white and wart like. One can also see the mucus patches on the genitals or mouth. All of the infections consist of treponeme organisms. The patient in this stage is most contagious. The other symptoms which included are the fever, sore throat, malaise, weight loss, headache and large lymph nodes. Some of the manifestations are not so common and include the acute meningitis in 2 percent of the people. One can also observe the presence of hepatitis, renal disease, hyper trophic gastritis, ulcerative colitis, arthritis, iritis, uveitis, recto sigmoid mass and patchy proctitis.

3. In the case of latent syphilis the infection occurs with a serological proof and without the signs and symptoms. It is further classified as late or early.

4. In the early latent syphilis the time duration is two year or less from the time of infection without showing any signs or symptoms. In the late latent syphilis the time duration is two year or more from the time of infection without showing any signs or symptoms. One should know about the classification so that one can decide the therapy and the risk of transmission. The timing of infection is not clear and is presumed to be late. An early latent syphilis is treated with the single dose of intra muscular of penicillin which is long acting.

5. The late syphilis is not contagious as compared to the early syphilis. Nearly, half of the patients infected with the latent syphilis will progress to late stage syphilis. One fourth of them stay in the latent stage and one fourth of them show recovery.

6. In the case of tertiary syphilis the infection occurs after 1 to 10 years. In few cases it takes 50 years. In this stage gummas are formed which are soft and tumor like and are inflammatory in nature and are referred as granulomas. These are chronic and represent the inability of the immune system to clear the organism. They occur everywhere in the body. The gummas form a chronic inflammatory state in the body with a mass effect. The other symptoms are the presence of neuropathic joint disease in which there occurs a degeneration of joint surfaces which lead to the loss of sensation and position referred as a proprioception. The manifestations can be severe which involve the neuro and cardio syphilis. A study was done among the patients who were not treated and it came to know that the 10 percent of them suffered from cardio vascular syphilis and 16 percent of them suffered from gumma and 7 percent had neuro syphilis. The complications in the nerves can be complex.

7. In few patients there occur a generalized paralysis of insane in which there occurs a change in personality and emotional behavior. The reflexes become hyper active and Argyll Robertson pupil is present. It is a diagnostic sign in which the small and irregular pupil constricts in response to the focusing of eyes but not the light. There is a disorder of spinal cord which is known as the tabes dorsalis or locomotor ataxia. It results in the shuffling gait. There are cardio vascular complications which involve the syphilitic aortitis, aortic aneurysm and aneurysm of sinus with aortic regurgitation. It also affects the ascending aorta leading to the aortic dilation and aortic regurgitation. It is heard with a stethoscope as a heart murmur. The tunica media contracts and gives a tree bark appearance which is wrinkle in outlook. The dilation of aortic valve leads to diastolic regurgitation. It leads to massive hypertrophy of left ventricle. The heart becomes so large and is known as the cow’s heart. In this disorder heart failure may occur in the later stages. The course is insidious. It may also involve the coronary arteries and make them narrow. The syphilitic aortitis can cause de Mussets sign in which there is a bobbing of head along with the heart beat. The clinical course of the cardio vascular affects a mediastinum and leads to the respiratory and swallowing problems which are known as the dyspnea and dysphagia respectively. The cough is persistent and this is due to the pressure on the recurrent laryngeal nerve leading to the cough reflex. The erosion of ribs can also lead to the pain. The aneurysm which is developed may lead to the large intra thoracic hemorrhage. It may lead to the death. It may also occur due to the heart failure as a result of aortic regurgitation.

8. The neuro syphilis occurs at a site of infection involving the CNS. It occurs at any stage of syphilis. Its prevalence was around 20 to 30 percent but the prevalence dropped when the antibiotics were used. It is the most common disease associated with the AIDS disorder. The reports of neuro syphilis in HIV infected person are similar to the cases before the HIV pandemic. The extent and significance of neurological involvement in HIV patients with syphilis is confirmed by the laboratory and clinical criteria. The anti retroviral therapy alters the host immune suppression and has been further complicated. Nearly 40 percent of the people with secondary syphilis have asymptomatic central nervous system. It is confirmed by the CNS examination. It showed that there was an abnormal leukocyte count along with the protein and glucose levels. There is a demonstrated reactivity to VDRL antibody test and is known as the Venereal Disease Research Laboratory. There are different types of nuerosyphilis like asymptomatic and meningo vascular syphilis. It also includes the general paresis and tabes dorsalis. These Forms are seen less frequently and this is due to the introduction of antibiotics. Asymptomatic meningitis is the most common manifestation of this disorder. In the first year of infection one can observe the acute syphilitic meningitis. When the secondary rashes are seen one can diagnose 10 percent of the cases. There are patients which have headache, meningeal irritation along with the cranial abnormalities. It also involves the optic nerve, facial and vestibulo cochlear nerve. It may affect the spine rarely instead of the brain which leads to the focal muscle weakness and loss of senses. The meningo vascular syphilis occurs from few months to 10 years. It occurs after the primary syphilis infection. It is associated with some pro dormal symptoms which last from weeks to months. They include the uni lateral numbness, paresthesias, weakness in the upper and lower extremity, headache, vertigo, insomnia and the change in personality. The focal deficits are intermittent and may progress slowly. It is also present as an infectious arteritis and leads to ischemic stroke. It is more commonly seen in the young patients.

9. The angiography has the ability to detect the narrowing in blood vessels and occlusion. The general paresis is also known as general paresis of the insane which denotes the severe manifestation of neuro syphilis. This is mainly a chronic dementia which may lead to the death of individual. It takes 2 to 3 years to happen. The patients see a personality change, memory loss and poor judgment. One can also observe the psychosis, depression and mania in the rare cases. The imaging of brain shows atrophy.

What is the diagnosis of Acquired syphilis?

In the 20th century the effective methods to treat this disorder were developed. The microscopy of the fluid from primary and secondary lesion by the dark field illumination can diagnose this condition. It is more accurate than the other conditions. The treponemas can be confused with the other species. A proper care must be done to evaluate the microscopy so that symptoms can be correlated with the disease. There are many syphilis tests which have been done and includes the rapid plasma regain which is referred as RPR and venereal disease research laboratory which is referred as VDRL. These tests are cheap and fast but they are not specific as positive results can be seen in many other conditions. These tests are used to screen blood donors. The spirochete which cause syphilis do not survive the condition which is used to store blood. The number of transfused cases of syphilis is minute and the test is used to identify the donors which have contracted the HIV due o high risk sexual activity. There has been a lot of improvement in the testing of AIDS and this has challenged the testing of this disorder. In the viral infections a false positive on the rapid tests can be seen. The viral infection includes the Epstein Barr, hepatitis, varicella, lymphoma, tuberculosis, malaria, chagas disease, endocarditis, connective tissue disorder, pregnancy and intra venous drug abuse.

A more specific treponemal test must be done along with the above two tests. The tests which are based on the mono clonal antibodies and immune fluorescence are more specific. This includes the treponeme palladium heam agglutination assay which is referred as TPHA and Fluorescent treponemal antibody absorption which is referred as FTA ABS. They are more expensive. The false positives can also occur in the related treponemal infections like yaws and pinta. There are certain tests which are based upon the enzyme linked immunosorbent assays and are used to confirm the results of simple screening tests of this disorder. The neuro syphilis is diagnosed by the high number of leukocytes and there occurrence in the CSF. There are high protein concentrations in the setting of syphilis infection.

The CSF must be tested with the VDRL test along with the FTA ABS test. The incidence of neuro syphilis is higher in the HIV patients and a few have recommended that the lumbar puncture must be done among the patients of HIV along with the syphilis so to look for asymptomatic neuro syphilis. The treponematoses is the disease which is caused by the spirochete species of Treponema. It includes the yaws which is a tropical disease and includes the infection of skin along with the bone and joints. It is caused by the treponeme pallidum sub species pertenue. The pinta is caused by the Treponema palladium sub species carateum. The Bejel caused by the Treponema palladium sub species endemicum.

What are the preventive methods for Acquired syphilis?

There are many ways by which this disorder can be prevented. One is the abstinence from any type of sexual activity. It is the most effective method to prevent this disorder. The causative agent has the ability to cross the intact mucosa and cu skin. It includes the areas which are not covered by the condom. One must always use the latex condoms to prevent this disorder. It cannot guarantee as the non genital body parts can be infected also. The individuals which are sexually exposed to the person suffering from primary, secondary or any other form of syphilis within 90 days must be presumed to be infected. They must be treated for syphilis even if they are sero negative. If exposure is for more than 90 days the presumptive treatment is followed and should be follow up if there is no arrangement of serologic testing. In the patients which have syphilis of unlimited duration one can see the non treponemal serological titres which indicate the presence of early syphilis. The partner must be notified and treated accordingly. The individual suffering from late syphilis must include the long term sexual partner for clinical and serological evaluation. They must be treated accordingly. The patient with the syphilis must be tested for the HIV. Patient education is also required.

What is the history of Acquired syphilis?

There are many theories which deal with the origin of this disorder.

1. Most of the historians and anthropologists have agreed that this disorder was present among the indigenous people of America. It occurred before the European traveled to and from the new world. The strain of syphilis present in the entire world or not is a controversial issue.

2. There is a pre Columbian theory which states that the syphilis were present in the Europe before the Americans discovered it. This disorder has been described by the Hippocrates and some other authors. They were described in the classical Greece in the tertiary form. Other suspected findings of the syphilis were found in pre contact Europe. It included the 13 and 14th century in the north eastern English port at Kingston upon Hull of soldiers. It is concerned with the arrival of sailors. They came from distant places and played an important role in the transmission of syphilis. The skeletons of monk which are carbon dated showed bone lesions. It was typical of syphilis but it was not supported fully. There were skeletons found in the pre Columbus Pompeii and metaponta in the Italy showed that the damage was similar to the congenital syphilis. The interpretation of this evidence has been controversial.

3. A physical anthropologist such as Douglas Owsley at a reputed institute stated that there were many cases of leprosy in the Europe and was referred as a lepra. But they were cases of syphilis. Most of the common people claimed that the syphilis was not known in the Europe. It came to known from the sailor’s point of view of Columbia.

4. According to the Columbian exchange theory syphilis was a new world disease which was brought back by the Columbus and M.A Pinzon. Documentary evidence proved a link between a sailors voyage of Columbus to the naples syphilis in the year 1494. It is supported by the genetic studies of veneral syphilis and related bacteria. It is an intermediate disease between yaws and syphilis in Guyana, South Africa.

5. Another historian Alfred Crosby supported both the theories but the bacteria which causes syphilis belongs to the same phylo genetic family. The bacterium also causes yaws and other diseases. The home lands were assigned to the yaws of sub Saharan Africa. This historian claimed that there was no evidence of the related disease which is present in the pre Columbia Europe, Africa or Asia. He also said that you cannot rule out the role of America in the year 1490 to cause treponematosis. It evolved in both the venereal and non venereal syphilis and yaws. It is more likely that the contagious disease of this disorder moved with the human ancestors. It moved across the land bridge of Bering Straits many thousand years ago. It did not die out from the original source of population. He stated that the different ecological conditions produce a different type of disorders and in time is closely related to the different diseases.

6. There was a Japanese scientist which worked at the Rock feller University in the year 1913. He said there is a presence of treponeme in the brain of progressive paralytic patient. It proved that the Treponeme was the cause of disease. Previously, it was considered a burden to the humanity. Its cause was not known and was misdiagnosed and misattributed by many political enemies. There were other famous Historians like the Charles 8th of France, H. Cortez of Spain, Adolf Hitler and Benito Mussolini who suffered from syphilis.

7. There were few historians who were killed by this disease like the G.D Maupassant and F. Nietzche. There were few historians who were killed by this disease when they were young like the Al Capone. The syphilis reached its third stage making him confused and disoriented. There were few historians who were killed by this disease like the E. Manet and P. Gauguin. There were few composers also who were killed by this disease. The most common form of the dementia is the mental illness caused by the late stage of syphilis. It is known as the general paresis of the insane. It was observed in the noted composer like Robert Schuman but the cause of it is not properly known. There were few authors who were killed by this disease in their youth period like the Leo Tolstoy of Russia. He was treated by the use of arsenic. The founder of communism in Russia V.L Lenin also died of neuro syphilis. It was published in the Euopean Journal of Neurology in the year 2004.

8. During the period from 1932 to 1972 the US public health service conducted a Tuskege study of untreated syphilis in the Negro males. It is also known as the Tuskegee experiment or Tuskegee Syphilis study. The study was conducted in the Alabama. There were 400 poor illiterate African American men which were included in the study. The syphilis was not treated with the medicine and it was allowed to grow so that the progression of the disease can be observed. It was the un ethical behavior of the researchers to conduct the study and led to the major changes in the treatment of patients.

9. The first break down of the syphilis was seen in the Europe in year 1494. It started from the French troops as Naples. The French caught it from the Spanish people while they were serving the King Charles of France. From here the disease spread through the Europe. It was recorded in the Europe in year 1495. The pustules covered the body from head to knees causing the flesh to fall from peoples face and lead to their death within few months. It was more fatal in the previous years.

10. In the year 1546 the disease has evolved so that the symptoms are well known. This disorder was a new or occurs as a mutated form as came to known from the epidemiology of the syphilis. The syphilis was carried from the new world to Europe after the Columbus voyages. The Europe people must have carried this disorder back to the home and where the organism causing these diseases must have mutated. They became more deadly and occur in the low immunity of the people of Europe. It was a major killer in the Europe. There was no specific treatment for this disorder.

11. There was a Spanish priest who wrote the book in Rome about the use of guaiacum in the treatment of syphilis. He himself contracted this disease. The other treatment was done by the use of mercury which gave the statement that a night in the arms of Venus leads to the life time on mercury. It was given via mouth or skin. It could be injected also. The other famous method was the fumigation in which the patient was placed in the closed box and his head was sticking out. The fire was started and the mercury was placed in the box and leads to the vaporization of mercury. It was not effective in the treatment of this disorder and was a grueling procedure. The earliest treatment of the syphilis was done with the use of mercury. It was possible only when the syphilis existed in the old world. It was used in the year 1496 by Giorgio Sommariva. The disease was under stood later on and more effective treatments were used.

12. The first antibiotic to treat this disorder was an arsenic containing drug known as the Salvarsan. It was developed in the year 1908 by S. Hata. He was working in combination with the noble prize winner P. Ehrlich. It was later modified into the Neosalvarsan. These drugs were not effective in treating this disorder.

13. The people who develop fever can be cured for syphilis. The treatment for tertiary syphilis was provided by the brief time malaria. It produces a long and high fever. It is a risk factor as malaria can be treated with the quinine. It was available at that time. The discovery was mainly done by the J.W Jauregg who got the noble prize for medicine for his work. It was a reserve treatment for the late syphilis mainly the neuro syphilis. It is followed by the Salvarsan and neosalvarsan as an alternate therapy.

14. After the discovery of penicillin the role of treatment discussed became almost nil. It was very effective in treating the syphilis after World War 2. In the year 1906, the first effective test for syphilis was the Wassermann test. It yielded false positive results and was a major advancement in this field. Before the acute symptoms were developed the testing was done before it. It prevents the transmission of syphilis and the cure provided by it was not sufficient.

15. In the year 1930, there was a Hinton test which was developed by the W.A Hinton and was based on the flocculation. It showed less false positive reactions than the Wassermann test. These tests have been over taken by the newer analytical methods.

What is the epidemiology of Acquired syphilis?

In the developed countries the prevalence of this disorder has decreased. It is due to the large use of antibiotics in between 1980 to 1990. In the year 2000 the rate of syphilis has again increased in few developed countries. The increase has been mainly seen in the MSM community. This is mainly due to the increase rate of un safe sexual activities in their group. in the

What is the treatment of Acquired syphilis?

There are many ways by which this disorder can be treated.

1. One is the use of penicillin in the form of penicillin G. It has been established previously by the multiple studies which have been done before. The treatment is based on the case series and with the help of experts. They also take into account the clinical experience. The documented effect during pregnancy has been observed in the case of parenteral penicillin G. In case of early syphilis one dose of penicillin is sufficient. The non pregnant individuals who are allergic to penicillin must be treated with the oral dose of tetracycline and doxycycline. The data which supports this fact is limited. The alternative therapy can be provided by the ceftriaxone but its optimal dose is not so clear.

2. There are few cross reactions which are seen in the cases of penicillin allergic patients with cephalo sporins. The alternative therapy can also be provided by the azithromycin. The treatment has been failed in some areas. If there is no compliance and follow up there must be de sensitization with the use of penicillin. It has been recommended by the CDC. All pregnant women must be desensitized first and then must be treated with the penicillin. There must be a clinical evaluation after 1 to 2 weeks which must be followed by the clinical and serological evaluation at the interval of 3, 6, 9, 12 and 24 months. In the past azithromycin has been used to treat syphilis as it is easy to give one dose. In a study in the San Francisco showed that the azithromycin resistant rates in syphilis have raised from 0 to 56 percent from the year 2000 to 2004.

3. The late latent syphilis is defined as a latency which exists for more than one year. If the CSF examination yields no evidence of neuro syphilis then penicillin G is given. It is given weekly for three weeks. If one is allergic to penicillin it is replaced by the tetra cycline or doxy cycline. It is used for 28 days instead of 14 days. The data which supports the use of tetracycline and ceftriaxone is limited. The patients which are diagnosed with the neuro syphilis along with the ocular or auditory syphilis it is treated with the use of penicillin G. The results of CSF can be positive or non positive. It should be replaced by the intra venous treatment which is done every 4 hours for 10 to 14 days. If the intra venous treatment is not possible than it is followed by the procaine penicillin and is given along with the probenecid for two weeks. The procaine injections are painful and are difficult to ensure the patient compliance.

4. In the late latent disease the course of treatment is for 21 days and area of concern is the slow dividing treponemes. Now, a 3 weekly dose is recommended of benzathine penicillin G after the 14 days course is completed. It contains a procaine penicillin G. It is used to treat neuro syphilis. The use of oral antibiotics in the treatment of neuro syphilis has not been recommended. It can be replaced with the use of ceftriaxone intra muscular for two weeks.

5. The psychiatric diagnosis includes the neuro syphilis dementia. The atypical anti psychotic medications which are used to control the patient’s abnormal behavior showed a limited success. It is used in the classification of organic disorders in the brain. It is also known as the brain syphilis. There are certain alternative regimens which include the use of tetra cycline. They are not well studied in the HIV infection. It is recommended by a regular follow up. They are not given during the pregnancy. In case of early syphilis along with the presence of HIV it leads to higher risk of neurological complications. It also leads to the treatment failure. The magnitude of the risks associated with the disease is small. It is not precisely defined.

6. In the case of latent syphilis a skin testing or desensitization is recommended. It is also recommended in the case of neuro syphilis. There is a unique reaction known as the jarisch herxheimer reaction. The clinicians must warn the patients before starting any treatment. It is associated with the use of penicillin and in the secondary syphilis stage. It is quite common in the HIV patients. It is accompanied by the fever, fatigue and worsening of the muco cutaneous symptoms. They subside within 24 hrs. These symptoms increase with the use of paracetamol and should be distinguished from the drug allergy.

7. The clinicians must inform the HIV patients that the current regimens are not effective in the treatment of non HIV infection. A serological follow up is always required. In US a study was done to study the un ethical human medical experimentation in the 20th century. It was the Tuskegee syphilis study. The study was done in Albama. It was supported by the U.S Public health department along with the Tuskegee Institute. The study started in the year 1932 when there was a wide spread of this disorder. It occurred in the poor communities when there was no effective treatment. In this study around 600 black male share croppers in the rural area of Alabama. Out of the total 600, 400 were having the disease in latent phase and was asymptomatic in nature. Around 200 were un infected control patients. The public health department wanted to study the progress of disease and the effect of treatment on it. The treatment had multiple side effects and the benefits of the treatment were questioned by the doctors. They were also confused that the best treatment is provided by the no treatment done.

8. The patients were not properly told about the diagnosis of the disease and the treatment procedures. It included the use of painful lumbar puncture. In the great depression period and in a segregated state which had under fund services for blacks the patients were recruited for the physical examination. There was a free health care for minor illnesses and free meals along with the free transportation on the day of exams. A death benefit of 50 dollar was also given. The progression of the disorder was also measured in another study. It also helped to know that the syphilis may lead to the cardio vascular injury or not or it is more than the neurological damage. The untreated disorder may lead to the effects in other parts of the body.

9. The studies were also done to know whether the course of disease in the white as well as black men was same or different. A more information was gathered among the white mean in regards to the spread of disease. The effective cure for syphilis was provided by the penicillin. It was during the year 1947. It was commonly used by the public health centre’s and the doctors. The PHS head continued the study without treating the patients with penicillin. They did not allow them to take penicillin from the other sources. The men were told they do not have syphilis and so no treatment was provided to them. It included the arsenical drugs which were used early in the study. The main study was to study the patient in different phases. The treatment was provided from 6 to 9 months. It followed the original members and their families for four decades. The study ended in the year 1972. A long study showed that the 40 wives and 19 children were infected and many men died of syphilis. Around 30 men directly died of this disorder and 100 from the other complications. The study came to an end as one of the PHS leaked information about it to the Washington Star. The survivor and patient families filed a law suit against the government. It was settled out of the court and the living subjects and their descendants were given 10 million dollars as a compensation amount. After this settlement, government passed the National Research Act which allowed the government to review the medical studies which dealt with the human subjects.

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