Syphilis

Disease Description (Causes and Symptoms)

• Cause: An infectious disease caused by Treponema pallidum, transmitted mainly through sexual contact and capable of vertical transmission from a pregnant woman to the fetus.
• Pathophysiology: Symptoms begin at the site of local contact and may spread throughout the body through the bloodstream. If untreated, it may pass through a latent period (early latent and late latent) and cause cardiovascular complications (such as aortic aneurysm) or neurological complications (neurosyphilis) years to decades later.
• Main symptoms:
  • Primary stage: A painless, firm ulcer (hard chancre) — usually resolves spontaneously
  • Secondary stage: Generalized rash (including the palms and soles), mucosal lesions, enlarged lymph nodes, etc. — usually resolves spontaneously
  • Latent stage: Asymptomatic (seropositive) — divided into early latent (1–2 years after infection) and late latent (thereafter)
  • Tertiary stage (late syphilis): Aortitis, cardiovascular complications, neurological damage (dementia, motor and sensory abnormalities, etc.)
• Other: Incubation period in the early stage of infection (average 21 days, range 10–90 days). The risk of cardiovascular complications has been reported in approximately 10% of cases and nervous system involvement in approximately 7% of cases.

Treatment Methods

• Diagnostic tests: If a screening test (RPR or VDRL) is positive, confirmation is performed with a treponemal test (FTA-ABS or TPHA). Cerebrospinal fluid (CSF) testing is performed when neurosyphilis is suspected. Concurrent HIV testing is recommended.
• Standard drug therapy:
  • Primary, secondary, and early latent stages (≤1 year after infection): Benzathine penicillin G (IM) 2.4 million units as a single injection
  • Late latent stage (or when the duration of infection is unknown): Benzathine penicillin G (IM) 2.4 million units once weekly for a total of 3 doses (3 weeks)
  • Neurosyphilis: Aqueous penicillin G (IV) for 10–14 days (adjusted according to the recommended dose and duration)
• Penicillin allergy:
  • In pregnant women, penicillin is the only safe treatment; therefore, if there is an allergy, treatment after penicillin desensitization is recommended.
  • In nonpregnant adults, doxycycline or tetracycline-class drugs may generally be used as alternatives, but for neurosyphilis or in pregnant women, penicillin desensitization is prioritized.
• Precautions during treatment:
  • A Jarisch–Herxheimer reaction (fever, chills, muscle aches, and temporary worsening of symptoms) may occur within 24 hours immediately after treatment and generally improves with supportive treatment.
  • Avoid sexual contact: Patients and their sexual partners should avoid sexual contact until treatment is completed and for the period recommended by the doctor (generally until lesions have healed and the specified period has elapsed).
  • Partner management: Recent sexual partners (the range varies depending on the time of infection) are recommended to undergo testing and simultaneous treatment.
  • Follow-up: The serological response after treatment (RPR/VDRL titer) is checked at 6 and 12 months (early stage), and in some cases at 24 months (late stage). Reassessment is needed if there is no treatment response or recurrence is suspected.

Pre-Outpatient Visit Checkpoints (Items to Bring and Example Questions)

• Items/information to prepare:
  • Currently used medications (including prescription drugs, OTC drugs, and supplements) and drug allergies (especially whether there is a penicillin allergy)
  • Previous syphilis test results (if available, including the test date and values), recent sexual contact history, and information about sexual partners
  • Possibility of pregnancy or current pregnancy (for women), and whether breastfeeding
  • Time of symptom onset and changes (ulcers, rash, fever, enlarged lymph nodes, etc.); photographs can be useful if available
  • Existing underlying conditions (e.g., HIV or an immunocompromised state) and history of previous antibiotic treatment
• Key points the medical staff may check during the visit (example questions):
  • When did your symptoms begin? Do you have photographs of the ulcers or rash?
  • When were you exposed to your recent sexual partner, and did you use protection?
  • Do you have a history of penicillin allergy? What was your previous reaction?
  • Are you pregnant or planning to become pregnant?

Examples of General Questions to Ask the Doctor

• "What are the specific details of the treatment I will receive (drug name, dosage, and duration of administration)?"
• "What side effects are expected from the treatment, and how should they be managed?"
• "When and how will follow-up tests (serological tests) be performed after treatment? What changes indicate successful treatment?"
• "Should I also be tested for HIV?"
• "What partner management (testing and treatment recommendations) is needed, and when can I resume sexual activity?"

Examples of Disease-Specific Questions

• Pregnancy-related: "I am currently pregnant. What tests are needed to prevent fetal infection, and how will the treatment differ?"
• If neurological involvement is suspected: "If I have headaches, vision problems, or neurological symptoms, do I need a cerebrospinal fluid test? If so, what is the test procedure and what are its risks?"