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Infectious Syphilis/Sexually Transmitted Infections (STI)

May 27, 2011

Context

Alberta continues to experience a high number of new cases of infectious syphilis as well as other STIs including HIV. Cases are occurring throughout the province in males and females of all ages, ethnicities and sexual preferences. Although some cases have been linked to the sex trade, many are in persons reporting casual and/or anonymous sexual encounters and occasionally in people who had assumed their situation was monogamous. Testing is critical to identification of at risk individuals who may be asymptomatic.

Clinical Presentation

Primary syphilis – classically presents as painless ano-genital or oral ulceration. May heal spontaneously.

Secondary syphilis – Generalized rash, particularly on the palms and soles, sometimes accompanied by fever and lymphadenopathy; mucus lesions, condyloma lata, patchy or diffuse alopecia, meningitis, headaches, uveitis, retinitis. Untreated, it progresses to latent and tertiary stages.

Latent syphilis – asymptomatic.

Tertiary syphilis – Cardiovascular syphilis (aortic aneurysm, aortic regurgitation, coronary artery ostial stenosis); neurosyphilis (ranges from asymptomatic to symptomatic with headaches, vertigo, personality changes, dementia, ataxia, presence of Argyll Robertson pupil); gumma (tissue destruction of any organ; manifestations depend on site involved).

Actions

  1. Offer testing for syphilis, other STIs (e.g., gonorrhea and chlamydia) and HIV to anyone engaging in sexual contact (penile-vaginal, penile-anal, oral-genital) and especially outside of a mutually monogamous relationship. Syphilis increases the risk of transmission or acquisition of HIV. Condoms do not provide complete protection against syphilis.
  2. Screen all pregnant women for syphilis early in pregnancy, again at mid-pregnancy, and again at the time of giving birth. In addition, some pregnant women identified as being at high-risk (e.g., sex trade workers) should be screened more frequently. Infectious syphilis during pregnancy can result in congenital syphilis in the newborn, with the possibility of serious complications such as stillbirth, prematurity and multi-system organ involvement.

Laboratory Tests

Assistance with interpretation of test results, management of suspect/confirmed cases and partners and treatment can be obtained by contacting:

Additional Reference