Ice cream–just love it! But I don’t eat a whole lot of it for health reasons. Skiing-exhilarating ! Well, until I tore my ACL and had surgery because a stupid snowman pushed me (I’m sticking with this story). TV-entertaining ! Though after a while I feel like my IQ drops 100 points, and I feel like a sloth.

For every yin there’s a yang, for every rainstorm there’s a flower, for every Marco there’s a Polo … you get the point. With sex there can also be consequences: broken hearts, nasty gossip, and sexually transmitted diseases (STD).

One particularly nasty STD, syphilis, is on the rise, according to the Virginia Department of Health. Between 2003-2007 in Virginia alone, the number of syphilis cases has increased a whopping 160 percent, in particular in men who have sex with men.

Syphilis is a sexually transmitted disease (with the exception of a pregnant mother infecting her fetus) dating back over 500 years that infected many famous people in history. It’s caused by Treponema pallidum–a spiral shaped, moving bacterium. Left untreated, this bad boy can cause lifelong medical problems.

There are three stages. After exposure to the bacterium, the incubation period is 10-90 days (average is three weeks). In primary syphilis, a chancre (pronounced shan-ker) appears at the site of infection and usually heals in a few weeks. It’s a painless ulcer that feels somewhat hardened.

Most men who find one on their penis run to the doctor faster than Marion Jones on steroids to the finish line. But some dudes don’t really pay attention to their body parts, and since it doesn’t hurt, they never notice it. Or if they’re in denial (like politicians believing no one will ever find out about their visits to ladies of the night), they ignore the chancre. “Nay, it’s just a flesh wound” as Monty Python might say.

However, when the chancre occurs in the mouth, throat, vagina, or anus, it can go unnoticed. So I guess you could say syphilis is also a kissing disease because you can get it that way.

Secondary syphilis, which rears its ugly head weeks to months later, occurs in 25 percent of untreated people. Syphilis is called “the great mimicker” because of the similarity of symptoms to other diseases: rash (especially on the hands and feet), canker sores, swollen lymph nodes, fever, headache, hair loss, just not feeling well, loss of appetite. Hmm, kind of like how I feel about certain American Idol contestants. Left untreated, it can spontaneously go away but then pop up later-up to five years later!

Tertiary syphilis occurs in 25 percent of untreated people, and it can infect any organ: brain, heart, skin, stomach. Neurosyphilis, which can cause dementia, weakness, and sensory problems, can be a challenge to treat. Tertiary syphilis can be deadly.

You can’t culture T. pallidum, but it can be seen on dark field microscopy in primary and secondary syphilis. So diagnosis is usually made with a blood test (for neurosyphilis, cerebral spinal fluid is evaluated). However, it can take up to 10 weeks for a positive reading, so what should be done if someone is exposed to syphilis?

A shot of benzathine penicillin G may be effective, although more than one dose might be required depending on certain factors. For those who get help within 90 days of exposure, treatment is recommended by the Health Department.

Those who are sexually active outside an exclusive sexual relationship, or for those who have just entered a new relationship, had better not throw caution to the wind. It’s better to be safe than sorry. Vital info available at cdc.gov/std/treatment/2006/rr5511.pdf

© Dr. John Hong, Inc

Notes: Syphilis: a historically well-known infection caused by Treponema pallidum – a spirochete which is a spiral shaped, moving bacteria. Many leaders have been infected by this bug through the centuries. The cases were going down but March 12, 2008 the Virginia Department of Health announced a 160% increase in syphilis cases from 2003-2007. Left untreated, it can be lifelong disease with many medical consequences.

Contagious: it is sexually transmitted or pregnancy from mother to fetus. STD – about 30% transmission rate. T. pallidum is open and available in chancre (painless ulcer on infected site such as penis, vulva, vagina, mouth) or in other lesions seen in secondary syphilis. Incubation 10-90 days.

3 stages of syphilis. Primary: in men chancre heals usually in few weeks. Many people don’t notice them. Secondary: occurs in 25% of those not treated, and rears its ugly head weeks to months later. This is the great mimicker of many other diseases because presents with all sorts of symptoms such as: rash, lymph node swelling, fever, headache, not feeling well, and loss of appetite. Rash most common to hands and feet. Mouth looks like huge aphthous ulcers. Left untreated, usually goes away, though can pop back up again up to 5 years later.
Tertiary syphilis: about 25% of untreated folks. Can infect any organ. Most common is neurosyphilis (which can cause mental problems, weakness, sensory problems), cardiovascular diseases, and gummatous syphilis (nodules like on skin and bones)
Latent syphilis: blood testing positive for syphilis but no active symptoms. If it is early latent syphilis (infection occurred in past year), they are contagious. If late latent syphilis (occurred more than a year prior), probably not contagious but probably more resistant strain of T. pallidum.

Diagnosis: not made by culturing T. pallidum because can’t be grown. Blood testing is most common, though if there is an active infection, the bug can be seen on darkfield microscopy (in primary and secondary syphilis). DFA-TP and PCR are alternative methods.
For blood tests, VDRL and RPR are nontreponemal tests, and RPR can stay positive up to life after syphilis is treated. Treponemal tests: FTA-ABS, MHA-TP, and TPPA. RPR is probably the most commonly checked. But know false positives are common, so might need to do more than one test. So if RPR is positive, an FTA-ABS is usually checked to confirm. Also the titer level of the RPR needs to be noted.
20-30% have false negative tests because it takes time for the antibodies to T. pallidum to develop. Might take 10 wks before test will show up positive.

Treatment: benzathine penicillin is drug of choice, and duration of treatment depends on primary, secondary, or tertiary. Doxycycline is used in persons allergic to penicillin.

This entry was posted on Thursday, May 1st, 2008 at 12:36 pm and is filed under Sex Issues, Infections, Gay Lesbian. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.