Although it can be cured with antibiotics, people can get re-infected. In the early stages of disease, syphilis causes disease of the genitals, mucous membranes and skin.
If it is not treated, syphilis can lead to serious complications and death. These include heart problems; neurological problems and dementia, known as neurosyphilis; and infection in the eye that can cause visual impairment or blindness, known as ocular syphilis.
Syphilis is passed from person to person through direct contact with an active sore or lesion, usually during vaginal, front, anal or oral sex or by sharing sex toys. Pregnant women with syphilis can pass it before and during child birth. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils. The sores can also make it easier for HIV to be sexually transmitted. Studies suggest that people with HIV who become infected with syphilis may be more likely to develop lesions and may have a faster progression of disease.
Their CD4 counts may drop and HIV levels rise temporarily during early syphilis, but then improve after being treated. Syphilis has four stages: primary, secondary, latent and tertiary. Symptoms depend on the stage of disease. Transmission is more likely to occur during the primary and secondary stages. Primary syphilis : In most cases, primary syphilis appears as a painless sore chancre that develops within 2—6 weeks after infection. The sore usually develops on the penis, vulva, vagina or anus, but it can also be found on the cervix, tongue, lips, and other parts of the body.
The sore usually heals within a few weeks without treatment, but the person remains infected. Sometimes more than one sore is present or sores may not be present. HIV is much easier to transmit when these sores are present. Secondary syphilis : The most common symptom is an outbreak of small, pox-like skin lesions—usually brownish-pink in color—that seem like a non-itchy rash when clustered together. They can appear anywhere on the body, but they appear more often on the palms of the hands and soles of the feet.
These lesions are highly contagious. They can spread the bacteria if the skin is broken and another person touches them. They can also take several weeks or months to heal, and possibly recur, without treatment. Learn more. This handout is provided to you by your family doctor and the American Academy of Family Physicians. This information provides a general overview and may not apply to everyone.
Talk to your family doctor to find out if this information applies to you and to get more information on this subject. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp.
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Next: Understanding Tics and Tourette's Syndrome. Apr 15, Issue. Am Fam Physician. What is syphilis? What are the signs of syphilis? How does my doctor know I have syphilis? How did I get syphilis? Should I tell my sex partner I have syphilis? What is the treatment for syphilis? How will I know my syphilis has been cured? Most health insurance will cover it, with a possible copay depending on your plan.
You should abstain from sexual contact until your treatment is completed and blood tests have confirmed that the infection is cured. Your doctor may also recommend that you be tested for HIV , since having syphilis puts you at increased risk for this infection.
If you've been infected for less than a year, a single injection of penicillin G benzathine can halt the progression of syphilis. If you've had the disease for more than a year, you may need additional doses. But even late-stage, or tertiary, syphilis can be treated, although penicillin cannot reverse any organ damage that has been caused by syphilis.
If neurosyphilis — syphilis affecting the brain or spinal cord — is diagnosed, an intensive regimen of penicillin lasting 10 to 14 days is necessary, and it may need to be repeated in some individuals. If you're allergic to penicillin , your doctor will suggest another antibiotic, but penicillin is the only recommended treatment for pregnant women with syphilis.
While penicillin is the drug of choice for syphilis, other antibiotics may be used in nonpregnant individuals who are allergic to penicillin. The CDC recommends that penicillin-allergic patients be treated in consultation with an infectious disease specialist. Alternatives to penicillin include the following:. Due to shared transmission route and risk factors, coinfection with syphilis and human immunodeficiency virus HIV is not uncommon [ 3 ].
In the United States, the coinfection rate is particularly high among men who have sex with men, with the reported rate ranging from Few studies have evaluated the response to treatment of syphilis in HIV-infected patients [ 4 , 5 ]. They suggest that patients with HIV have a slower decrease in RPR titer after treatment and that they may progress to neurosyphilis in earlier stages. This led to speculation regarding the need to treat early syphilis with an increased total dose of penicillin [ 6 ].
This recommendation has remained unchanged in the last several guideline cycles. The evidence for it is mainly based on the result of 1 prospective randomized trial, which did not find a significant difference in the clinical response between patients treated with 2.
However, of patients enrolled in that study, only To our knowledge, there have been no randomized controlled trials comparing the efficacy of a single dose of BPG with that of 3 doses of BPG administered at 1-week intervals for early syphilis in HIV-infected patients. The results of observational studies have been conflicting.
In a single-center study, we reported higher rates of treatment failure among HIV-infected patients treated with 2. We carried out a randomized controlled trial to compare the efficacy of 3-dose vs single-dose regimens of intramuscular BPG for the treatment of early syphilis in HIV-infected patients. Patients with compatible genital, anal, or oropharyngeal ulcers were classified as having primary syphilis. Full physical examination was performed by a licensed clinician physician or physician assistant with special attention to signs of primary and secondary syphilis, including evaluation of regional lymph nodes.
Patients were classified to have secondary syphilis if they had cutaneous rash or mucosal lesions. Exclusion criteria were history of penicillin allergy, diagnosis of late latent syphilis, and antibiotic use with significant activity against Treponema pallidum including macrolides, tetracyclines, and cephalosporins within the preceding 2 weeks. After obtaining written informed consent, we randomly assigned patients to either a single intramuscular injection of 2.
Simple randomization was performed using a random number table. All injections were given by a trained nurse at study sites. Performance of lumbar punctures was not a study procedure but could be ordered at the discretion of the treating physician.
Patients were interviewed about symptoms, interval sexual activity, and interval antibiotic exposure at the initial visit and at each follow-up visit at 3, 6, 9, and 12 months. Serum samples were also obtained at initial visit and each follow-up visit for serological testing for syphilis. Other pertinent laboratory results were collected at each visit. Both intention-to-treat and per-protocol analyses were performed. The intention-to-treat analysis included all participants who underwent randomization.
For patients with missing data, we assumed that these patients have failed treatment. For the per-protocol analysis, we excluded patients who were lost to follow-up 5 patients and those who received extra doses of BPG in the standard therapy group 1 patient. Sample size calculations were based on a 2-tailed, 2-sample comparison of proportions with a type 1 error of 0.
With these parameters, the required sample size in each group was 59 subjects total subjects. We used conventional measurements of central location and dispersion to describe the data. From June through April , patients were screened; of those, 64 patients were included in the study Figure 1.
Among included patients, 35 were randomized to standard therapy with a single dose of BPG and 29 to enhanced therapy with 3 doses of BPG. The baseline characteristics of subjects in both groups are shown in Table 1. The mean age of study participants was 35 years. The median RPR titer was interquartile range, — There were no statistically significant differences in any of the baseline characteristics between the standard therapy group and the enhanced therapy group.
Study flowchart. Data are presented as No. There was a significant decrease in RPR geometric mean titers by the end of follow-up 12 months in both treatment groups Figure 3. Intention-to-treat and per-protocol analyses of the comparison between a single dose vs 3 doses of 2. Abbreviation: BPG, benzathine penicillin G.
Rapid plasma reagin RPR geometric mean titers and standard deviations in standard and enhanced therapy groups at different time points. The 2 patients who did not respond to a single dose of BPG had RPR titers of 4 and 32, respectively, at baseline and 2 and 16, respectively, at the month follow-up. This patient received a single dose of intramuscular benzathine penicillin.
Six of them had received single-dose benzathine penicillin and the remaining 2 received the 3-dose regimen. None of the participants in our study developed neurologic symptoms during the month follow-up period.
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