Why Is Syphilis Important?

1. Why Is Syphilis Important? http:// Tammy Foskey, MA Manager, STD/HIV Public Health Follow-Up Team tammy.foskey@dshs.state.tx.us (512) 533-3020

2. Syphilis Is: • A Bacterial Infection that can be chronic and systemic • Infectious During Specific Time Frames related to Stage • Sexually Transmitted (oral, vaginal, anal) • Curable

3. Many persons (including physicians) are unaware that we are currently seeing an increase in the number of syphilis infections • Syphilis can increase the risk for transmission of HIV (if co-infected) by 3-5x • Having HIV can make someone more susceptible to an infection with syphilis, if exposed • Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected persons with new syphilis infections

5. Syphilis Syphilis is sometimes called: • “bad blood”, • pox, or • a “zipper cut”

6. Epidemiology of Syphilis • In the 1940s: Syphilis was distributed widely throughout the U.S. • 1986-90: 85% increase in the incidence of primary and secondary syphilis –Why? • After 1990, reported cases of syphilis decreased approximately 15% per year to an all-time low in 2000

7. Epidemiology of Syphilis (continued) • Late 1990s: syphilis elimination a feasible goal • Rates remain high in: • Some urban areas throughout the U.S.; • Rural areas in the South; • Some minority populations who suffer from poverty, lack of access to health care, and breakdown of stable community and personal relationships. • Recent outbreaks have been associated in men who have sex with men (MSM)

8. Syphilis – Treponema pallidum

9. Syphilis – Treponema pallidum on darkfield examination

10. How is Syphilis Transmitted? • Sexual contact with infectious lesion • In utero and intrapartum • Sharing needles (extremely rare)

11. So what Does Syphilis Look Like?

12. Syphilis has Several Stageswith different signs/symptoms Incubation Stage 10 - 90 Days Average 21 Days Not infectious to others during this stage No signs/symptoms are present Blood tests are negative

13. Common Symptoms of SyphilisPrimary Stage • Occurs in males and females • A painless sore called a chancre develops where the spirochete entered the body • The sore may be located on the genitals, lips, anus, or other area of direct contact • The chancre will last 1-5 weeks (on average 3 weeks) and heal without treatment • The person can transmit the infection very easily during this stage

14. Clinical Manifestations-Primary Syphilis • Chancre • Clean based, painless, indurated ulcer with smooth firm borders • Unnoticed in 15-30% of patients often because of the location and because it is painless • Resolves in 1-5 weeks • HIGHLY INFECTIOUS Blood tests may not show infection for up to 7 days after the chancre develops

15. Primary syphilis-chancre

16. Primary Syphilis- chancre Source: Florida STD/HIV Prevention Training Center

17. Primary syphilis - chancre

18. Primary syphilis - chancre

19. Primary syphilis – chancre of anus

21. Primary syphilis - chancre

26. Syphilis Early Latency Stage • Lasts 0 - 10 weeks (average 4 weeks) • No symptoms are present, not infectious • Happens between primary and secondary stages • 2/3 of persons will have some period of latency between primary and secondary stages • Blood tests are positive • VDRL or RPR • TPPA or FTA-ABS

27. Common Symptoms of SyphilisSecondary Stage • May include skin rashes, fever, swollen lymph glands, headache, hair loss, and muscle ache • The skin rash may be on the palms of hands, bottoms of the feet, or any part of the body • The rash may last 2-6 weeks (average of 4 weeks); it will heal without treatment • The person may be infectious (C. Lata and/or Mucous Patches)

28. Secondary Syphilis • Diagnosed by • Symptoms • RPR or VDRL • FTA-ABS or TPPA • Darkfield examination (of C. lata)

29. Secondary Syphilis: Papulosquamous Body Rash Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

30. Secondary Syphilis: Generalized Body Rash Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

31. Secondary syphilis

32. Secondary Syphilis: Rash Source: Cincinnati STD/HIV Prevention Training Center

33. Secondary syphilis

34. Secondary Syphilis: Palmar Rash Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

35. Secondary Syphilis: Plantar Rash Source: Florida STD/HIV Prevention Training Center

37. Secondary Syphilis Source: Florida STD/HIV Prevention Training Center

38. Secondary Syphilis:Condylomata Lata Source: Florida STD/HIV Prevention Training Center

41. Secondary Syphilis: Mucous Patches

43. Secondary syphilis: alopecia

45. Secondary syphilis: papulo-pustular rash

46. Primary and Secondary Syphilis Disease Process Date of inoculation Incubation 10-90 days Avg: 21 days Primary Syphilis Lasts 1 – 5 weeks Average: 3 weeks Early Latency 0 – 10 weeks Avg: 4 weeks Secondary Syphilis: Lasts 2-6 weeks Average: 4 weeks Most will have a period of latency between primary and secondary. If not, overlap could be 2-3 days

47. Neuro-Syphilis • Can occur any time after initial infection • May occur more commonly early in the course of infection (secondary or latent) when someone is co-infected with HIV • Associated with neurologic symptoms including: • Vision changes or eye pain • Hearing loss • Headaches/dizziness • Generalized weakness • Seizures • Confusion • Changes in personality or affect

48. Neurosyphilis: spirochetes in neural tissue

49. Congenital Syphilis • Syphilis that is transmitted during pregnancy (or at time of delivery) • Often the mother has received no or inadequate prenatal care

50. Syphilis in Pregnancy can Cause: • Preterm delivery • Stillbirth • Congenital infections • Neonatal death