Tertiary syphilis
Key points
- Tertiary syphilis is a late phase of the sexually transmitted disease syphilis, caused by the spirochete Treponema pallidum.
- Tertiary syphilis can follow the initial infection, primary syphilis, by 3 to 15 years.
- Symptoms of tertiary syphilis depend on which organ systems have been affected.
- Treatment The treatment of syphilis is determined by the length of time the person has been infected.
Alternative names
Late syphilis; Syphilis - tertiary
Definition
Tertiary syphilis is a late phase of the sexually transmitted disease syphilis, caused by the spirochete Treponema pallidum.
Causes, incidence, and risk factors
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
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.
- Infiltrative tumors of skin, bones, or liver (gumma)
- Cardiovascular syphilis which affects the aorta and causes aneurysms or valve disease
- Central nervous system disorders (neurosyphilis)
Signs and tests
- VDRL or RPR blood tests
- Confirmatory blood tests, such as FTA-ABS (fluorescent treponemal antibody test)
- Spinal fluid examination in neurosyphilis shows signs of meningitis.
Treatment
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:
- Benzathine penicillin 2.4 million units injected into a muscle (IM) as a single dose.
Written and revised by
Gerald Hurowitz, M.D.
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