Primary Syphilis

Key Points
Condition is the first stage of a sexually transmitted bacterial infection resulting in a painless sore in the mouth, anus or vagina.
If the sore leads to rash or flu-like symptoms, this is indicative of the secondary stage of Syphilis.
Condition typically affects sexually active men and women between the ages of 15-34, but can be transmitted through bad transfusions or placenta to an unborn child.

Syphilis is a sexually transmitted infection caused by the bacteria treponema pallidum. The disease fluctuates between active periods and latent periods where the patient remains infected without signs or symptoms. Initially, Syphilis appears as a painless sore (ulcer) where the infection entered — either the mouth or more frequently the genitals, and may go unnoticed. The sore is known as a chancre, and this phase of the infection is known as primary syphilis. The sore typically heals within 4-8 weeks. It may go unnoticed because it is inside the vagina or anus. If the patient experiences widespread rash and flu-like symptoms, this can potentially by secondary Syphilis, which left untreated can develop into tertiary syphilis and cause a variety of problems.

Sexually active people may be at risk of syphilis. It is passed from person to person through direct contact with syphilis ulcers. These are most commonly on the genitals and anal area but may also be found on the lips or mouth. Hence, vaginal, anal or oral sex is the main way of passing the infection from one individual to another. Syphilis can also be passed on through bad fluid transfusions, if donors are not screened, or the placenta to an unborn baby. Men and women are equally at risk of syphilis. The peak incidence arises between the age of 15 and 34 years.

Differential Diagnosis (Other conditions with similar appearance)
Chancroid
Drug eruptions
Erythema multiforme
Herpes simplex
Leprosy
Lymphogranuloma venereum
Pityriasis rosea
Pityriasis rubra pilaris
Rubella
Sarcoidosis
Scabies
Tinea Corporis

Diagnosis
Key Points
Tissue or tissue fluid examinations of the chancres can detect primary syphilis.
Genital infection can increase the risk of HIV.

Syphilis can be detected during the early stages by a tissue or tissue fluid examination of the primary chancres (ulcers). Syphilis of the genitals can increase the risk of HIV, so HIV testing should also be performed.

Treatment
Key Points
Penicillin by injection is the most effective treatment for all types of syphilis.
*Treatment can fail at any stage, so follow-ups and abstaining from sexual activity are important until symptoms clear.

Penicillin by injection is still the best and most effective treatment for all stages of Syphilis. Other Antibiotics such as tetracyclines, erythromycin, or cephalosporins may be used in those allergic to penicillin. Treatment can fail at any stage, so follow-up for one or two years is important to prevent tertiary syphilis. All sexual activity should be refrained from until all sores and lesions are completely healed. Syphilis can be prevented by limiting the number of sexual partners, using condoms, and immediately informing partners if you suspect an outbreak so testing and treatment can begin.