REPROSAIT 4 U

What is syphilis?

Syphilis is a sexually transmitted infection (STI) that's caused by a type of bacterium called a spirochete. If left untreated, syphilis can have very serious short- and long-term consequences. Fortunately, with timely antibiotic treatment, these consequences can usually be avoided.

Syphilis is transmitted by direct contact with a sore on an infected person. The most common way to get syphilis is through vaginal, anal, or oral sex, but it's also possible to get it by kissing someone with a syphilitic sore on or around the lips or in the mouth or by exposing an area of broken skin to a sore.

Syphilis can be transmitted to your baby through the placenta during pregnancy or by contact with a sore during birth.

The infection is relatively rare among women in the United States, with 1.1 cases per 100,000 women in 2007, but that number was up 10 percent from 2006. The rates are significantly higher in communities with high levels of poverty, low levels of education, and inadequate access to health care.

The number of babies in the United States born with syphilis also rose – after 14 years of decline – from 339 new cases in 2005 to 382 cases in 2006 to 430 cases in 2007.

What are the symptoms?

Syphilis progresses in stages, with symptoms that differ from one stage of the disease to the next and from person to person. In some cases, the symptoms aren't noticeable and you may not know you have the disease until you're tested.

In the first stage, known as primary syphilis, the characteristic symptom is a painless and highly infectious sore (or sores) with raised edges called a CHANCRE. The chancre shows up at the site of infection, usually about three weeks after you're exposed to the bacteria, though it may appear earlier or up to three months later.

Because the chancre may be inside your vagina or your mouth, you might never see it. A chancre could also show up on your labia, perineum, anus, or lips, and your lymph nodes may be enlarged in the area where the sore develops.
If you get appropriate treatment at this stage, the infection can be cured. If you're not treated, the sore lasts three to six weeks and then heals by itself. However, the spirochetes are likely to continue to multiply and spread throughout the bloodstream. When this happens, the disease progresses to the next stage, called secondary syphilis.

In the secondary stage, syphilis can have a variety of symptoms that show up in the weeks or months after the sore first appeared, but again, they might not be noticeable.

Most people with secondary syphilis develop a non-itchy rash, commonly on their palms and soles, though it may also appear on other parts of the body. You might also have lesions in your mouth and vagina, as well as painless but infectious wart-like sores in the genital area, flu-like symptoms, weight loss, and hair loss. The infection is still curable with treatment at this stage.

Without treatment, the symptoms generally clear up on their own within a few months, but the infection stays in your body. The bacteria continue to multiply during this latent phase and can cause very serious problems years later.

In fact, about 1 in 3 people who don't get proper treatment will progress to what's called tertiary syphilis. This late stage of the disease can develop up to 30 years after you were first infected and can cause serious heart abnormalities. Damaging and potentially lethal lesions can develop in your bones, on your skin, and in a host of organs. Fortunately, most people get treated early enough these days that very few end up with tertiary syphilis.

Syphilis can also infect your central nervous system – your brain and spinal cord. This is called neurosyphilis, and it can occur at any stage of the disease. Early on, it may cause problems like meningitis.

Late neurosyphilis can lead to seizures, blindness, hearing loss, dementia, psychosis, spinal cord problems, and eventually death.

How can syphilis affect my pregnancy and my baby's health?

Syphilis can travel from your bloodstream across the placenta and infect your baby anytime during pregnancy. It can also infect your baby during delivery. If your syphilis is detected and treated early, you and your baby will most likely be fine.
If you don't get treated, there's a very high chance that your baby will be infected, particularly if you're in the early stages of the disease, when it's most infectious. About 40 percent of pregnant women with untreated early syphilis end up having a miscarriage, a stillbirth, or a baby who dies soon after birth. Syphilis also increases the risk of preterm birth and intrauterine growth restriction.

Some babies infected with syphilis whose mothers are not treated in a timely fashion during pregnancy develop problems before birth that are visible on an ultrasound. These problems might include an overly large placenta, fluid in their abdomen and severe swelling, and an enlarged liver or spleen.

An infected baby may have other abnormalities at birth, such as a skin rash and lesions around the mouth, genitals, and anus; abnormal nasal secretions; swollen lymph glands; pneumonia; and anemia.
Most babies don't have these symptoms initially, but without treatment they develop some symptoms within the first month or two after birth. And whether or not there are obvious symptoms early on, if the disease isn't treated, babies born with syphilis may end up with more problems years later, such as bone and teeth deformities, vision and hearing loss, and other serious neurological problems.

That's why it's critical for women to be tested and treated during pregnancy, and for any baby who may have syphilis at birth to be fully evaluated and treated as well.

Will I be tested for syphilis during my pregnancy?

Yes. Even though the infection is relatively rare, it's considered vitally important to detect and treat syphilis during pregnancy. The CDC recommends that all pregnant women be screened for the infection at their first prenatal visit, and some states require that all women be tested again at delivery.

If you live in a community where syphilis is prevalent or you're otherwise at high risk, you should be tested again at 28 weeks and at delivery. You'll also be retested for syphilis if you've contracted another STI during your pregnancy or if you or your partner develops symptoms of syphilis.
Because it takes about four to six weeks after exposure to get a positive result from the blood test, the result may be negative if you're tested too soon.

So if you had high-risk sex a few weeks before your test or your partner recently had symptoms, tell your practitioner so you can be tested again in a month. If your screening test is positive, the lab will perform a more specific test on your blood sample to tell for sure whether you have syphilis.

Having syphilis makes you more susceptible to HIV if you're exposed to it, so if you test positive for syphilis, you should also be tested (or retested) for HIV and other STIs.

And if you have primary syphilis, you'll need to be tested for HIV again in three months

How is syphilis treated during pregnancy?

Penicillin is the only antibiotic that's both safe to take during pregnancy and able to successfully treat both mother and baby for syphilis. If you have syphilis, you'll get treated with one or more injections of penicillin, depending on the stage of the disease and whether you have neurosyphilis. (If you have any symptoms of neurosyphilis, you'll have a spinal tap to check for it.) If you're allergic to penicillin, you'll need to be desensitized to the drug first, so you can receive it.

In many pregnant women, treatment for syphilis causes a temporary reaction that may include fever, chills, headache, and muscle and joint aches. These symptoms tend to appear several hours after treatment and go away on their own in 24 to 36 hours.

The treatment may also cause some changes in your baby's heart rate, and if you're in the second half of your pregnancy, it may cause contractions. (If you notice any contractions or a decrease in fetal movement, you should call your caregiver immediately. In some cases, your caregiver may opt to treat you in the hospital so you can be monitored.)

Your partner will also need to be tested, and he'll be treated if he's positive or has had sexual contact with you in the last three months, even if his blood test is negative. You need to refrain from sexual contact until both of you have been treated. After treatment, you'll have regular blood tests to make sure the infection has cleared and you haven't been reinfected, and you'll have an ultrasound to check on your baby.

How can I avoid getting syphilis?

Have sex only with a partner who has sex only with you and has tested negative for syphilis. While condoms can prevent transmission of HIV and other STIs, they only offer protection from syphilis if the sore is on your partner's penis – they won't protect you from sores that aren't covered by the condom.

Remember, too, that you can get syphilis if a partner's sore touches any of your mucous membranes (such as in your mouth or vagina) or broken skin (a cut or scrape).

If you've had syphilis once, that doesn't mean you can't get it again. You can become reinfected.

If there's a possibility that you've been exposed to syphilis or any other STI during pregnancy, or you or your partner has any symptoms, tell your practitioner right away so you can be tested and treated if necessary.