Tertiary Syphilis

Tertiary Syphilis General Information

Syphilis is the generic medical term given to a sexually transmitted disease caused by an infection with the Treponema Pallidum Pallidum spirochetal bacterium. While in most cases the disease is transmitted through sexual intercourse, there have been some cases where the disease has been transmitted congenitally – from the mother to the child at birth. Tertiary Syphilis is a stage of the general disease.

There are numerous signs and symptoms that are associated with syphilis, and before the development of serological testing it was very difficult to diagnose the disease. Many of the symptoms mimicked other diseases, causing the affection to be mistaken very often. Tertiary syphilis in particular posed great problems in placing the correct diagnose due to this situation. Untreated cases of syphilis may lead to severe heart damage, or irreversible damage to the eyes, brain, bones and major blood vessels. In some cases, the action of the bacteria upon the patient’s system can prove fatal. However, these effects can be prevented through proper treatment, and the patient may be cured.

In some cases, the disease occurred years after the initial infection. While this is not very uncommon, especially due to the fact that the disease may be manifested through asymptomatic occurrences such as brain / spinal cord fluid accumulations, it also means that the disease may cause irreversible damage before it is discovered and treated. As such, it is highly recommended that sexual hygiene and protective measures are employed, in order to prevent infection.

Tertiary Syphilis Symptoms

As noted, in many cases the Tertiary Syphilis occurs years after the initial infection occurred. Asymptomatic complications may appear over time, such as meningovascular fluid accumulations. Apart from that, the disease causes a variety of signs and symptoms which may be initially mistaken for symptoms of other affections. However, a serologic test will reveal the nature of the affection and will allow the specialized health care professional to place the correct diagnosis.

In many cases, Tertiary Syphilis may cause the appearance of tumor-like skin lesions, also called gummas. The patient may experience shortness of breath, caused by the underlining aortic insufficiency, and chest pains (angina). Seizure and headaches are also common. Balance problems on walking have been noted in patients affected by this disease as well. Cranial nerve palsies, unequal reflexes and irregular dilation of the pupils – or Argyll-Robertson pupils - may also be observed in some cases. Joint damage may be present, in an affection known as Charcot’s joint. Urinary incontinence is also common in many cases, and some patients may experience laryngeal spasms.

In many cases of Tertiary Syphilis, the patient also presents psychological disorders as well, especially when the damage extends to the brain and central nervous system. Dementia and confusion have been observed in many such cases. Psychosis is also common in such cases, as well as paresthesia. Visual problems may also appear.

Tertiary Syphilis Treatment

One of the most effective means of preventing Tertiary Syphilis is sexual abstinence. However, while this may not be a valid solution for many, using proper protection during sexual intercourse may greatly reduce the chances of infection. The bacteria are able to easily penetrate cut skin and mucosa, so proper protection (including proper placement of a latex condom) is very effective in preventing infection. Apart from protection, any person that has had sexual contact with a patient diagnosed with syphilis within the 90 days that have preceded the diagnosis should also be presumed to be infected, and should follow treatment – even in the event that test results appear negative.

While Tertiary Syphilis treatment was generally penicillin, it is still the first choice treatment in modern medicine. Under the form of Penicillin G, its positive effects were known even before the modern clinical trials had been developed. Apart from scientific proof, experience and expert opinions, which show this drug to be very effective in treating any form of syphilis, therapy with this medicine is also the only one that may be employed without risk in the cases where the patient is pregnant. Typical treatment of early syphilis consists of one dose of penicillin, and in most situations, this is sufficient to ensure the patient’s return to a normal health state.

In cases where the patients suffer from severe allergic reactions to penicillin, for example patients that are anaphylactic, treatment consists of oral Tetracycline or Doxycycline – however these therapies may only be employed in patients that are not pregnant, and the data to support these therapies is still being researched. As an alternative therapy, Ceftriaxone may be employed, but currently there are no studies that define the optimal dose of this medication. Cross reactions in patients that are allergic to penicillin, with cephalosporins (for example Ceftriaxone) are possible. Another alternative for the treatment of Tertiary Syphilis is Azithromycin, but treatment with this drug may fail due to disease resistance. However, Azythromycin therapy has been used in the past mostly on account of the easy one-time dosage – however studies performed in San Francisco have shown that from a 0% resistance in 2000, the disease achieved a 56% resistance by the year 2004.

In Tertiary Syphilis cases where follow-up and compliance cannot be ensured, it may be recommended for the patient to be desensitized with penicillin, and afterwards therapy with penicillin should be employed. This procedure should be used in all female patients that are pregnant. Follow-up to Tertiary Syphilis treatment consists of clinical evaluation of the patient within 1 to 2 weeks from the treatment. Afterwards, the patient needs to be clinically and serologically evaluated again, at 3 months intervals within the first year and then again after 2 years from the initial treatment.

In cases where Tertiary Syphilis has already extended to the brain, the patient must undergo penicillin intravenous administration for up to two weeks, coupled with intramuscular injections of Penicillin with Probenecid administered daily for the same time period. Benzathine Penicillin should also be administered under the form of intramuscular injections once a week for three weeks. In Penicillin allergic patients, Chloramphenicol, Ceftraxone or Doxycycline may be considered as alternatives. After the treatment, the patient should have a spinal tap at six months intervals to further check on his or her state, until the testing shows proper response to the treatment.