Syphilis Information Leaflet

Transcription

1 Syphilis Information Leaflet Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit

2 Syphilis information leaflet Syphilis is a sexually transmitted infection (STI) that can have serious long term complications if left untreated. It can be treated completely when treated as early as possible. We will provide effective treatment as soon as it is diagnosed. What is syphilis? Syphilis is caused by a bacterium called Treponema pallidum (T. pallidum). This is a spirochete (looks like corkscrew under the microscope) that can only infect humans. Spirochetes are a form of highly evolved bacteria. How is syphilis spread? Like other STIs, syphilis can be transmitted during sex. Any type of sex with someone infected with syphilis can cause transmission of infection. This includes oral sex. Syphilis can be transmitted from a mother to her foetus during pregnancy. Syphilis is particularly infectious if left untreated in the first two years of infection. For this reason, anyone with syphilis should inform their partner(s) within the past two years that they should also be tested. How does syphilis present? Syphilis can cause lifelong infection when untreated. A person infected with syphilis remains mostly well during an average of 21 days, ranging between 10 and 90 days after infection. One or more ulcers at the site of infection normally develop after that period. This is generally on genital, pubic, or anal skin, on the lips, or inside the mouth. The ulcer can look quite large. It is typically round, firm and painless. Without treatment, it resolves without any scar after an 2 PI/1527 Syphilis Information Leaflet

3 average of four to six weeks. The ulcer is called chancre and highlights primary syphilis. After resolution of the chancre, the untreated individual can be without any symptoms for an average of six weeks. The infection however will be spreading to the other parts of their body during this period. If untreated, the secondary stage of syphilis begins. During this stage, syphilis mostly presents as a skin rash that can affect the entire body. Typically it can affect the palms of the hands or soles of the feet. At this stage syphilis can also present with fever, swollen glands, sore throat, weight loss, headache, muscle ache, fatigue, painful and irritable eyes with loss of vision on occasions, or patchy loss of hair of the head, eyebrow, or any other part of the body. Without treatment, all the symptoms of secondary syphilis will resolve. The first two years of infection are considered as early syphilis. It is important to note that some individuals with early syphilis may not have any symptoms. Irrespective of presence or absence of symptoms, untreated individuals can easily transmit the infection to their sexual partners during early syphilis. After the first two years, untreated infection will become latent. During latent syphilis, an infected person remains asymptomatic. Between 10 and 30 years later, some of the infected individuals develop symptoms of late syphilis. Late syphilis manifests in the brain and nerves, heart and major arteries, skin or bone. People with late syphilis may present with difficulty in coordinating movement, inability to move certain muscles, blindness, numbness and memory loss. Syphilis at the late stage can cause damage to internal organs (heart, aorta, liver, skeletal bones) that can lead to death. Syphilis can affect the central nervous system (brain and spinal cord) at any stage. It can cause many symptoms such as: headache, numbness, muscle weakness, altered behaviour PI/1527 Syphilis Information Leaflet 3

4 and movement problems. These manifestations of syphilis are collectively known as neurosyphilis. Syphilis can also affect eyes, causing red eyes, sensitivity to light and blurred vision, among other symptoms. This can result in loss or sight so urgent referral to an eye specialist in addition to treatment for syphilis will be required. Women diagnosed with syphilis during pregnancy must be treated as soon as possible. Although the risk of miscarriage, premature labour, stillbirth or delivery of a baby with syphilis infection is reduced by treatment it cannot always prevent complications. The baby may require treatment after birth. Syphilis and HIV Many people infected with HIV and syphilis will develop symptoms that are different from those described above. For example, HIV infected individuals with syphilis may present with pale skin rashes or have more pronounced neurological manifestations at an earlier stage of infection. Syphilis in HIV infected individuals can progress rapidly that results in development of some presentations of syphilis at earlier than expected stages of infection. Syphilis significantly increases the chances of catching HIV. It has been estimated that HIV transmission can increase fivefold when one sexual partner has syphilis. Unless the person already has HIV, it is important that all people infected with syphilis are tested for HIV. HIV infected individuals who acquire syphilis from each other are also at a possible risk of passing antiretroviral resistant HIV infection to each other too. This is especially important for those not on HIV treatment or not taking antiretroviral drugs regularly. 4 PI/1527 Syphilis Information Leaflet

5 How is syphilis diagnosed? Diagnosis of syphilis relies on the detection of human antibody responses to treponemal infection. A human s immune system develops antibodies against syphilis, however the antibodies are not able to stop the infection. Testing for syphilis relies on searching for these antibodies in blood samples. The procedure is complicated and requires laboratory equipment in most cases. We can send a blood sample for testing with a result available within a few days. Because syphilis tests may not be able to detect very early infection, having a negative syphilis test within four weeks after sex may not exclude the infection. Diagnosis of neurosyphilis is complicated and requires measurement of treponemal antibodies in the blood and in cerebrospinal fluid (the fluid surrounding the brain and spinal column). When suspected, Doctors may advise a lumbar puncture for obtaining a sample of cerebrospinal fluid for syphilis testing. What to do after possible exposure to syphilis? Because of the ease of syphilis transmission and the difficulty for its diagnosis, it is important to check yourself for syphilis often. At the HIV department at UHB, we routinely test every one of our patients for syphilis at least three times a year. You could have been exposed to syphilis if your partner(s) in the past two years have been diagnosed with the infection. In that case please immediately attend Whittall Street Clinic ( birminghamsexualhealth.co.uk/), or our department, for STI screening and syphilis treatment if required. Because it can take up to 3 months to develop antibodies against syphilis, a negative syphilis test early after exposure (having sex with an infected partner) may not exclude infection. In that case, a repeat syphilis test should be considered. Our nurses and health advisers can provide more information on the follow-up plan. PI/1527 Syphilis Information Leaflet 5

6 Treatment Syphilis can be cured when treated early with antibiotics. The sooner syphilis is treated, the more likely it will be eradicated from the body. Penicillin is the best antibiotic for treatment of syphilis. It is important that you should inform the doctor/nurse if you are allergic to penicillin. Treatment and cure of early syphilis (within the first two years of infection) can be achieved by a single dose of benzathine penicillin G. The dose contains 2.4 million units of penicillin and is administered as an injection into the buttocks. Late syphilis (infection for longer than two years) requires weekly injections of benzathine penicillin for three weeks. The course has to be restarted when there is a delay greater than seven days between the doses. Please make sure that you book the appointments for your next treatments before leaving the clinic. Treatment of neurosyphilis requires daily injections of another form of penicillin for two to three weeks. Your doctor will discuss the exact duration and follow up plan with you. People who are allergic to penicillin can be treated with alternative antibiotics that, depending on the stage of syphilis, should be taken between two and four weeks. Data to support the effectiveness of antibiotics other than penicillin for treatment of syphilis are limited. Individuals treated for early syphilis should abstain from sex until they no longer show symptoms. All individuals infected with early syphilis should inform their partner(s) in the past two years to be tested and treated for syphilis. 6 PI/1527 Syphilis Information Leaflet

7 Jarisch-Herxheimer reaction Following syphilis treatment, some people may feel unwell with fever, chills, muscle pain (including pain in the injection site) and joint pain. This is called Jarisch-Herxheimer reaction and can be managed with paracetamol or ibuprofen. The symptoms normally resolve after 24 hours. It is important to inform your doctor if you become unwell after receiving penicillin injections. Can syphilis recur? Syphilis does not recur after successful treatment. Becoming infected with syphilis does not protect against future infections. Individuals can become re-infected after successful treatment of syphilis. Prevention of syphilis Correct and regular use of latex condoms reduces the risk of transmission of syphilis. Condoms do offer some protection but may not provide a barrier over all the area which is infectious. Regular screening for syphilis is the most reliable method of early detection of infection. This is routinely carried out with in the HIV department at UHB. PI/1527 Syphilis Information Leaflet 7

8 Please use the space below to write down any questions you may have and bring this with you to your next appointment. The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit or call HIV/GU Medicine Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Telephone: PI14/1527/01 Author: Heather Bowen and Kaveh Manavi Date: April 2015 Review date: March 2017