Syphilis - tertiary

Definition

Tertiary syphilis is a late phase of the sexually transmitted disease syphilis, caused by the spirochete Treponema pallidum.

Alternative Names

Late syphilis; Tertiary syphilis

Causes, incidence, and risk factors

Syphilis is a sexually transmitted, infectious disease caused by the spirochete Treponema pallidum.

Syphilis has three main stages:

• Primary syphilis
• Secondary syphilis
• Tertiary syphilis

This article focuses on tertiary syphilis. Tertiary syphilis can follow the initial infection (primary syphilis) by 3 to 15 years.

In tertiary syphilis, the infection-causing organisms have continued to grow for years. Pockets of damage, or lesions, affects various tissues such as the bones, skin, nervous tissue, heart, and arteries. These areas are called gummas, and are very destructive.

Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment.

Symptoms

Symptoms of tertiary syphilis depend on which organ systems have been affected. They vary widely and are difficult to diagnose. In individuals with tertiary syphilis, the primary and secondary stages of syphilis usually have been long forgotten. Medical findings of aortic aneurysms and neurological problems require astute diagnostic ability to link them to syphilis. Some of the symptomatic problems are listed below.

• Cardiovascular syphilis which affects the aorta and causes aneurysms or valve disease
• Central nervous system disorders (neurosyphilis)
• Infiltrative tumors of skin, bones, or liver (gumma)

Signs and tests

VDRL or RPR blood tests are used as screening tests. If they are positive, one of the following is needed to confirm the diagnosis of syphilis:

• FTA-ABS (fluorescent treponemal antibody test)
• MHA-TP

Spinal fluid examination in neurosyphilis shows signs of meningitis.

Treatment

The treatment of syphilis is determined by the length of time the person has been infected.

Syphilis can be treated with antibiotics such as penicillin, G benzathine, doxycycline, or tetracycline (for patients who are allergic to penicillin). Length of treatment depends on the extent of the infection and factors such as the person's overall health.

For treating syphilis during pregnancy, only penicillin is recommended. Tetracycline cannot be used because it is toxic to the fetus, and erythromycin may fail to prevent the spread of the infection (congenital syphilis) to the fetus. Penicillin-allergic individuals should be desensitized and then treated with penicillin.

Several hours following treatment of early stages of syphilis, some individuals may undergo a febrile reaction called Jarisch-Herxheimer reaction. This is thought to be caused by the release into the circulation of material from dead or dying spirochetes. Symptoms of this reaction include:

• Chills
• Fever
• General feeling of being ill (malaise)
• Generalized joint aches (arthralgia)
• Generalized muscle aches (myalgia)
• Headache
• Nausea

These symptoms usually disappear within 24 hours.

Follow-up blood tests must be done 3, 6, 12, and 24 months after treatment to ensure that the infection has been eliminated.

Individuals with primary or secondary syphilis should abstain from sex until they have been treated. Syphilis is extremely contagious in the primary and secondary stages.

Expectations (prognosis)

Late syphilis may be permanently disabling and may lead to death.

Complications

• Aneurysms
• Heart valve disease
• Neurosyphilis
• Syphilis infection of the heart

Calling your health care provider

Untreated syphilis can result in serious health problems. It is very important that you tell your doctor if you think you might have had syphilis, even if it was many years ago.

Prevention

If you are sexually active, practice safe sex and always use a condom.

All pregnant women should be screen for syphilis.

References

Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 235.