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Medical Disability Advisor  >  Syphilis

Syphilis

Related Terms

  • Sexually Transmitted Disease (STD)

Differential Diagnoses

Specialists

  • Cardiovascular Internist
  • Infectious Disease Internist
  • Neurologist

Comorbid Conditions

  • Immune system disorders

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Factors Influencing Duration

The length of disability will be influenced by the stage of the disease and by the specific organs affected by the disease. If the individual is in late-stage syphilis, periods of extended disability may be required.

Medical Codes

ICD-9-CM:
090 - Syphilis, Congenital
090.0 - Early Congenital Syphilis, Symptomatic; Choroiditis; Coryza (Chronic); Hepatomegaly; Mucous Patches; Periostitis; Splenomegaly; Epiphysitis; Osteochondritis; Pemphigus; Any Congenital Syphilitic Condition Specified as Early or Manifest Less than Two Years after Birth
090.1 - Early Congenital Syphilis, Latent; Congenital Syphilis without Clinical Manifestations, with Positive Serological Reaction and Negative Spinal Fluid Test, Less than Two Years after Birth
090.2 - Early Congenital Syphilis, Unspecified; Congenital Syphilis NOS, Less than Two Years after Birth
090.5 - Late Congenital Syphilis, Other; Symptomatic; Gumma Due to Congenital Syphilis; Hutchinsons Teeth; Syphilitic Saddle Nose; Any Congenital Syphilitic Condition Specified as Late or Manifest Two Years or More after Birth
090.6 - Late Congenital Syphilis, Latent; Congenital Syphilis without Clinical Manifestations, with Positive Serological Reaction and Negative Spinal Fluid Test, Two Years or More after Birth
090.7 - Late Congenital Syphilis, Unspecified; Congenital Syphilis NOS< Two Years or More after Birth
090.9 - Congenital Syphilis, Unspecified
091 - Early Syphilis, Symptomatic
091.0 - Early Syphilis, Symptomatic; Syphilis, Genital (Primary); Genital Chancre
091.1 - Early Syphilis, Symptomatic; Syphilis, Primary Anal
091.2 - Early Syphilis, Symptomatic; Syphilis, Primary, Other; Primary Syphilis of Breast, Fingers, Lip, or Tonsils
091.3 - Early Syphilis, Symptomatic; Syphilis of Skin or Mucous Membrane, Secondary; Condyloma Latum; Secondary Syphilis of Anus, Mouth, Pharynx, Skin, Tonsils, Vulva
091.4 - Adenopathy Due to Secondary Syphilis; Syphilitic Adenopathy, Secondary; Syphilitic Lymphadenitis, Secondary
091.5 - Uveitis Due to Secondary Syphilis
091.6 - Syphilis, Secondary of Viscera and Bone
091.61 - Secondary Syphilitic Periostitis
091.62 - Secondary Syphilitic Hepatitis; Secondary Syphilis of Liver
091.69 - Syphilis, Secondary of Other Viscera
091.7 - Syphilis, Secondary, Relapse; Treated, Untreated
091.8 - Syphilis, Secondary, Other Forms
091.81 - Acute Syphilitic Meningitis, Secondary
091.82 - Syphilitic Alopecia
091.9 - Syphilis, Secondary, Unspecified
092 - Syphilis, Early, Latent
092.0 - Syphilis, Early, Latent, Serological Relapse after Treatment
092.9 - Syphilis, Early, Latent, Unspecified
093 - Cardiovascular Syphilis
093.0 - Cardiovascular Syphilis; Aneurysm of Aorta, Specified As Syphilitic; Dilatation of Aorta, Specified as Syphilitic
093.1 - Cardiovascular Syphilis; Syphilitic Aortitis
093.2 - Cardiovascular Syphilis; Syphilitic Endocarditis
093.21 - Cardiovascular Syphilis; Syphilitic Endocarditis; Mitral Valve
093.22 - Cardiovascular Syphilis; Syphilitic Endocarditis; Aortic Valve; Syphilitic Aortic Incompetence or Stenosis
093.23 - Cardiovascular Syphilis; Syphilitic Endocarditis; Tricuspid Valve
093.24 - Cardiovascular Syphilis; Syphilitic Endocarditis; Pulmonary Valve
093.8 - Cardiovascular Syphilis, Other Specified
093.9 - Syphilis, Cardiovascular, Unspecified
094 - Neurosyphilis
094.2 - Neurosyphilis; Meningitis, Syphilitic; Meningovascular Syphilis
094.3 - Neurosyphilis; Asymptomatic
094.8 - Neurosyphilis, Other Specified
094.9 - Neurosyphilis, Unspecified; Gumma of Central Nervous System NOS; Syphilis of Central Nervous System NOS; Syphiloma of Central Nervous System NOS
097 - Syphilis, Other and Unspecified
097.9 - Syphilis, Unspecified; Syphilis, Acquired, NOS

Definition

Syphilis is a complex venereal disease caused by the spirochete bacterium, Treponema pallidum. It is spread by direct contact with a skin ulcer (chancre) of an infected person. This usually occurs through sexual contact with mucous membranes of the genital area or mouth, but the disease can also be transmitted through broken skin on other parts of the body and through contact with infected blood. Therefore, syphilis is unlike other venereal diseases in that it can be transmitted nonsexually.

After entering the body through broken skin, the bacteria quickly move to the lymph nodes, where they can spread throughout the body. A pregnant woman can also pass the disease to her unborn child, which results in stillbirth in 33% of cases, or a syphilis-infected infant (Liu).

The course of the disease can be divided into four stages: primary, secondary, latent, and tertiary. The primary and secondary stages can last 1 to 2 years, during which time the infected person can spread the disease to others. These stages are often unidentifiable because the skin ulcers are usually painless, are difficult to identify, and pass rather quickly. The individual thinks he or she is cured, but the disease progresses to its later stages. In the later two stages, latent and tertiary, the disease is no longer contagious. During tertiary syphilis, seriously damaged internal organs, mental disorders, and death can result. This stage can last for years or decades. This stage can last for years or decades. Syphilis is often called the great imitator, because its symptoms mimic those of so many other diseases.

In the US, syphilis is a reportable disease and is tracked by the Centers for Disease Control and Prevention.

Risk: Certain lifestyle choices put individuals at higher risk for acquiring syphilis, including sexual activity without the protection of a condom and sex with multiple partners. Homosexual men have a particularly high rate of syphilis. Syphilis also plays a role in increasing the risk of acquiring the human immunodeficiency virus (HIV) or AIDS.

Individuals are most likely to acquire syphilis during the peak years of sexual activity, with most new infections occurring in individuals aged 20 to 29. Men are slightly more likely to contract the disease than women. In 1997, the rate of blacks contracting syphilis was 44 times higher than the rate for whites (Liu).

Incidence and Prevalence: The number of new syphilis cases in the US has been declining, possibly due to education about safer sexual practices and more aggressive testing for sexually transmitted diseases. Current US rates are about 17.4 cases for every 100,000 people (Liu). Tertiary syphilis is now rare in the US.

Source: Medical Disability Advisor



History

History: Syphilis occurs in four stages. The primary stage occurs 10 days to 3 months (on average, 3 weeks) after exposure. Individuals may complain of a painless chancre sore at the site of infection. Ten percent of sores occur in areas other than the genitals (Liu). Individuals may report that the sores heal rapidly. Individuals may also report swollen lymph glands. A complete social history aids diagnosis. There may be a history of sexual contact with an infected individual or sharing of needles among substance abusers. Individuals may report unprotected sex with many partners.

The secondary stage begins 6 to 24 weeks after infection, and lasts for two or more years. Individuals may report symptoms of a rash of small open sores that can cover any part of the body (most likely the palms of the hands and the soles of the feet). Fever, sore throat, fatigue, headache, swollen lymph glands, and hair loss may also occur. Meningitis, hepatitis, arthritis, and inflammation of the bone or eye can also occur during this stage. This stage can recur at any time and with any severity in about 30% of individuals (Liu).

Individuals usually enter the latent stage 1 to 2 years after initial infection. This stage lasts for months to a lifetime. Individuals are not contagious, have no symptoms during this time, and may believe they are cured.

Physical exam: In the early stages of syphilis, chancre sores may be identified on the penis or cervix. Swollen, but not tender, lymph glands may be identifiable during the first two stages. The late stages of syphilis may reveal tumors (gummas) in the organs, neurological conditions, blindness, or insanity.

Tests: There are several blood tests available for syphilis, including the well known venereal disease research laboratory test (VDRL test). An increasing number of enzyme immunoassays (EIAs) for detecting syphilis antibodies have become available. Treponemal EIAs are an appropriate alternative to the use of combined VDRL/rapid plasma reagin (RPR) and Treponemal pallidum hemagglutination assay (TPHA) tests for screening for syphilis. If treponemal EIA is used for screening, an alternative treponemal test, such as TPHA, should be used to confirm the diagnosis. The fluorescent treponemal antibody-absorbed test is probably best reserved for specimens giving contradictory results. The most accurate method, however, is a microscopic examination of tissue or fluid from the ulcers for identification of the syphilis bacteria. A spinal tap can also be done in later stages of the disease to diagnose infection of the nervous system. Individuals with tertiary syphilis may need chest x-rays, CT scans, and MRIs to determine involvement of other organs in the body.

Individuals diagnosed with syphilis should also be tested for other sexually transmitted diseases, including HIV infection. Pregnant women should be tested for syphilis to prevent transmission of the disease to their children.

Source: Medical Disability Advisor



Treatment

Treatment in the early stages involves a single injection of an antibiotic. Twenty-four or forty-eight hours after treatment, most individuals can no longer transmit the disease. Individuals should refrain from sexual activity during this time. Partners of individuals with syphilis should also be treated. Individuals who have been exposed to syphilis can be treated by an injection of antibiotic immediately to prevent infection by the bacteria.

In later stages of syphilis, longer treatment with antibiotics is required. Parenteral penicillin continues to be the drug of choice for treatment of all late stages of syphilis.

The proper use of condoms and limiting sexual relationships to a single uninfected partner can decrease the risk of contracting syphilis.

Source: Medical Disability Advisor



Prognosis

If treated, syphilis can be cured no matter what stage the disease is in. However, serious, irreversible damage can occur before treatment is sought. Individuals need follow-up care, usually at 3 months, to determine whether the infection has been cleared.

The first and second stages of syphilis are self-limiting. About one-third of individuals undergo spontaneous cure during the early stages, one-third will remain in the latent stage, and one-third will develop serious late lesions.

Neurosyphilis (in which the bacteria invade the nervous system) can occur in untreated individuals. This results in meningitis, paralysis, mental illness, and degeneration of the spinal nerves. If the blood vessels are affected, a stroke may occur.

Source: Medical Disability Advisor



Rehabilitation

No rehabilitation is necessary for early stages of syphilis. Rehabilitation for later stages will depend upon the course of the disease.

Source: Medical Disability Advisor



Complications

Early treatment of syphilis can result in Jarisch-Herxheimer reaction, which is caused by the sudden release of toxins from the syphilis bacteria as they are destroyed. These toxins can aggravate symptoms. Treatment should be continued, however, unless the symptoms become severe. The reaction usually disappears within 24 hours.

The secondary stage of syphilis may cause meningitis, hepatitis, or kidney inflammation.

Progression of the disease to late or tertiary syphilis causes many complications. During this stage, damage to the cardiovascular system, eyes, brain, bones, and joints occurs. A secondary bacterial infection of the skin ulcers may occur, as well as scarring.

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)

Individuals with the open sores found during the first two stages of syphilis should be kept away from other employees, because the sores are highly contagious. Depending upon the course of the disease, during the later stages, significant work restrictions may be necessary. Individuals may be unable to perform duties due to weakness, confusion, or pain in the joints. Reassignment may be necessary.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What stage of the disease is individual in?
  • Did individual initially have painless chancre sores at the site of infection?
  • Were swollen lymph glands present?
  • Did a rash develop or small open sores that cover any part of the body?
  • Does the individual have fever, sore throat, fatigue, headache, and swollen lymph glands?
  • Has individual had any hair loss?
  • Has individual had meningitis, hepatitis, arthritis, or inflammation of the bone or eye?
  • Has individual developed benign tumors in the organs, particularly the skin and bones?
  • Does individual complain of hoarseness and respiratory distress?
  • On exam, did the physician find a chancre on the penis or cervix?
  • Were tumors known as gummas found in the organs?
  • Does individual have any neurological conditions? Insanity? Blindness?
  • Did individual have a VDRL test or antibody testing?
  • Was microscopic examination of fluid from the ulcers or tissue done?
  • Was individual tested for other sexually transmitted diseases?
  • In later stages, was a spinal tap done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • In the early stage, was individual treated with a single injection of penicillin?
  • Was individual's partner also treated?
  • In later stages, was individual treated with parenteral penicillin for a longer period?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Is reassignment necessary in order for the individual to return to work?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications, such as a Jarisch-Herxheimer reaction?
  • Does individual have meningitis, hepatitis, or kidney inflammation?
  • Does individual have damage to the heart, eyes, brain, bones, and joints?

Source: Medical Disability Advisor



Cited References

Liu, Peter, and Brian Euerle. "Syphilis." eMedicine. Ed. Daniel R. Lucey. 16 Oct. 2004. Medscape. 28 Oct. 2004 <http://emedicine.com/med/topic2224.htm>.

Source: Medical Disability Advisor






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