This weeks' topic is syphilis, a sexually transmitted infection that was described by physicians all over Europe by the beginning of the 16th Century, although there were differing opinions as to where it originated.

It was known by several names; in Italy it was known as the "French Disease''; in England as "The Spanish Disease''; other names, such as "Bad Blood'' and "The Pox'' remain with us today. It is now worldwide, and thousands of cases are diagnosed on each continent every year.

Syphilis, caused by a spiral shaped organism called Trepenema Pallidum, is primarily transmitted by sexual contact as previously stated. However, it can also be passed from an infected mother to her unborn child through the placenta. It is also a multi-system disease, in that, if untreated, it can affect the heart, brain and nervous system, bones and joints in the final stage.

The disease is identified in four stages; primary, secondary, latent, and tertiary or final stage. It can be passed from one person to another at any stage, but the highest risk of transmission is during the primary and secondary stage.

The incubation period can vary from 10-90 days. The first stage is a painless ulcer called a chancre, which is usually found in the genital area, appearing within two to six weeks after contact and which will disappear within two months without treatment. Because there is no pain, and also because the chancre may be on the vulva and cervix in the female, and also on the anus, it may not be noticed, or be ignored by the person. This does not mean that there is no longer any infection present.

The secondary stage occurs within six weeks of the chancre healing, and is characterised by a rash over the whole body, and in particular on the palms of the hands and soles of the feet.

This rash can look like rashes caused by other infection, and will also disappear in time, usually two to ten weeks without treatment. Other symptoms at this time may include a low grade fever; a general feeling of being unwell, and swollen glands.

The latent stage is the time when the infection is silent, i.e. when the infected person has no signs or symptoms of the disease. This stage may last as long as 20 years and it is at this time that it affects the other systems of the body. There is still some risk of transmission at this stage.

The tertiary or final stage is when the devastating effects of the disease take their toll. In the vascular system there may be weakening of the walls of blood vessels called aneurysms which can burst causing bleeding internally; effects on the brain lead to insanity -- usually paranoia and delusions of grandeur; in the nervous system, the person has problems with balance, and generalised lack of sensitivity to injury can lead to fractures on bones and joints.

A diagnosis of syphilis can be made in two ways. First be a simple blood test, and it is important to note, that in Bermuda, as in many countries, it is the law that all pregnant women have this test as a routine procedure to protect the unborn child. The second method is by taking a sample from the chancre and examining it under a special microscope for the presence of the organism.

Treatment is usually two injections of penicillin one week apart if the infection has been contracted within a period of one year. For longer periods of infection, then the treatment is extended to three treatments at weekly intervals. For people who are allergic to penicillin, alternative treatment is sought, but it is important that anyone who has had sexual contact with an infected person attends a clinic or sees a physician for evaluation and treatment.

To make sure that the infection has been cured the blood test is repeated at three months; six months; and one year and sometimes annually thereafter. As with any sexually transmitted infection, prevention of transmission is of paramount importance. Teaching people to practice "safe sex'' by getting to know their partner before a sexual relationship develops; making sure that the relationship is monogamous, and using condoms is the key to lowering the risk.

HEALTH HTH