The Return of Syphilis

Syphilis is an ancient disease dating back to before the fourth century A.D. Cases have declined since the advent of penicillin in the 1940s, and so in 1999 the Centers for Disease Control and Prevention announced its plan to eradicate syphilis before the end of the first decade of this millennium. These good intentions were dashed in 2001 and 2002 when an alarming rise in syphilis cases was reported in major metropolitan areas among men who have sex with men. This news has stunned medical professionals and has confirmed the widespread speculation that safer-sex practices are being abandoned. Syphilis is most often acquired by oral, anal, or vaginal sex. It is not spread by casual contact with toilet seats, hot tubs, shared clothing, or eating utensils. More ominously, an open syphilis sore increases your risk of acquiring HIV infection two- to five-fold. Syphilis has three distinct stages, each with characteristic physical signs and symptoms. Primary syphilis appears about 21 days after infection and manifests as a single, round painless sore'a chancre'at the spot where the syphilis bacteria entered the body (penis, mouth, anus, or vagina). After three to six weeks, the sore heals on its own, even without treatment. Secondary syphilis then emerges as a skin rash in the days to weeks after the chancre sore has disappeared. The rash most often materializes as a bunch of rough, nonitchy, reddish-brown spots on the palms of the hands, the bottoms of the feet, and possibly anywhere else on the body. It can resemble many other nonsyphilitic skin diseases (such as scabies, allergic reactions, etc.), and it is not uncommon for patients to be mistakenly treated for other diseases if syphilis infection is not suspected. Secondary syphilis can also cause flulike symptoms such as fever, headache, weight loss, body aches, and fatigue. If left untreated, the rash and the other flulike symptoms of secondary syphilis eventually clear up on their own. However, syphilis lives on. Untreated syphilis hides out in the body as 'latent' or 'late stage' disease, slowly doing internal damage to the heart, blood vessels, brain, eyes, nerves, joints, etc. Symptoms may not become apparent for decades, and the disease may result in paralysis, blindness, dementia, and death. Syphilis is easily diagnosed by any one of a number of blood tests, and a doctor can monitor a person's response to treatment via these same blood tests. In patients with HIV infection, spinal fluid samples may be needed to rule out a dangerous syphilitic brain infection, or neurosyphilis. Syphilis can be cured with simple antibiotics, such as penicillin, given in large doses. Penicillin-allergic patients may be treated equally well with a number of other antibiotics, such as tetracycline, doxycycline, or ceftriaxone. The duration of treatment depends on the stage of syphilis, with longer courses of treatment required for people with later stages of the disease. Since prevention is always preferable to treatment, the basic guidelines regarding syphilis prevention are simple and straightforward: Always use condoms (which, unfortunately, do not offer complete protection) and get tested for syphilis frequently. Remember, having had syphilis in the past offers no protection from getting syphilis again, since antibody levels decrease rapidly after the infection clears. There's just no getting around safer sex. Cohan is an attending physician and vice president with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif. He serves on the board of AIDS Project Los Angeles and has expertise in nutrition, anabolics, and exercise.