Tertiary syphilis is a late phase of the sexually transmitted disease syphilis , caused by the spirochete Treponema pallidum .

Alternative Names

Late syphilis; Tertiary syphilis

Causes, incidence, and risk factors

Tertiary syphilis can follow the initial infection, primary syphilis , by 3 to 15 years. Secondary syphilis is the stage that precedes tertiary syphilis if primary syphilis is not treated. In tertiary syphilis, the spirochetes have continued to reproduce for years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive. Lesions in the central nervous system produce neurological disease called neurosyphilis which can include tabes dorsalis , general paresis , and optic atrophy. Lesions of the heart, heart valves and aorta can lead to aneurysms , valvular heart disease , and aortitis. Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment. The incidence of tertiary syphilis is approximately 5 per 100,000 individuals annually in the US.

Signs and tests

VDRL

or

RPR blood tests

Confirmatory blood tests, such as

FTA-ABS (fluorescent treponemal antibody test )

Spinal fluid examination

in neurosyphilis shows signs of meningitis.

Treatment

The treatment of syphilis is determined by the length of time the person has been infected. Primary, secondary, and latent syphilis of less than one year duration is treated as follows:

Benzathine penicillin 2.4 million units injected into a

muscle (IM) as a single dose.

Doxycycline 100 mg by mouth twice per day for 2 weeks.

Tetracycline 500 mg by mouth 4 times per day for 2 weeks.

Erythromycin 500 mg by mouth 4 times per day for 2 weeks.

Ceftriaxone 250 mg IM (intramuscular injection) daily for 10 days.

For treatment of syphilis of greater than one year duration :

Benzathine penicillin 2.4 million units IM weekly for 3 weeks.

Doxycycline 100 mg by mouth twice per day for 30 days.

Tetracycline 500 mg by mouth twice per day for 30 days.

For treatment of neurosyphilis :

Aqueous penicillin G 12 to 24 million units injected into a vein (IV) daily for 10 days followed by benzathine penicillin 2.4 million units once a week for 3 weeks.

Procaine penicillin 2.4 million units IM daily given with oral probenecid 500 mg 4 times per day -- both for 10 days.

To treat syphilis during pregnancy : Penicillin is recommended as the only real drug of choice. Tetracycline cannot be used because of toxicity to the fetus, and erythromycin may fail to prevent congenital syphilis in the fetus. Penicillin-allergic individuals should be desensitized and then treated with penicillin. Several hours following treatment of early stages of syphilis, some individuals may undergo a febrile reaction called Jarish-Herxheimer reaction. This is thought to be caused by the release into the circulation of material from dead or dying spirochetes. Symptoms of this reaction include:

Fever

Chills

Headache

Nausea

General feeling of being ill (

malaise )

Generalized

joint aches ( arthralgia )

Generalized

muscle aches ( myalgia ) These symptoms usually disappear within 24 hours. Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure that the infection has been eliminated. Individuals with primary or secondary syphilis should abstain from sex until they have been treated. Syphilis is extremely contagious in the primary and secondary stages.

Expectations (prognosis)

Late syphilis may be permanently disabling and may lead to death.

Complications

Cardiovascular

syphilis

Aneurysms

Valvular

heart disease

Neurosyphilis

tabes dorsalis

general paresis

optic nerve atrophy or optic neuritis

Calling your health care provider

Untreated syphilis can result in serious health problems. It is imperative that you inform your physician of the possibility of having had

syphilis previously, even if it was many years ago.

Prevention

People who have multiple or unknown sex partners or partners who are involved in any high-risk sexual practices are at risk for acquiring sexually transmitted diseases (STDs). Individuals who recognize that they are at risk have taken the first step toward prevention. Total abstinence is the only way to completely avoid the possibility of infection with a sexually transmitted disease. Monogamous sex with a healthy partner is lower risk, and protected sex using condoms also dramatically reduces risk. Condoms act as a barrier to the transmission of infectious organisms (pathogens) and should be used in any and all situations that could be considered risky. Syphilis is a " reportable disease " as required by law. The infection must be reported to public health authorities. Information acquired from reporting helps public health investigators identify, locate, and treat infected sexual contacts, which helps prevent continued spread of disease.