Syphilis is capable of producing the most varied of all skin changes. It may also mimic a wide variety of internal diseases. Consequently it is essential to bear in mind the possibility of any unusual rash being due to syphilis.
Syphilis is a chronic infectious disease caused by the bacillus Treponema pallidum, which is acquired by intimate contact with an infected person or as a congenital infection in infancy. In the western world it is most easily transmitted, under moist conditions, by genital or oral contact. It may also be transmitted by an infected mother from the fifth month of pregnancy onwards. In underdeveloped countries a form of syphilis occurs which is spread by intimate contact rather than by sexual intercourse; it is usually associated with bad living conditions and poor hygiene.
In Europe, from 30000 to 40000 cases of contagious syphilis are registered every year, the greatest incidence being amongst homosexual men. As with all venereal diseases, it is more common during times of unstable social conditions and war. After World War II cases rapidly declined. However the past 20 years has seen a marked resurgence. The reasons for this are speculative but may include the following: increased travel, both tourist and migratory; altered moral standards; a more liberal attitude to homosexuality; the effect of oral and intrauterine contraceptives on human sexual behaviour; the diminished use of condoms, and the widespread use of drugs.
Syphilis may be thought of as occurring in four stages. Primary infection occurs 10-30 days after contact, and takes the form of a persistent chancre or sore. Associated with this there are enlarged tender lymph glands. The chancre usually appears on the genitals, in the anal area, or in or around the mouth. It may take 3-8 weeks to heal, leaving a small scar. At this stage, it is best diagnosed by a direct bacterial examination of the sore.
Secondary syphilis will usually occur 1-2 months after the primary stage. This stage may manifest a wide variety of different rashes, and is best diagnosed by appropriate blood tests. At this time the person is highly contagious, and bacteria may be found on most parts of the body. This stage may persist for up to two years. The rashes may resemble measles, chicken pox, hives, drug allergies, tinea, eczema, warts, and psoriasis, to name but a few conditions. However invariably there are other associated symptoms, such as a fever, tiredness, patchy hair loss, joint pains and headaches, particularly at night. This stage is also accompanied by enlarged, but not tender, lymph glands.
Latent syphilis, which is the stage without symptoms, may last from 2-20 years. It is only diagnosed from an adequate history and positive blood tests.
The final stage, tertiary syphilis, may affect all organs of the body; more commonly, though, it affects the heart, brain, and liver. In the skin it appears either as odd patterns of grouped nodules or large, painless ulcers. This stage is not infectious.
The treatment for syphilis is penicillin. For primary and secondary stages, this is either given on ten consecutive days or in one very large single dose. These people require follow-up treatment, including blood tests for two years. Contact tracing of people who are likely to have become infected is an essential part of the proper management of this contagious and important disease. Cases of syphilis which are of longer than 12 months duration require more intensive therapy over a longer period.
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