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Syphilis is a contagious disease caused by a micro-organism called Treponema pallidum. It is different from most other sexually transmitted diseases in that the symptoms can subside in its early stages, but the disease will continue to develop with long periods which are symptom less until the progress of the disease has run a course which might ultimately involve damage to the brain, the nervous system and the cardiovascular system.

The development of this disease is normally described as stages, i.e. primary, secondary and late or tertiary. It is highly contagious and can be transmitted by sexual contact including orogenital and anorectal, and occasionally by kissing or close body contact.

It can affect any tissue or vascular organ in the body and be passed from mother to foetus (congenital syphilis). The infecting organism enters the body through the mucous membranes or skin. Within hours the organisms have traveled to the lymph nodes and from there rapidly disperse through out the body.

The incubation period can vary from 1-13 weeks, but is usually between 3-4 weeks. The primary stage usually involves the appearance of a painless ulcer at the site of where the infection enters the body. This could be the penis, urethra, vulva, anus, lips and any other part of the mouth. Often these ulcers are ignored and if left untreated this ulcer will heal over after a while but the infection remains in the body until it reappears, some weeks or months later in the form of a skin rash.

This is the beginning of the secondary stage. Again if left untreated these rashes can come and go but gradually other organs in the body are being affected. Most people affected will have skin lesions, over half will have enlarged lymph nodes and many will have a variety of disorders affecting the eyes, the kidneys, the joints, liver and spleen. There will be symptoms of tiredness, malaise, headache and aching joints.

A small number of those affected can go on to develop acute syphilitic meningitis with headache, neck stiffness and disorders affecting the cranial nerves. The late or tertiary stage can involve the development of a tumor called a Gumma, which can be found in, the liver, brain, testes, heart, bone and connective tissue.

A gumma is a localized tumor, which grows as a reaction to the ongoing infection. It causes the death of the tissue in that area which then fibroses. If the cardiovascular system is affected then aneurysms may be found in the thoracic region.

If the brain is affected various problems can occur including mental confusion, epileptic type attacks, aphasia (disorder of language affecting the ability to find the appropriate words for both speech and understanding), eye problems and even paralysis and dementia.

Diagnosis is made by testing the primary site for evidence of T.pallidum, specific serological tests are carried out to screen for antibodies or antigens related to this disease. It is sometimes difficult in later stages of Syphilis to know to test for it in the first instance as so many of the symptoms could mimic other disorders.

Treatment is always Penicillin in various doses and may need to be repeated if symptoms reappear at a later stage. Sexual partners from at least 3 months prior to the first signs of infection, must be contacted, screened and treated if need be. Sexual contact must be avoided until the treatment is complete.

Children born with congenital syphilis can demonstrate similar symptoms as seen in the adult in the early stages but can also be affected with bony abnormalities including facial, teeth anomalies, deafness, and may be mentally retarded.

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