Syphilis is a sexually transmitted disease that was described by physicians as far back as the 16th century. Although there were differing opinions as to its origin, it was known by several names. In Italy it was known as the "French Disease''; in England it was known as the "Spanish Disease''. Other names such as "pox'' and "Bad Blood'' remain with us. Today, there are people in every country in the world who have been diagnosed with syphilis.

Syphilis is caused by a spiral-shaped organism called Treponema Pallidum which enters the body and infects the blood supply. It is mainly sexually transmitted, but can be passed from an infected mother to her unborn child through the placenta, since the blood supply is shared between the mother and the child in the womb. In this, it is no different from other diseases which are sexually transmitted, notably HIV and Hepatitis B and C.

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 stages. The incubation period, that is the time from being infected to developing symptoms, can vary from 10 to 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. It disappears within two months even if no treatment is given. Because it is usually painless, and also because this sore may be on the vulva or cervix in the female, it may be ignored. Likewise, if it is close to the anal area it may not be noticed. Unfortunately, the disappearance of the chancre does not mean the disease has also disappeared.

The Second Stages occurs approximately six weeks after the chancre has healed, and is characterised by a rash over the whole body, and in particular on the palms of the hands and soles of the feet. A syphilis rash can be fine raised red marks as in measles or it can look more like the rash associated with chicken pox. For this reason it is known as the "great imitator''. As with the first stage, the rash disappears in time, usually two to ten days after its initial appearance, and without treatment. Other symptoms noticed 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 disease remains "silent'', i.e., the infected person has no apparent sign or symptoms. It can last up to 20 years, spreading its way through the blood supply to all the body systems. There is still some risk of transmission at this stage.

The Tertiary or Final Stage is when Syphilis becomes a multi system disease affecting the heart, brain and nervous system, bones and joints. In the vascular system there may be weakening of the walls of blood vessels called aneurysms, which can burst, causing internal bleeding. Effects on the brain lead to insanity -- usually paranoia and delusions of grandeur; in the nervous system the person has problems with balance, and a generalised lack of sensitivity to injury can lead to fractures of bones and joints.

A diagnosis of syphilis can be made in two ways. First by 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, or for people whose immune system is compromised, for example people who are HIV positive, then the treatment is extended to three treatments at weekly intervals. Where there is involvement of the Central Nervous System, intravenous medication may be recommended. For people who are allergic to penicillin, alternative treatment is available. Syphilis in adults and children is curable if 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 is recommended annually thereafter.

As with any sexually transmitted disease, prevention of transmission is of paramount importance. Teaching people to practice "safer sex'' by getting to know their partner before a sexual relationship develops; making sure that the relationship is monogamous, and using condoms, are keys to lowering the risk.

Communicable Disease Programme Department of Health