Avoiding the “Great Imitator”: Syphilis Facts and Prevention

Published: 01/18/2019

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By Dr. Sebastian Ruhs
Chase Brexton Health Care

Syphilis remains an often-overlooked public health problem in Baltimore, but anyone who is sexually active should know the signs of this disease, as well as methods of treatment and prevention.

According to the Maryland Department of Health, cases of syphilis statewide increased by more than 12 percent last year from the year before, along with similar increases in gonorrhea and chlamydia. Last fall, executives at the Centers for Disease Control and Prevention said the country was losing ground in preventing new cases of these diseases.

Before we talk about treatment and prevention of syphilis, let’s briefly talk about the disease itself. Syphilis is caused by the bacteria treponema pallidum. It is most commonly spread via sexual activity. Penile/vaginal or penile/anal intercourse certainly bear the highest risk, but all kinds of sexual activity, such as oral, rimming, or even kissing have been reported to transmit this disease.

Syphilis is called the “great imitator” as it can present very similar to a large variety of other diseases, which can sometimes complicate its diagnosis, especially in the later stages.

The presentation of syphilis also varies depending on in which of the four stages it presents in. Primary syphilis is typically directly acquired from sexual contact with an infectious lesion of another person. After a few days to a few weeks a single ulceration develops with is typically located in the anal or genital area. As this lesion is often not very tender, it can be easily missed or be ignored. This ulcer is loaded with bacteria and highly contagious by physical contact. Those lesions resolve on their own after three to six weeks.

Stage 2 starts six to 10 weeks after the primary contact. The presentation in stage 2 can vary widely but typically is qualified by a non-itchy rash on the trunk and extremities including the palms and soles. However, wart-like lesions in the anal and genital area are frequently seen. All of those lesions contain bacteria and are considered contagious. The symptoms of secondary syphilis usually resolve within three to six weeks.

Stage 3 is called latent syphilis, which is divided into early latent (less than one year) and late latent (more than one year). During the latent phase there are no or only very minimal signs of being sick. Due to the lack of any clinical signs during this phase, a diagnosis is often only made through routine screening and getting positive blood work back. The last stage, or tertiary syphilis, occurs years to decades after the initial infection. During this late stage syphilis can infect the central nervous system, the skin, or multiple different internal organ systems including the cardiovascular system.

Syphilis is very treatable, especially during the early stages, with an antibiotic called penicillin or alternatively with doxycycline. The length and method of treatment depends on the stage. This is a decision your doctor will discuss with you after the diagnosis has been made.

There is no vaccine to prevent syphilis. Condoms are reducing the risk of transmission, but not completely eliminating it, especially when the syphilis lesion is located in an area that is not covered by the condom.

Dr. Sebastian Ruhs is the Director of the Chase Brexton Health Care Infectious Diseases Center of Excellence. For more on Chase Brexton’s treatment and prevention programs for sexually transmitted infections, visit www.chasebrexton.org/STI.