Treatment of Syphilis
Treatment of Syphilis
Syphilis is a highly contagious chronic sexually transmitted disease. Its course comprises three stages, ranging up to several decades. Untreated or inadequately treated syphilis may be in the late stage the cause of death or disability of the infected person. Syphilis is subject to mandatory reporting, which means that the diagnosing doctor must communicate this information to the local health department. All sexual contacts of the patient must be found and tested to exclude the infection. Treatment of syphilis should be guided by a dermatovenerologist, which is a branch of medicine specializing in skin and venereal diseases. The basis of syphilis treatment is penicillin administration; it is effective in all stages of the disease. Penicillin was introduced into the treatment as early as 1943 and no better treatment has been found since. However, it is very important to start treatment as early as possible.
Syphilis, or lues, as already mentioned in the introduction, is a highly contagious sexually transmitted disease that is caused by the bacterium Treponema pallidum. Treponema pallidum enters the body most of the time during sexual intercourse. Thus, the gateway most often is skin or mucous membrane of the genital area or the mouth. The disease has several different stages and can affect any tissue or organ in the body. Syphilis at the beginning manifests by various non-specific symptoms so that it can mimic various other diseases; later the symptoms and course of the disease become unambiguous. The primary stage consists of hard painless chancre in the genital area, on the penis or vulva, or around the anus. In the secondary stage, the bacteria spread through the entire body. Generally, the secondary stage is characterized by varied changes in the skin and mucous membranes. There may be a rash all over the body, different types of "pimples" that do not hurt or itch and often occur in groups, sometimes condylomata lata can be present. The patients usually suffer increased fatigue, headache, fever, sore throat, joint pain or disorders of hair growth. In the tertiary stage, damage to several organs is already present. Mostly brain and spinal cord damage finally leads to the death of the infected person. For the tertiary stage of syphilis, formations under the skin called gummas are also typical. Gummas contain yellowish liquid, the covering skin is red and decays over time. After healing of a gumma, a smooth white scar remains. Only early detection and early treatment of syphilis can be successful.
Treatment of Syphilis
The treatment of syphilis is best performed during stay in a hospital because of the infectious nature of the disease and possible complications. A penicillin antibiotic is administered, usually intravenous Penicillin G 4-6 times a day. Intravenous administration is always better than tablets due to variable drug absorption from the gastrointestinal tract. Early stages of syphilis are usually treated 15 days with antibiotics, in late stages of syphilis the treatment may be prolonged to 21 days. Alternative antibiotics in the case of allergy to penicillin are macrolides or doxycycline – the treatment lasts usually 30 days in these antibiotics, however. Pregnant women should only be treated with penicillin as therapy with the other drugs is not safe during pregnancy; penicillin is not toxic and does not harm the fetus during its development. If a pregnant woman is allergic to penicillin, it should be replaced by erythromycin. Prior to this replacement, penicillin allergy should be verified by serologic and skin tests. Allergic reaction to antibiotics is often confused with children's febrile infections with rash, during which concurrently penicillin is given to the little patient. Therefore, not everybody who believes he/she is allergic to penicillin must really suffer from this allergy.
Every treatment has a certain risk of complications. In the case of syphilis treatment, treatment complications usually occur in the first 24 hours. In up to 25% of complications it is so-called Jarisch-Herxheimer reaction, which is manifested by fever, increased heart rate, sweating, headache, muscle pain, or collapse. Generally, this reaction is generated by release of toxic products of necrotic bacteria. This complication is quite frequent and can be quite easily managed by short-term administration of corticosteroids.
Treatment of Syphilis and Removal from the Register of Patients
Every patient must be regularly serologically checked-up for at least 2 years after treatment of syphilis. The patient stays in the care of the Department of Dermatovenerology where the treatment was guided. Alongside with serological tests other examinations are performed, too – heart and lung X-ray, echocardiography of the aorta, neurological and psychiatric examination, ocular and cerebrospinal fluid examination. If all the results are negative, after 2 years the patient can be removed from the register of syphilitic patients. Otherwise, the patient is regularly monitored every 5 years for another 20 years.
Refusal of Syphilis Treatment
Every patient diagnosed with syphilis is in most countries legally obliged to undergo treatment. If he/she does refuse, it might be classified as a criminal offence. Any case, the treatment is simple and effective and the outcome of untreated syphilis is usually fatal.