Generality
Syphilis is an infectious disease that affects both men and women. The causative agent is the bacterium Treponema pallidum , which has a marked invasiveness for the human organism.
After infection, the bacterium responsible for syphilis is present in the blood and in all other body secretions, mainly at the level of the lesions it causes.
The appearance of the first symptoms occurs after three to four weeks: these are ulcers or round wounds in the pathogen entry point (ie in the areas that have come into contact with the infected areas of the other person). In women, these lesions appear more frequently in the genital area, particularly in the labia minora, vaginal or perineum orifice . Furthermore, in women, infection can lead to various complications during pregnancy .
Without an adequate and timely diagnosis and treatment, a progressive evolution of the disease is possible, which can cause serious damage to multiple organs and systems, such as skin, heart and skeleton. In its final phase, syphilis damages the central nervous system causing mental confusion, dementia and progressive paralysis.
Fortunately, thanks to the availability of adequate diagnostic methods and the efficacy of antibiotic therapy, syphilis is a controllable and treatable infection.
Treponema pallidum
- The causative agent of syphilis is a bacterium , Treponema pallidum . Upon observation with a microscope in a dark field, this micro-organism appears as a small spiral-shaped filament, mobile and flexible, varying in length between 5 and 20 microns.
- Treponema pallidum is able to pass through intact mucous membranes or damaged skin . The agent responsible for syphilis in women is therefore more easily transmitted through oral contact and unprotected vaginal and anal sex .
- The most frequent entry sites are, in fact, the mucous membranes of the genitals and the mouth, where the Treponema pallidum finds its ideal habitat to reproduce easily. Later, this microorganism migrates through the skin capillaries, then spread to the lymph nodes, where it multiplies until it reaches levels sufficient to cause clinical disease. Generally, the incubation times of syphilis extend from 2 to 12 weeks.
- In subjects with the disease, Treponema Pallidum is found in all body fluids, such as sperm and vaginal secretions. Furthermore, the bacterium is found in the cutaneous, genital and mucosal lesions, including that of the mouth, which occur during the course of the disease.
Contagion
How can a woman get syphilis?
Women contract syphilis mainly through unprotected sexual intercourse - whether genital (vaginal or anal), or oral - with an infected person.
The infection can be transmitted through direct contact with wounds or skin and mucous ulcers, which are formed in areas where the disease mainly occurs (vagina, anus, mouth, throat or damaged skin surface). Sometimes, some of these manifestations are painless and can go unnoticed, so it can happen that the person is not aware of being affected, thus risking infecting his partner.
During pregnancy, syphilis can be transmitted to the fetus via the transplacental route (through infected maternal blood) or at the time of passage through the birth canal . This, moreover, makes it possible to distinguish between acquired syphilis (when the disease occurs late in life) and congenital (if the infection is contracted before birth or during birth).
Occasionally, the disease can be transmitted through blood transfusions . This mode of infection is now very rare in the world and is limited to countries where blood is not controlled before it is transfused. Another risk factor is the use of intravenous drugs.
Syphilis is NOT usually transmitted indirectly, for example through contact with objects, dishes or clothing used by a sick person, as Treponema pallidum is poorly resistant in the environment.
Syphilis does not confer immunity against subsequent reinfection.
Symptoms
What are the symptoms of syphilis in women?
The course of syphilis in women is divided into several phases, each of which is characterized by variable symptoms. In any case, the disease is complex and - if not properly treated - can lead to various complications, such as heart disease and neurological disorders.
1) Primary syphilis in women
The initial stage of infection occurs after about 3-4 weeks from infection, with the appearance of a lesion ( syphiloma ) at the inoculation point of Treponema pallidum .
This initial sign is similar to a round-shaped papule, well-circumscribed, of variable size, usually painless and with a solid base. Soon the surface of this formation erodes and undergoes ulceration, exposing a bright red background, from which a serous exudate, containing the treponemes, comes out.
In women, the sifiloma appears more frequently on the genitals or on the area of sexual contact, especially in the cervix, vulva, vagina and perineum . This lesion can also occur in the anal-rectal area and inside the oral cavity, therefore on the lips, gums, pharynx or tongue.
About a week after the appearance of the syphiloma, another typical sign of primary syphilis appears, ie the lymph nodes increase in volume .
The symptoms of the first stage of syphilis in women tend to disappear 4-6 weeks after their onset, even without treatment, but the bacterium will remain in the body. Meanwhile, these lesions could have gone unnoticed, especially if they are very small or not easily visible (as in the case, for example, of sifilomas located on the cervix).
2) Secondary syphilis in women
Secondary syphilis begins 3-6 weeks after the onset of syphiloma. This phase is characterized by systemic manifestations, due to the proliferation and spread by blood and lymphatic system of Treponema pallidum . In the woman with syphilis, therefore, flu-like symptoms occur such as fever, asthenia, headache, muscle pain and general malaise.
However, the most obvious manifestation of secondary syphilis is a muco-cutaneous eruption in one or more areas of the body surface, which may be transient or recurrent and may have a very variable appearance. For example, roundish cracks can appear on the palms of the hands and on the soles of the feet, and clusters of pink spots spread over the entire trunk and limbs, which remind us of the measles rash. The rash is accompanied by an enlarged lymph nodes.
Secondary syphilis in a woman with a history of unprotected sexual intercourse. Involvement of the sole of the foot
In the absence of treatment, the lesions may disappear within a few days or weeks, may persist for months or recur in a recurring manner; all, however, eventually go into remission, usually without leaving scars.
Syphilis in women can also lead to sore throat, lack of appetite, weight loss, visual disturbances, hearing and balance alterations, bone pain, hair loss in locks and the appearance of thickened patches, gray or pink (warts) in wet areas of the skin. Then, during the secondary stage, meningitis can occur.
3) Latency period
After the regression of the secondary stage, a long latency period begins, which can last months or even years. At this stage, the woman with syphilis has no symptoms, but the infection persists.
4) Tertiary syphilis in women
In women, syphilis progresses to the tertiary phase when Treponema pallidum "reactivates" at the end of the latency period, generally after about 10-25 years from the time of infection. At this stage, the disease can have various effects and permanent damage to the heart, liver, bones, joints, blood vessels, skin and other organs.
In tertiary syphilis, the most important manifestations are, however, in the central nervous system, with degenerative changes affecting the tissues of the brain and spinal cord. In the so-called neurosyphilis, progressive degeneration can cause alterations of the personality, gradual blindness, loss of memory up to dementia, the inability to control muscle movements, progressive paralysis and, in the most serious cases, the patient's death.
Syphilis in pregnancy
Syphilis can be transmitted via the hematogenous route (via the placenta) from the mother to the child during gestation, with serious consequences.
If you contract during pregnancy, in fact, the disease can cause fetal malformations and other problems, including:
- Premature birth;
- Born mortality;
- Spontaneous abortions;
- Bullous eruption on the skin of the newborn;
- Blindness;
- Deafness;
- Serious damage to bones, brain, lungs, liver and other organs.
To avoid such complications, it is essential for the woman to contact her doctor, who will be able to give the correct directions regarding the best measures to take.
Usually, in pregnant women the prevention of congenital syphilis is implemented by promptly establishing penicillin therapy . In addition, in Italy, all women are screened for infection at the beginning of pregnancy .
Diagnosis
The diagnosis of syphilis in women is formulated starting from the evaluation of the set of symptoms reported by the patient during an accurate medical examination ; then, the observation of the material taken from any lesions and specific blood tests under the microscope.
The diagnosis can be confirmed by the search for treponemes in exudate and by positive serological tests, aimed at detecting the possible presence of antibodies against the bacterium already in the early stages of infection. Through these analyzes it will be possible to understand if the syphilis has been contracted and in what degree of activity the infection is found in the patient, so as to start the most appropriate treatment.
Because of its "aggressiveness" syphilis is a disease subject to reporting . This means that health professionals are required to inform public health authorities if they become aware of an infected patient.
Treatment and Prevention
Treatment of syphilis in women consists of parenteral administration of penicillin . Only in patients who are allergic to this active ingredient do you use other drugs, such as doxycycline and tetracycline .
To establish the correct dosage and duration of antibiotic therapy, the doctor will rely on the stage of the disease defined during the diagnostic procedure.
The treatment is more effective if started early in syphilis. In fact, it does not allow to remedy any damage already occurred to the various bodies. Naturally, it is necessary to carry out diagnostic tests and treatment also on all the woman's previous partners, up to three months before the onset of symptoms.
During pharmacological treatment, to avoid infecting her partner, abstinence of the woman from any type of sexual relationship is mandatory, until the complete recovery of lesions caused by syphilis. In fact, it must always be kept in mind that wounds and skin ulcers can transmit the infection even during oral sex or any other skin contact with the infected areas.
Finally, it must be remembered that, once healed, one does not become immune to the pathogen, but it can happen to get infected over and over again in the course of life; this means that the woman can contract syphilis again .
As with other sexually transmitted diseases, a good measure of prevention is given by the use of condoms, which must be used from the beginning to the end of sexual intercourse, whether vaginal, anal or oral. Even any sex toys used for this purpose must be adequately covered in case of mixed use.
Finally, it should be pointed out that the correct use of the condom does not guarantee absolute protection, given that the infection can be transmitted by contact with lesions in genital areas not covered by the condom.
