Syphilis: The Great Imitator
Background
Syphilis is known as "the great imitator" because its early symptoms are similar to those of many other diseases. Sexually active individuals should consult a doctor about any suspicious rash or sore in the genital, rectal, or oral areas. Those who have been tested and/or treated for other STDs, such as gonorrhea or chlamydia, should also be tested for syphilis.
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually by disrupting barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of, and susceptibility to, HIV.
Men who have sex with men (MSM) and bi-sexual males who use the Internet to arrange sexual liaisons with other men should be tested regularly for STDs, including syphilis and HIV. The Pennsylvania Department of Health (DOH) has reported an increase in infectious syphilis rates, most notably among this population.
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Symptoms
All patients presenting with any of the following symptoms should be immediately tested for syphilis:
- A macular and/or papular rash on the palms of the hands or on the soles of the feet
- A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
- A lesion in the genital, rectal, or oral area
- Moist papules in the anogenital region or the mouth
- Sudden “moth-eaten” scalp alopecia with a typical onset at the back of the head
- Loss of eyelashes and the lateral third of the eyebrows
- Generalized lymphadenopathy
- Malaise
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Follow-up and treatment
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Patients who have primary, secondary or early latent syphilis should be treated with the following regime:
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Persons who were exposed within 90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sex partner might be infected even if seronegative; therefore, they should be both tested and presumptively treated with the following regime:
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Patients should be advised of the importance to abstain from all sexual activity until their sex partner (s) have been evaluated.
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If serologic test results are not immediately available, and the opportunity for follow-up is uncertain, persons who were exposed more than 90 days prior to the diagnosis of primary, secondary, or early latent syphilis in a sex partner should be prophylactically treated with Benzathine penicillin G 2.4 million units IM in a single dose.
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Patients presenting with a rash or sore in the genital, rectal, or oral area need to be tested for syphilis. If the person is considered to be at high risk, presumptive treatment with Benzathine penicillin G 2.4 million units IM in a single dose should be considered.
To report a suspect case:
DOH is requesting that all suspected or confirmed syphilis be immediately reported to the department through the standard Suspected Case Notification form, or by telephone (8:00 AM-5:00 PM) at (717) 787-3981 or toll free at 1-877-PA-HEALTH.
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Complications
If left untreated, individuals infected with syphilis may go on to develop:
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Syphilitic meningitis
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Paresis
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Tabes dorsalis
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Disabling lesions of the aorta
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Gummas of the skin, viscera and bone
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Damage to the central nervous system
Signs and symptoms of the late stage of syphilis include:
This damage may be serious enough to cause death.
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Links
For follow-up and treatment materials, see the DOH's STD program website or call (717) 787-3981.
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Last Updated: 10/30/2007