Syphilis (Lues)

Explanation

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. A characteristic of the disease is that it progresses in stages over many years. The rate of new cases per year in Germany (2014) is about 7 / 100,000 inhabitants.

Transmission and symptoms

Transmission occurs from person to person through direct contact of the mucous membranes. The typical feature is the progression in stages:

• Primary syphilis:
  After an incubation period of about 3 weeks (10 - 90 days), a tough ulcer known as a "hard chancre" develops at the entry point of the pathogens, i.e. typically in the genital area. About half of all patients have no memory of this primary manifestation when looking back.
• Secondary syphilis:
  After about 6 - 12 weeks, general symptoms such as headaches and aching limbs, generalised swelling of the lymph nodes and a skin rash that mostly occurs on the trunk appears. This develops into nodules (condylomata lata), which can burst open and are highly infectious. In the area of the skin and mucous membranes, many different manifestations can occur, which are easily confused with other skin diseases. Other organs such as the joints or the central nervous system can also be affected.
• Latency stage:
  The symptoms of secondary syphilis can subside even if left untreated and are not externally visible. This is called the latency stage.
• Tertiary stage:
  After 3 - 5 years the pathogens have spread throughout the body and attacked the internal organs. Typical are rubbery nodules and ulcers in various places, which increase in size and locally destroy the tissue. Depending on their localisation, corresponding complications can occur. A typical manifestation is, for example, the occurrence of a bulge in the aorta as a result of nodules in the vessel wall, which can lead to life-threatening bleeding when they burst open.
• Neurosyphilis:
  The infestation of the nervous system only occurs after 10 – 20 years and is accompanied by severe symptoms. These include dementia, personality changes, gait, speech and coordination disorders, blindness and generalized paralysis.

Diagnosis

Identification of the disease can be done by direct detection from a smear (technically very difficult) but mostly takes place through the detection of antibodies in the blood. It is not yet possible to cultivate the pathogens on culture media.

Therapy

Since no resistant pathogens have yet been detected, the therapy of choice is classical penicillin. It is administered as an injection into the muscle (i.m.) in order to maintain a constant effective level in the blood over a longish period of time. In the early stages, a single administration is sufficient, but in the more advanced stages, treatment should be carried out for several weeks.