Syphilis an infectious venereal disease caused by the spiral-shaped bacterium, Treponema pallidum. The germ is usually transmitted by sexual contact. Syphilis is the most dangerous of the venereal diseases, and the bacteria are able to pass into a fetus in the womb, causing syphilis in the newborn at birth.

There are three stages in syphilis. The first stage (primary syphilis) is marked by the appearance of a small, painless, red pus-forming bump on the skin or mucous membrane between 10 and 90 days after exposure. The sore may appear anywhere on the body where contact with a sore of an infected person has occurred, but is seen most often in the pelvic region. It quickly wears away, forming a painless, bloodless ulcer, called a chancre, releasing a fluid that swarms with bacteria. The chancre may not be noticed by the patient, and many people may become infected. It heals by itself within 10 to 40 days, often creating the mistaken impression that the sore was not a serious event.

The second stage (secondary syphilis) occurs about 2 months later, after the bacteria have increased in number and spread throughout the body. This stage is marked by general malaise, loss of appetite, nausea, fever, headache, hair loss, bone and joint pain, or the appearance of a rash that does not itch, flat white sores in the mouth and throat, or pimples on the moist areas of the skin. The disease remains highly contagious at this stage and can be spread by kissing. The symptoms usually continue for 3 weeks to 3 months.

The third stage (tertiary syphilis) may not develop for 3 to 15 or more years. It is marked by the appearance of soft, rubbery tumours called gummas. Gummas may develop anywhere on the surface of the body and in the eye, liver, lungs, stomach, or sexual organs. Tertiary syphilis may be painless, unnoticed except for gummas, or it may be accompanied by deep, burrowing pain. The ulceration of the gummas may result in punched-out areas of the palate, nasal septum, or larynx. Various tissues and structures of the body, including the central nervous system, and the wall and the valves of the heart may be damaged or destroyed, leading to mental or physical disorders and premature death.

Congenital syphilis resulting from infection in the womb may result in the birth of a deformed or blind infant. Such children may also have visual or hearing defects, and poor health may develop. Syphilis is sometimes detected from blood tests, but often the only evidence is the patient's reports that he or she has been exposed.

Once syphilis was quite prevalent in Bangladesh. With the beginning of penicillin therapy the incidence has sharply fallen. The disease may be treated with antibiotics in the first and second stages. It is also very important to tell the doctor about any sexual partners who have been exposed to syphilis so that they can be treated. [Md Shahidullah]