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medicine for syphillis
Oct 30, 2008

what is the medicine for syphillis?

Response from Dr. Frascino

Hello,

The primary treatment is penicillin. How much and how it is given depend on the type of syphilis you have. See below for some general information about syphilis and its treatment.

Dr. Bob

U.S. National Institute of Allergy and Infectious Diseases Syphilis

November 14, 2006

Overview

Syphilis is a sexually transmitted bacterial infection (STI) that initially causes genital ulcers (sores). If untreated, these ulcers can then lead to more serious symptoms of infection.

An ancient disease, syphilis is still of major importance today. Although syphilis rates in the United States declined by almost 90 percent from 1990 to 2000, the number of cases rose from 5,979 in 2000 to 7,980 in 2004. In a single year, from 2003 to 2004, the number of syphilis cases jumped 8 percent.

There also was a dramatic change in whom the disease affects. Between 2002 and 2003, the number of cases in men increased 13.5 percent, reflecting an increase in syphilis in men who have sex with men. During the same time the number of cases in women declined by 27.3 percent.

Syphilis also disproportionately affects African Americans, who represent 41 percent of all cases reported to the Centers for Disease Control and Prevention (CDC).

HIV infection and syphilis are linked. Syphilis increases the risk of transmitting as well as getting infected with HIV.

Cause

Syphilis is caused by a bacterium called Treponema pallidum.

Transmission

The most common way to get syphilis is by having sexual contact with an infected person. If you get infected, you can pass the bacteria from infected skin or mucous membranes (linings), usually your genital area, lips, mouth, or anus, to the mucous membranes or skin of your sexual partner.

Syphilis can be passed from mother to infant during pregnancy, causing a disease called congenital syphilis.

The bacteria are fragile; you can't get them from eating utensils or through using spas, pools, or toilets.

Symptoms

Syphilis is sometimes called "the great imitator" because it has so many possible symptoms, and its symptoms are similar to those of many other diseases. Having HIV infection at the same time can change the symptoms and course of syphilis. Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.

Primary Syphilis

The first symptom of primary syphilis is often a small, round, firm ulcer called a chancre ("shanker") at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres also can develop on the cervix, tongue, lips, or other parts of the body. Usually there is only one chancre, but sometimes there are many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout the body.) The chancre usually appears about 3 weeks after you're infected with the bacteria, but it can occur any time from 9 to 90 days after exposure.

Because a chancre is usually painless and can appear inside your body, you might not notice it. The chancre disappears in about 3 to 6 weeks whether or not you are treated. Therefore, you can have primary syphilis without symptoms or with only brief symptoms that could be overlooked. If primary syphilis is not treated, however, the infection moves to the secondary stage.

Secondary Syphilis

Most people with secondary syphilis have a non-itchy skin rash. Although the rash is usually on the palms of your hands and soles of your feet, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include

Sore throat

Tiredness

Headache

Swollen lymph glands

Less frequent symptoms include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area.

Your symptoms may be mild. The sores of secondary syphilis contain many bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will disappear even without treatment. Without treatment, however, the infection will move to the next stages.

You may have recurrences of secondary syphilis.

Latent Syphilis

The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over.

In early latent syphilis, you might notice signs and symptoms, but the infection remains in your body. When you are in this stage, you can still infect a sexual partner.

In late latent syphilis, the infection is quiet and the risk of infecting a sexual partner is low or absent. If you don't get treated for latent syphilis, you will progress to tertiary syphilis, the most serious stage of the disease.

Tertiary Syphilis

Even without treatment, only a small number of infected people develop the dreaded complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage.

Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurological problems, heart disease, and death. Late neurosyphilis (brain or spinal cord damage) is one of the most severe signs of this stage.

Diagnosis

It can be very difficult for your health care provider to diagnose syphilis based on symptoms. This is because symptoms and signs of the disease might be absent, go away without treatment, or be confused with those of other diseases. Because syphilis can be hard to diagnose, you should

Visit your health care provider if you have a lesion (sore) in your genital area or a widespread rash Get tested periodically for syphilis if your sexual behaviors put you at risk for STIs Get tested to be sure you do not also have syphilis if you have been treated for another STI such as gonorrhea or HIV infection Your health care provider can diagnose early syphilis by seeing a chancre or rash and then confirming the diagnosis with laboratory tests. Because latent syphilis has no symptoms, it is diagnosed only by laboratory tests.

There are two laboratory methods for making the diagnosis.

Identifying the bacteria under a microscope in a sample taken from a lesion Performing a blood test for syphilis If your doctor thinks you might have neurosyphilis, your spinal fluid will be tested as well.

Treatment

Syphilis is easy to cure in its early stages. Penicillin, an antibiotic, injected into the muscle is the best treatment for syphilis. If you are allergic to penicillin, your health care provider may give you another antibiotic to take by mouth.

If you have neurosyphilis, you may need to receive daily doses of penicillin intravenously (in the vein) and may need to be treated in the hospital.

If you have late syphilis, damage done to your body organs cannot be reversed.

While you are being treated, you should abstain from sex until your sores are completely healed. You should also notify your sex partners so they can be tested for syphilis and treated if necessary.

For updated information on treatment for syphilis, read the CDC Sexually Transmitted Diseases Treatment Guidelines.

Prevention

To prevent getting syphilis, you must avoid contact with infected tissue (a group of cells) and body fluids of an infected person. Usually syphilis is transmitted from people who have no visible sores or rashes and who do not know they are infected, however.

If you are not infected with syphilis and are sexually active, having mutually monogamous sex with only one uninfected partner is the best way to prevent syphilis. Using condoms properly and consistently during sexual intercourse reduces the risk of getting syphilis.

Washing or douching after sex will not prevent syphilis. Even if you have been treated for syphilis and cured, you can be re-infected by having sex with an infected partner.

The risk of a mother transmitting syphilis to her unborn baby during pregnancy declines with time but persists during latent syphilis. To prevent passing congenital syphilis to her unborn baby, all pregnant women should be tested for syphilis.

Complications

Pregnancy

Untreated syphilis results in a high-risk pregnancy. There are an estimated 8,000 pregnant women with syphilis in the United States. Untreated early syphilis results in death of the unborn baby in up to 40 percent of cases. Studies show that if a woman contracts syphilis during the 4 years before her pregnancy, untreated early syphilis may lead to infection of her unborn baby in more than 70 percent of cases. Therefore, if you are pregnant, you should be tested for syphilis.

Syphilis can cause miscarriages, premature births, stillbirths, or death of newborn babies. Some infants with congenital syphilis have symptoms at birth, but most develop symptoms later.

Untreated babies with congenital syphilis can have deformities, delays in development, or seizures along with many other problems such as rash, fever, swollen liver and spleen, anemia, and jaundice. Sores on infected babies are infectious. Rarely, the symptoms of syphilis go unseen in infants so that they later develop the symptoms of late-stage syphilis, including damage to their bones, teeth, eyes, ears, and brains.

HIV Infection

There is an estimated two- to five-fold increased risk of getting infected with HIV when syphilis is present. Substantial biological evidence shows the increased likelihood that getting and transmitting HIV is linked to the presence of sexually transmitted infections (STIs). You should discuss this and other STIs with your health care provider.

Research

Developing better ways to diagnose and treat syphilis is an important research goal of scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID).

Scientists are developing new tests that may provide better ways to diagnose syphilis and define the stage of infection. Efforts to develop a diagnostic test that would not require a blood sample are a high priority. For example, researchers are evaluating saliva and urine to see whether they would work as well as blood. Researchers also are trying to develop other diagnostic tests for detecting infection in babies.

In an effort to stem the spread of syphilis, scientists are conducting research that could lead to the development of a vaccine. Molecular biologists are learning more about the various surface parts of the syphilis bacterium that stimulate the immune system to respond to it.

Another research priority is the development of a safe, effective single-dose oral antibiotic for syphilis. A clinical trial is evaluating oral azithromycin for treating primary syphilis.

NIAID-funded researchers have also sequenced the genetic blueprint, or genome, of the bacterium that causes syphilis. The DNA sequence represents an encyclopedia of information about the bacterium. Researchers have identified clues in the genome that may help better diagnose, treat, and vaccinate against syphilis, fueling intensive research efforts.

Related Links Government Links National Library of Medicine MedlinePlus 8600 Rockville Pike Bethesda, MD 20894 1-888-FIND-NLM (1-888-346-3656) or 301-594-5983

Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 1-800-CDC-INFO (1-800-232-4636) or 404-639-3311

Non-Government Links American Social Health Association P.O. Box 13827 Research Triangle Park, NC 27709-3827 919-361-8400

-------------------------------------------------------------------------------- This article was provided by U.S. National Institute of Allergy and Infectious Diseases.

RPR (SYPHILIS) Jun 5, 2007

i got an RPR test...what is it and does it have anything to do with STDS? is this bad?

Response from Dr. Frascino

Hello,

RPR is rapid plasma regain. It's a screening test for syphilis.

Is that bad? Well that would depend on whether you have syphilis!

See below. I'll reprint some questions form the archives concerning RPR and syphilis.

Good luck.

Dr. Bob

RPR Testing Apr 21, 2006

I have concerns about the accuracy of the RPR test I took recently. About 5 and a half years ago, I experienced symptoms that appeared to be syphilis. However, at the time I assumed if something cleared up on it's own, it wasn't an STD. I'm older and wiser now, and since then, have tested myself for everything. My concerns lie in the RPR. It came back negative, but after reading several websites, now have concerns about the accuracy of the test. After 5 and a half years, will the RPR test be accurate? Do you recommend further testing. Thank you very much for your response. This has been waying heavily on me.

Response from Dr. Frascino

Hello,

If you are concerned about syphilis, you should talk to your doctor and explain the symptoms you experienced in the past. Diagnosing syphilis can be tricky. If your RPR is in question, your physician may order an FTA test. I'll repost a recent question related to syphilis testing below.

Good luck!

Dr. Bob

3rd tryPlease Help! RPR test reliabilty with Uveitis Mar 13, 2006

Dr Bob,

im desperate for a straight answer(no pun intended) I know that immunology is your specialty, and hope you can/will help. I have had a second bout of Uveitis (Anterior) and am terrified of the many diseases that have been linked to this eye inflammation. I have had recently been tested for Syphilis and Hiv, both negative. The syphilis test was the RPR, which I am now hearing may not be accurate. My opthamologist wants to also now order a confirmatory test in addition to the RPR. My question, how reliable is the RPR? Why would it be used for screening if it is not accurate? P.S I have not had any sexual encounters in over a year, so I am hoping waiting periods are not an issue.

Response from Dr. Frascino

Hello,

Syphilis testing is very confusing and the interpretation of the tests can at times be complicated. Basically there are several types of syphilis tests and several different stages of syphilis (primary, secondary and tertiary). Not all tests are positive for all stages. Generally speaking, RPR (or VDRL) tests are run for routine syphilis screening. A high value (called "titer") would indicate recent infection; however, various things can affect these tests. Consequently, they need to be confirmed with a secondary test (usually FTA or MHA). I don't know what tests your ophthalmologist has ordered for you and suggest you discuss this with him/her. Regarding the interval since your last sexual encounter, my, you've really had a dry spell, haven't you?!? However, you don't worry about test accuracy. The FTA will usually remain positive for life, once you've had syphilis (even if it's been treated and the RPR and VDRL decrease very dramatically). Try not to worry too much, OK? You're doing the correct thing by having your problem properly evaluated. Your HIV test is negative, which is great news. If your syphilis test does turn up positive, curative treatment is available.

Good luck.

Dr. Bob

Syphilis

May 2004

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.

How common is syphilis?

In the United States, health officials reported over 32,000 cases of syphilis in 2002, including 6,862 cases of primary and secondary (P&S) syphilis. In 2002, half of all P&S syphilis cases were reported from 16 counties and 1 city; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of infectious syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns decreased from 2001 to 2002, with 492 new cases reported in 2001 compared to 412 cases in 2002.

Between 2001 and 2002, the number of reported P & S syphilis cases increased 12.4 percent. Rates in women continued to decrease, and overall, the rate in men was 3.5 times that in women. This, in conjunction with reports of syphilis outbreaks in men who have sex with men (MSM), suggests that rates of syphilis in MSM are increasing.

How do people get syphilis?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission appears to occur from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from persons who are unaware of their infection.

Primary Stage

The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage

Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and late stages of disease.

Late Stage

The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

How does syphilis affect a pregnant woman and her baby?

The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

How is syphilis diagnosed?

Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

What is the link between syphilis and HIV?

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.

What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Will syphilis recur?

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after treatment has been received.

How can syphilis be prevented?

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Based on findings from several research studies, N-9 may itself cause genital lesions, providing a point of entry for HIV and other STDs. In June 2001, the CDC recommended that N-9 not be used as a microbicide or lubricant during anal intercourse. Transmission of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

Where can I get more information?

STD information and referrals to STD Clinics CDC-INFO 1-800-CDC-INFO (800-232-4636) TTY: 1-888-232-6348 In English, en Español

CDC National Prevention Information Network (NPIN) P.O. Box 6003 Rockville, MD 20849-6003 1-800-458-5231 1-888-282-7681 Fax 1-800-243-7012 TTY E-mail: info@cdcnpin.org

American Social Health Association (ASHA) P. O. Box 13827 Research Triangle Park, NC 27709-3827 1-800-783-9877

Sources

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(no. RR-6).

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2002. Atlanta, GA: U.S. Department of Health and Human Service, September 2003.

K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, chapters 33-37.



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