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Syphilis - tertiary

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Contents of this page:

Illustrations

Late-stage syphilis
Late-stage syphilis
Antibodies
Antibodies

Alternative names    Return to top

Late syphilis; Tertiary syphilis

Definition    Return to top

Tertiary syphilis is a late phase of the sexually transmitted disease syphilis, caused by the spirochete Treponema pallidum.

Causes, incidence, and risk factors    Return to top

Tertiary syphilis can follow the initial infection, primary syphilis, by 3 to 15 years. Secondary syphilis is the stage that precedes tertiary syphilis if primary syphilis is not treated.

In tertiary syphilis, the spirochetes have continued to reproduce for years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

Lesions in the central nervous system produce neurological disease called neurosyphilis which can include tabes dorsalis, general paresis, and optic atrophy. Lesions of the heart, heart valves and aorta can lead to aneurysms, valvular heart disease, and aortitis.

Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment. The incidence of tertiary syphilis is approximately 5 per 100,000 individuals annually in the US.

Symptoms    Return to top

Symptoms of tertiary syphilis depend on which organ systems have been affected. They vary widely and are difficult to diagnose. In individuals with tertiary syphilis the primary and secondary stages of syphilis usually have been long forgotten. Medical findings of aortic aneurysms and neurological problems require astute diagnostic ability to link them to syphilis. Some of the symptomatic problems are listed below.

Signs and tests    Return to top

Treatment    Return to top

The treatment of syphilis is determined by the length of time the person has been infected. Primary, secondary, and latent syphilis of less than 1 year duration is treated as follows: For treatment of syphilis of greater than 1 year duration : For treatment of neurosyphilis:

To treat syphilis during pregnancy:

Penicillin is recommended as the only drug of choice. Tetracycline cannot be used because of toxicity to the fetus, and erythromycin may fail to prevent congenital syphilis in the fetus. Penicillin-allergic individuals should be desensitized and then treated with penicillin.

Several hours following treatment of early stages of syphilis, some individuals may undergo a febrile reaction called Jarisch-Herxheimer reaction. This is thought to be caused by the release into the circulation of material from dead or dying spirochetes. Symptoms of this reaction include:

These symptoms usually disappear within 24 hours.

Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure that the infection has been eliminated.

Individuals with primary or secondary syphilis should abstain from sex until they have been treated. Syphilis is extremely contagious in the primary and secondary stages.

Expectations (prognosis)    Return to top

Late syphilis may be permanently disabling and may lead to death.

Complications    Return to top

Calling your health care provider    Return to top

Untreated syphilis can result in serious health problems. It is imperative that you inform your physician of the possibility of having had syphilis previously, even if it was many years ago.

Prevention    Return to top

People who have multiple or unknown sex partners or partners who are involved in any high-risk sexual practices are at risk for acquiring sexually transmitted diseases (STDs). Individuals who recognize that they are at risk have taken the first step toward prevention.

Total abstinence is the only way to completely avoid the possibility of infection with a sexually transmitted disease. Monogamous sex with a healthy partner is lower risk, and protected sex using condoms also dramatically reduces risk. Condoms act as a barrier to the transmission of infectious organisms (pathogens) and should be used in any and all situations that could be considered risky.

Syphilis is a reportable disease. The infection must be reported by health care professionals to public health authorities. Information acquired from reporting helps public health investigators identify, locate, and treat infected sexual contacts, which helps prevent continued spread of disease.

Update Date: 7/14/2004

Updated by: Daniel Levy, M.D., Ph.D., Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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