| February
19, 2004 Little Rock
— The Arkansas Health Department (ADH) is reporting an outbreak of syphilis cases in the Northwest region of the state. There have been a total of 38 cases of syphilis reported as of December 2003 in Washington County. These infections have affected various groups, including young adults and older individuals from varying ethnic backgrounds. Health Department physicians, nurses, and disease intervention specialists are following the patients and their contacts closely and are providing treatment according to agency protocols. The Health Department is working closely with regional health care providers to alert the medical community that there has been a sharp increase in the number of cases in Washington County.
The surest protection from sexually transmitted diseases, including syphilis, is to abstain from sexual intercourse or to have sex only in a mutually monogamous relationship with an uninfected partner. Condoms do not provide complete protection from syphilis because syphilis sores can sometimes be on areas not covered by a condom.
In 2003, there were 114 cases of early syphilis reported in Arkansas; the majority of cases were in males in the 20-54 year age group. Although syphilis cases have sharply dropped in Arkansas during the past decade, there is still an average of 100 cases reported each year since 2001. Union and Crittenden counties ranked highest in 2002 for syphilis cases.
The Health Department will continue to monitor the situation in Washington County and issue further advisories as necessary.
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Facts on Syphilis
What is syphilis?
Syphilis is a bacterial, sexually transmitted disease (STD) that progresses in stages. The disease is curable and progression of disease is preventable, but if left untreated it can cause cardiovascular and neurological diseases, and blindness. Syphilis causes genital ulcers, which increase the likelihood of sexual HIV transmission two- to five-fold. Untreated, syphilis can be transmitted from a pregnant woman to her fetus.
How is syphilis spread?
Syphilis is passed from person to person through direct contact with a syphilis sore or lesion. These occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.
What are the signs and symptoms in adults?
Primary Stage
The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The average is 21 days. The primary stage of syphilis is usually marked by the appearance of a single sore – called a chancre – but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts from three to six weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage
The second stage starts when one or more areas of the skin break into a rash that usually does not itch. A rash can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rash is so faint that it is not noticed. Even without treatment, the rash clears up on its own. In addition to a rash, second-stage signs and symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.
Late or Tertiary Syphilis
The latent or hidden stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. The syphilis bacteria remain in the body and may begin to damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints, in up to one-third of untreated persons. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
Is there a cure for syphilis?
Yes, a single dose of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to cure someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Penicillin treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. People who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. People with syphilis must notify their sex partners so that they also can be tested, and, if necessary, receive treatment.
How can people protect themselves against infection?
The surest protection from sexually transmitted diseases, including syphilis, is to abstain from sexual intercourse or to have sex only in a mutually monogamous relationship with an uninfected partner. For others who are sexually active, male latex condoms, when used consistently and correctly, can reduce the risk of other sexually transmitted diseases, including syphilis. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Only lab tests can confirm whether someone has syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.
References:
W. Cates et al. Estimates of the Incidence and Prevalence of Sexually Transmitted Diseases in the United States. Sex Trans Dis 1999; 26 (suppl): S2-S7.
K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, chapters 33-37.
M.E. St. Louis and J.N. Wasserheit. Elimination of Syphilis in the United States. Science 1998;281:353-4.
Division of STD Prevention. Sexually Transmitted Disease Surveillance, 2000. U.S. Department of Health and Human Services, Atlanta: Centers for Disease Control and Prevention (CDC), September 2001.
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