a. General. Syphilis ("lues," "bad blood," "pox") is an acute or chronic systemic
disease caused by the organism Treponema pallidum, a spirochete. It is one of the
most widespread of communicable diseases. Untreated syphilis normally occurs in four
stages: primary syphilis, characterized by a sore at the site of infection; secondary
syphilis, characterized by systemic infection with a generalized skin eruption; long
periods of latent syphilis with no outward symptoms; and late syphilis involving
practically any organ and tissue in the body.
(1) Primary syphilis. The first symptom of syphilis is normally the
appearance of an open sore called a chancre. The chancre appears from 10 to 90 days
(average three weeks) following sexual exposure. It usually appears at the site of entry
of the spirochete. The usual location of the chancre is on the genital organs, but it may
also occur on the lips, tongue, breasts, fingers, anus, or other location. Infections
without chancres are frequent and often the chancre is so small and painless that it
causes no concern. In women, the chancre may be internal and easily overlooked.
Since the appearance of a chancre is so variable, any person with a genital lesion
should report to a medical clinic immediately for further examination.
(2) Secondary syphilis. The infected person enters the secondary stage
anytime from two weeks to six months (usually four to seven weeks) after the
appearance of the chancre. The chancre has normally disappeared by this time without
treatment. The secondary stage is marked by a generalized skin eruption. Other
symptoms of secondary syphilis that may occur include enlarged lymph glands, lesion in
the mouth and genitalia, small moist flattop elevations in the skin of the genitalia, sore
throat, headache, and fever. Symptoms of secondary syphilis are quite variable;
therefore, anyone with a skin rash or eruption who has had recent or frequent sexual
exposure should report to a medical clinic for examination.
(3) Latent syphilis. Following disappearance of secondary symptoms
(which usually occurs spontaneously within a period from several weeks to a year after
they occur), a period of latency follows. The periods of latency may last from several
weeks to life, during which there may be recurrences of symptoms.
(4) Late syphilis. Late syphilis may involve destructive lesions of the skin,
bone, internal organs, or the central nervous system. While actual fatality rates cannot
be accurately estimated, late syphilis impairs physical and mental health, shortens life,
and limits occupational efficiency.
c. Treatment. Penicillin is the treatment of choice and can usually be carried
out in a duty status. Favorable results may be anticipated in over 90 percent of the
cases discovered and treated in the primary stage and in 75 to 85 percent of those
treated in the secondary stage. If the patient is allergic to penicillin, erythromycin is