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Tertiary Syphilis

more about Tertiary Syphilis


  • Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum.  The infection is usually transmitted person to person through minor cuts in the skin or mucous membranes (genitals or mouth) during sexual intercourse.  Syphilis has three stages: Primary, Secondary, and the Tertiary disease stage.  There is a long asymptomatic period between secondary and tertiary Syphilis called the latent or "hidden" phase.
  • Tertiary Syphilis occurs years after the initial infection.  It is of note that the transmission of Syphilis can occur to a fetus even during the latent period.  Tertiary Syphilis may have one or a combination of various disease manifestations in the body.  These manifestations include asymptomatic, brain/spinal cord fluid (meningovascular), spinal cord posterior columns (tabes dorsalis), and heart/blood vessels (cardiovascular).
  • The primary danger of Tertiary Syphilis is that it can result in permanent damage to the brain, nervous system, heart or large blood vessels (e.g., the aorta inflammation or an aortic aneurysm).  Tertiary Syphilis can affect the skin, skeletal systems, eyes, respiratory tract, and gastrointestinal tract (as well as the cardiovascular and central nervous system).

  • Tertiary (Late) Syphilis -- occurs years after original exposure
  • Tumor-like skin lesions (gummas)
  • Shortness of breath due to Aortic Insufficiency
  • Angina (Chest pain)
  • Seizures
  • Headaches
  • Dementia
  • Confusion
  • Psychosis
  • Gait problems (balance problems on walking)
  • Paresthesia -- sensory problems
  • Visual problems
  • NeuroSyphilis (Brain and Central Nervous System) -- specific symptoms and signs
  • Headaches
  • Irritability
  • Cranial nerve palsies
  • Unequal reflexes
  • Irregular pupils
  • Argyll-Robertson pupils
  • Joint damage (Charcot's joint)
  • Urinary incontinence (neurogenic bladder)
  • Nausea/Vomiting
  • Laryngeal spasm

  • Cardiovascular (heart/circulation) involvement:
    1. Heart exam may reveal Aortic Regurgitation murmur
    2. Lung exam may have evidence of failure (e.g., crackles)
    3. Chest X-Ray or CT scan may show an aortic aneurysm
    4. Chest X-Ray may show infiltrates or cardiomegaly
    5. Echocardiogram may show Aortic Regurgitation

- Lumbar puncture (spinal tap) reveals increased cells (100-1000/ml), elevated protein levels, and positive serologic test for Syphilis


- Benzathine Penicillin intramuscular injections once a week for three weeks

    1. Penicillin is administered intravenously for 10 to 14 days
    2. Procaine Penicillin with Probenecid intramuscular injections daily for 10-14 days
    3. Both of the above it is often recommended to give Benzathine Penicillin intramuscular injections once a week for three weeks
    4. Chloramphenicol, Doxycycline, or Ceftriaxone may also be considered in penicillin allergic patients.
    5. Persons should have a spinal tap every six months until the spinal fluid shows the person has responded appropriately (cell count is checked)

  • Treating Syphilis at early stages (Primary and Secondary) will prevent the occurrence of tertiary Syphilis and its serious manifestations. If you have any symptoms of primary or secondary Syphilis (see that section) you should seek treatment immediately.





more about Tertiary Syphilis


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