Syphilis

had a response to the vaccine. Over the course of one’s lifetime, the antibody response diminishes but is effective in most people. The baby born to a hepatitis B positive mother will get the vaccine plus immune globulin against hepatitis B, which prevents transmission in up to 99 percent of cases.

Hepatitis B cannot be cured but there are drugs that can be used in very sick patients. Most people will clear the infection by themselves. The medications that exist will prevent replication of the virus so that the damage to the liver is diminished. Patients who already have cirrhosis can improve their situation with treatment.

SYPHILIS

Syphilis is strictly a sexually transmitted disease, although vertical transmission is possible. The bacterium Treponema pallidum is the causative agent of this infection. There are four stages to the disease, with a person going through all four stages if they are not treated early on. In the primary stage, the person develops a painless chancre, usually on or near the genitals. Figure 17 shows a primary chancre of the lip:

Figure 17.

In secondary syphilis, the patient has a rash over their entire body that involves the palms and soles of the feet. Sores can exist in the vagina or mouth as well. Latent syphilis can last for several years and involves no real symptoms. Tertiary syphilis involves neurological symptoms, soft tissue growths called gummas, and heart damage.

Primary syphilis can show itself between 3 and 90 days after contact with an infected person. Most women will have this on the cervix, while men will have chancres of the penis, anus, or rectum. Lymph nodes can also be swollen with this stage lasting between 3 and 6 weeks.

Secondary syphilis happens between four and ten weeks after the initial infection. The rash may be flat or slightly warty in appearance with many patients feeling generally unwell. Without treatment, the problem goes away after about three to six weeks.

Latent syphilis can only be determined with a blood test that proves the patient has the infection. It can last less than a year or longer than a year, depending on the person. There is still the chance of infectivity but it is less as the latency period goes on.

Tertiary syphilis can take up to 15 years to develop after the initial infection. There is gummatous syphilis with soft tissue swellings throughout the body, neurosyphilis, or cardiovascular syphilis. Those with neurosyphilis have many types of neurological symptoms with things like seizures and dementia taking the longest to develop. Cardiovascular syphilis, usually means inflammation of the aorta but it can mean other heart-related symptoms.

Congenital syphilis happens in babies, who don’t usually have symptoms at birth. The main findings are liver and spleen enlargement, rashes, fever, lung inflammation, and neurological symptoms. Babies can be born with birth defects, primarily involving abnormally-shaped teeth.

The most infective stages of syphilis are the primary and secondary stages. More than half of all cases happen in men who have sex with men, which includes oral sex. Blood products can pass on the infection but all blood products are screened for the disease. Rarely can sharing needles lead to syphilis transmission. The organisms die outside the body so fomites like surfaces are not usually the cause of the disease.