Editing Syphilis (section)

{{Short description|Sexually transmitted infection}}
{{Distinguish|Sisyphus}}
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{{Infobox medical condition (new)
| name = Syphilis
| image = Treponema pallidum Bacteria (Syphilis) (cropped).jpg
| alt = 
| caption = Colorized [[electron micrograph]] of ''Treponema pallidum'' bacteria, 2022
| field = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms = Firm, painless, non-itchy [[skin ulcer]]<ref name=Goldman2020/>
| complications = 
| onset = 
| duration = 
| causes = ''Treponema pallidum'', usually spread by sex<ref name=Goldman2020/>
| risks = 
| diagnosis = [[serological testing|Blood tests]], [[dark field microscopy]] of infected fluid<ref name=CDC2015Fact/><ref name=Kent08/>
| differential = Many other diseases<ref name=CDC2015Fact/>
| prevention = [[Condom]]s, [[Monogamy|Long-term monogamous relationships]]<ref name=CDC2015Fact/>
| treatment = [[Antibiotics]]<ref name=CDC2015Tx/>
| medication = 
| frequency = 45.4 million / 0.6% (2015, global)<ref name=GBD2015Pre/><!-- incidence table -->
| deaths = 107,000 (2015, global)<ref name=GBD2015Death/>
}}

'''Syphilis''' ({{IPAc-en|ˈ|s|ɪ|f|ə|l|ɪ|s}}) is a [[sexually transmitted infection]] caused by the [[bacterium]] ''[[Treponema pallidum]]'' [[subspecies]] ''pallidum''.<ref name=Goldman2020>{{cite book |last1=Ghanem|first1=Khalil G.|last2=Hook|first2=Edward W.|editor1-last=Goldman |editor1-first=Lee |editor2-last=Schafer |editor2-first=Andrew I. |title=[[Goldman-Cecil Medicine]] |date=2020 |publisher=Elsevier |location=Philadelphia|isbn=978-0-323-55087-1 |pages=1983–1989|edition=26th|volume=2 |chapter-url=https://books.google.com/books?id=7pKqDwAAQBAJ&pg=PA1983 |chapter=303. Syphilis}}</ref> The signs and symptoms depend on the stage it presents: primary, secondary, [[latent syphilis|latent]] or tertiary.<ref name=Goldman2020/><ref name=CDC2015Fact/> The primary stage classically presents with a single [[chancre]] (a firm, painless, non-itchy [[Ulcer_(dermatology)|skin ulceration]] usually between 1&nbsp;cm and 2&nbsp;cm in diameter), though there may be multiple sores.<ref name=CDC2015Fact/> In secondary syphilis, a diffuse [[rash]] occurs, which frequently involves the palms of the hands and soles of the feet.<ref name=CDC2015Fact/> There may also be sores in the mouth or vagina.<ref name=CDC2015Fact/> Latent syphilis has no symptoms and can last years.<ref name=CDC2015Fact/> In tertiary syphilis, there are [[Gumma (pathology)|gummas]] (soft, non-cancerous growths), neurological problems, or heart symptoms.<ref name=Kent08>{{cite journal |vauthors=Kent ME, Romanelli F |title=Reexamining syphilis: an update on epidemiology, clinical manifestations, and management |journal=Annals of Pharmacotherapy |volume=42 |issue=2 |pages=226–36 |date=February 2008 |pmid=18212261 |doi=10.1345/aph.1K086 |s2cid=23899851}}</ref> Syphilis has been known as "[[The Great Imitator|the great imitator]]", because it may cause symptoms similar to many other diseases.<ref name=CDC2015Fact>{{cite web |title=Syphilis – CDC Fact Sheet (Detailed) |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |website=CDC |access-date=3 February 2016 |date=2 November 2015|url-status=live |archive-url=https://web.archive.org/web/20160206003059/http://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |archive-date=6 February 2016}}</ref><ref name=Kent08/>

Syphilis is most commonly spread through [[human sexual activity|sexual activity]].<ref name=CDC2015Fact/> It may also be [[Vertical transmission|transmitted from mother to baby]] during pregnancy or at birth, resulting in [[congenital syphilis]].<ref name=CDC2015Fact/><ref name=Wood09>{{cite journal |author=Woods, CR |title=Congenital syphilis-persisting pestilence |journal=The Pediatric Infectious Disease Journal |volume=28 |issue=6 |pages=536–537 |date=June 2009 |pmid=19483520|doi=10.1097/INF.0b013e3181ac8a69}}</ref> Other diseases caused by ''[[Treponema]]'' bacteria include [[yaws]] (''[[Treponema pallidum|T. pallidum]]'' subspecies ''pertenue''), [[Pinta (disease)|pinta]] (''[[Treponema carateum|T. carateum]]''), and [[nonvenereal endemic syphilis]] (''T. pallidum'' subspecies ''endemicum'').<ref name=Kent08/> These three diseases are not typically sexually transmitted.<ref>{{cite web |title=Pinta |url=https://rarediseases.org/rare-diseases/pinta/ |website=NORD |access-date=13 April 2018 |archive-date=16 August 2018 |archive-url=https://web.archive.org/web/20180816031132/https://rarediseases.org/rare-diseases/pinta/ |url-status=live}}</ref> Diagnosis is usually made by using [[serological testing|blood tests]]; the bacteria can also be detected using [[dark field microscopy]].<ref name=CDC2015Fact/> The [[Centers for Disease Control and Prevention]] (U.S.) recommends for all pregnant women to be tested.<ref name=CDC2015Fact/>

The risk of sexual transmission of syphilis can be reduced by using a [[latex]] or [[polyurethane]] [[condom]].<ref name=CDC2015Fact/> Syphilis can be effectively treated with [[antibiotics]].<ref name=CDC2015Tx>{{cite web|title=Syphilis|url=https://www.cdc.gov/std/tg2015/syphilis.htm|website=CDC|access-date=3 February 2016|date=4 June 2015|url-status=live|archive-url=https://web.archive.org/web/20160221200405/http://www.cdc.gov/std/tg2015/syphilis.htm|archive-date=21 February 2016}}</ref> The preferred antibiotic for most cases is [[benzathine benzylpenicillin]] [[Intramuscular injection|injected into a muscle]].<ref name=CDC2015Tx/> In those who have a severe [[penicillin allergy]], [[doxycycline]] or [[tetracycline]] may be used.<ref name=CDC2015Tx/> In those with [[neurosyphilis]], [[intravenous]] [[benzylpenicillin]] or [[ceftriaxone]] is recommended.<ref name=CDC2015Tx/> During treatment, people may develop fever, headache, and [[myalgia|muscle pains]], a reaction known as [[Jarisch–Herxheimer reaction|Jarisch–Herxheimer]].<ref name=CDC2015Tx/>

In 2015, about 45.4&nbsp;million people had syphilis infections,<ref name=GBD2015Pre>{{cite journal|vauthors=((GBD 2015 Maternal Mortality Collaborators)) |title=Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet|date=October 2016 |volume=388 |issue=10053 |pages=1545–1602 |pmid=27733282 |doi=10.1016/S0140-6736(16)31678-6 |pmc=5055577}}</ref> of which six million were new cases.<ref name=New2015>{{cite journal |last1=Newman|first1=L|last2=Rowley|first2=J|last3=Vander Hoorn |first3=S |last4=Wijesooriya|first4=NS|last5=Unemo|first5=M|last6=Low|first6=N|last7=Stevens|first7=G|last8=Gottlieb|first8=S|last9=Kiarie|first9=J|last10=Temmerman|first10=M|title=Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. |journal=PLOS ONE|date=2015|volume=10|issue=12|pages=e0143304|pmid=26646541|doi=10.1371/journal.pone.0143304|pmc=4672879|bibcode=2015PLoSO..1043304N|doi-access=free}}</ref> During 2015, it caused about 107,000 deaths, down from 202,000 in 1990.<ref name=GBD2015Death>{{cite journal|vauthors=((GBD 2015 Mortality and Causes of Death Collaborators)) |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet|date=October 2016 |volume=388 |issue=10053 |pages=1459–1544 |pmid=27733281|doi=10.1016/s0140-6736(16)31012-1|pmc=5388903}}</ref><ref name=Loz2012>{{cite journal|last=Lozano|first=R|title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.|journal=Lancet|date=15 December 2012 |volume=380|issue=9859|pages=2095–128|pmid=23245604|doi=10.1016/S0140-6736(12)61728-0|pmc=10790329|hdl=10536/DRO/DU:30050819|s2cid=1541253|url=https://zenodo.org/record/2557786|hdl-access=free|access-date=9 April 2020|archive-date=19 May 2020|archive-url=https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786|url-status=live}}</ref> After decreasing dramatically with the availability of penicillin in the 1940s, rates of infection have increased since the turn of the millennium in many countries, often in combination with [[HIV|human immunodeficiency virus]] (HIV).<ref name=Kent08/><ref name=Music08>{{cite journal |last=Franzen|first=C|title=Syphilis in composers and musicians – Mozart, Beethoven, Paganini, Schubert, Schumann, Smetana|journal= [[European Journal of Clinical Microbiology & Infectious Diseases]] |date=December 2008|volume=27|issue=12|pages=1151–57|pmid=18592279|doi=10.1007/s10096-008-0571-x|s2cid=947291}}</ref> This is believed to be partly due to unsafe drug use, increased [[prostitution]], and decreased use of [[condom]]s.<ref name="Coffin2010">{{cite journal |last1=Coffin |first1=L.S. |last2=Newberry |first2=A. |last3=Hagan |first3=H. |last4=Cleland |first4=C.M. |last5=Des Jarlais |first5=D.C. |last6=Perlman |first6=D.C. |title=Syphilis in Drug Users in Low and Middle Income Countries |journal=The International Journal on Drug Policy |date=January 2010 |volume=21 |issue=1 |pages=20–27 |pmid=19361976 |doi=10.1016/j.drugpo.2009.02.008 |pmc=2790553}}</ref><ref name="Gao2009">{{cite journal |last=Gao |first=L. |author2=Zhang, L. |author3=Jin, Q |title=Meta-analysis: prevalence of HIV infection and syphilis among MSM in China|journal=Sexually Transmitted Infections|date=September 2009 |volume=85|issue=5|pages=354–58|pmid=19351623|doi=10.1136/sti.2008.034702|s2cid=24198278}}</ref><ref name="Karp2009">{{cite journal |last=Karp |first=G. |author2=Schlaeffer, F. |author3=Jotkowitz, A. |author4=Riesenberg, K. |title=Syphilis and HIV co-infection|journal=European Journal of Internal Medicine |date=January 2009|volume=20|issue=1|pages=9–13|pmid=19237085|doi=10.1016/j.ejim.2008.04.002}}</ref>
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