WHAT IS SYPHILIS?
It is sexually transmitted infection caused by the bacteria Treponema pallidium.

Patchy hairloss secondary syphilis

Charcot's joints in tertiary syphilis

Syphilitic chancre

White patches on tongue secondary syphilis

Neonatal syphilis

Patchy hairloss secondary syphilis

HOW DOES ONE GET SYPHILIS?

• Unprotected sexual intercourse with an infected person (vaginal, anal, oral)
  
• Mother-to-child (transplacental infection)
  
• Blood transfusion with contaminated blood products (all blood donations are screened in Singapore)
  
• Contaminated needle stick injury and sharing intravenous needles with an infected person

WHAT ARE THE STAGES OF SYPHILIS?
Syphilis is divided into:

A) Primary Syphilis

• Occurring from 9 to 90 days following infection
  
• Presents as a painless sore (called a chancre) usually on the penis, vulva or cervix

B) Secondary Syphilis

• Occurring a few weeks to up to 2 years after primary syphilis
  
• Presents with non-itchy rash, especially on palms and soles
  
• Lymph node enlargement
  
• Wart-like growths on the genitals and anus
  
• Other signs include hair-loss, mouth ulcers, liver and brain inflammation

C) Latent Syphilis

• No symptoms but the internal organs may continue to be affected by the disease
  
• Early latent syphilis - < 1 year after infection
  
• Late latent syphilis - > 1 year after infection

D) Tertiary Syphilis

• Occurring 5 to 30 years after secondary stage
  
• Presents with irreversible damage to vital organs such as brain (causing insanity) blood vessels and heart (causing heart failure), nerve fibres and spinal cord (causing numbness and paralysis)

E) Congenital Syphilis

• Bone deformities
  
• Blindness
  
• Deafness
  
• Deformed facies
  
• Dental deformities
  
• Skin rashes
  
• Neonatal death

HOW IS SYPHILIS DIAGNOSED?

• Positive blood test (4 to 6 weeks after exposure) called the VDRL or RPR test (screening test)
  
• This has to be confirmed by a positive TPHA (confirmatory test)
  
• Secretions from the chancre or skin lesions in the secondary stage examined under dark-ground microscopy may reveal the bacteria

WHAT IS THE TREATMENT FOR SYPHILIS?

• Penicillin by injection is the best treatment
  
• Alternative antibiotics are available for patients who are allergic to penicillin
  
• In primary, secondary and latent syphilis adequate treatment will result in a complete cure
  
• In tertiary and congenital syphilis treatment can stop the progress of the disease but may not be able to restore full function or reverse permanent damage

WHAT SHOULD I DO?

• Seek medical treatment as soon as possible if you suspect you may be infected
  
• Inform your doctor of any drug allergy
  
• Refrain from sexual intercourse until you have completed treatment
  
• Go for repeat blood tests till your doctor confirms that you are cured
  
• Do not donate blood
  
• Ensure that your sexual partner(s) come for a check-up so that he/she can be treated early if found to be infected
  
• Reinfections can occur as there is no permanent immunity conferred by a previous infection

KEY FACTS

• Early detection and treatment ensures complete cure
  
• Remember to inform your examining physician if you have been treated for syphilis in the past
  
• Always practise safer sex with casual partners and prostitutes (sex workers)

WHAT IS SAFER SEX?

• This is sex without the exchange of body fluids, e.g. vaginal secretions or semen during sex
  
• Use condoms correctly and every time you have sex
  
• Do not consume alcohol before or during sex, this may impair your judgement