Syphilis is a sexually transmitted disease known at least since the 15th century and causes countless deaths of anonymous and notable historical figures, from famous artists (Toulouse-Lautrec) and renowned writers (Tolstoy) to modern gangsters (Al Capone). Even today it takes the lives of hundreds of people annually, especially in some Central African republics. It is thought that the disease existed in the Americas by the time Columbus arrived to America and that his crew spread it in the European ports. The causative agent is a spiral bacterium spiral called Treponema pallidum

Transmission modes:

Sexual contact, Vertical (mother to fetus) and infrequently by transfusion or intravenous drug addiction.

Symptoms and Diagnosis:

Syphilis is known as one of the great imitators because it produces cutaneous, cardiovascular and neurological lesions that emulate many diseases in several organs and systems. In its early stages is asymptomatic and the diagnosis is suspected by routine laboratory tests and in late cases the diagnosis is obtained by studying serious neurological or cardiovascular lesions without apparent cause. The diagnosis is usually accidental due to the regular practice of tests such as VDRL or Treponemal tests (FTA-ABS) in almost all routine laboratory tests. The definitive diagnosis is achieved by PCR (detection of bacterial DNA) or the determination of the presence of the infectious agent under the microscope.

Primary syphilis: The typical lesion is the syphilitic canker (only 15-60% of the patients report this lesion), a painless genital ulcer that appears from 3 to 90 days after the sexual contact infecting (average 21 days, possibility of contagion 60% by a contact sexual). Inflammation of local lymph nodes is added about 10 days after the onset of canker. The lesion disappears in about 3-6 weeks without any treatment giving the false feeling of healing when in fact the infection is gaining ground slowly in the organism of the infected. Treatment eliminates infection by avoiding progression to other stages and leaves no sequelae.

Secondary Syphilis: Typical lesions are cutaneous but unspecific and difficult to identify for the untrained clinician; Lesions may look like rosettes or allergic papules in the general skin and plants and palms, swollen lymph nodes, and even increased size of the liver and spleen. It appears 4 – 10 weeks after primary syphilis and the manifestations disappear without treatment after 3 to 6 weeks of appearing. Treatment eliminates secondary infection by avoiding progression to other stages and leaves no sequelae.

Latent syphilis: Occurs after high school and the patient is perfectly asymptomatic and in many cases, non-infectious. It lasts about 3 to 15 years before manifesting itself as tertiary syphilis, final and disastrous stage of syphilis. Treatment at this stage can avoid the sequelae of the tertiary stage

Tertiary syphilis: Occurs 10-30 years after untreated initial contact and manifests with severe cutaneous, cardiovascular and neurological lesions leading to death even with treatment. Treatment at this stage does not eliminate the sequelae and may be unable to prevent death. The affected patient is not infectious to other people.

Treatment: It is very simple and is based on the intramuscular injection of deposit forms of penicillin G (Benzathine) The cure is total and without leaving sequels when it comes to early stages. Treatment removes the infectious agent but does not eliminate the lesions or sequelae of late infection.

Syphilis during pregnancy/congenital syphilis

In pregnancy, maternal syphilis behaves in a similar way to the non-pregnant woman. The problem occurs in the fetus in the form of irreversible congenital lesions and their sequelae in the newborn.

I do not want to extend much in the fetal lesions of syphilis, instead, I want to insist that the fulfillment of Prenatal control, or better yet, of preconceptional control, can early detect the infection before presenting the associated fetal damage, Even avoid them completely if it is detected before the pregnancy occurs. For more information on the congenital effects of syphilis follow this link

We approach the diagnosis of syphilis during pregnancy through laboratory tests (VDRL and PCR of common infectious agents). If any of these tests are positive, treatment is initiated immediately while the confirmatory studies are decided. We prefer to treat a false positive that wasting time confirming the presence of Treponema because the treatment, penicillin G Benzathine, does not affect the fetus.

It should be noted that I have never had a case of congenital syphilis and that in more than two decades as a specialist I have seen very few cases of syphilis during pregnancy. All were treated immediately and only 2 cases proved to be indeed syphilis, the remainder, some 8 cases, were false positive with negative confirmatory tests. Ultrasound studies did not detect any fetal defect in known cases.