Summary about Disease
Quaternary syphilis, also known as late or tertiary syphilis, is the final stage of syphilis infection. It develops in approximately one-third of untreated individuals, typically 10-30 years after the initial infection. This stage can cause severe damage to multiple organ systems, including the brain, heart, nerves, bones, joints, eyes and other organs. It is a serious condition that can lead to disability and death if left untreated. While the bacteria causing syphilis ( Treponema pallidum ) may still be present, quaternary syphilis is characterized more by the destructive effects of the chronic infection and the body's immune response rather than active bacterial multiplication.
Symptoms
Symptoms of quaternary syphilis vary widely depending on the affected organs. Some possible symptoms include:
Cardiovascular syphilis: Aortic aneurysms, aortic valve insufficiency, chest pain, shortness of breath.
Neurosyphilis: Meningitis, stroke, dementia, personality changes, seizures, vision problems, hearing loss, muscle weakness, numbness, difficulty coordinating movements, tabes dorsalis (progressive degeneration of the spinal cord).
Gummatous syphilis: Development of gummas (soft, non-cancerous growths) on the skin, bones, liver, or other organs. These lesions can cause significant tissue damage.
Ocular syphilis: Vision loss, eye pain, sensitivity to light.
Other: Damage to bones and joints.
Causes
Quaternary syphilis is caused by the bacterium Treponema pallidum. It develops as a result of untreated syphilis infection that has progressed through its earlier stages (primary, secondary, and latent). The bacteria damages organs slowly over many years.
Medicine Used
The primary treatment for quaternary syphilis is penicillin. High doses of intravenous penicillin are typically administered for neurosyphilis. Doxycycline or ceftriaxone may be used for patients with penicillin allergies, but penicillin desensitization and treatment with penicillin is preferred if possible. Treatment aims to kill the remaining bacteria and prevent further damage, but it cannot reverse existing damage caused by the infection. Additional medications may be prescribed to manage specific symptoms, such as pain relievers or anti-seizure medications.
Is Communicable
While quaternary syphilis itself is less directly communicable than primary or secondary syphilis, individuals with active lesions (especially gummas with open sores) may still potentially transmit the bacteria through direct contact. Transmission via sexual contact is less likely in this stage compared to earlier stages. However, pregnant women with untreated quaternary syphilis can still transmit the infection to their unborn child (congenital syphilis).
Precautions
Complete the full course of antibiotics as prescribed by your doctor. Do not stop taking the medication even if you start feeling better.
Follow-up with your doctor for regular check-ups and testing to monitor your response to treatment.
Inform your sexual partners so they can be tested and treated if necessary.
Avoid sexual contact until you and your partners have completed treatment and are confirmed to be cured.
Pregnant women should be screened for syphilis and treated if necessary to prevent congenital syphilis.
Practice safe sex to prevent future infections.
How long does an outbreak last?
Quaternary syphilis isn't characterized by "outbreaks" in the same way as earlier stages. It's a chronic, slowly progressing condition. Symptoms can persist for years or even a lifetime if left untreated. Once the disease progresses to this stage, damage already done may be irreversible, even with treatment. Treatment aims to halt further progression and manage existing symptoms.
How is it diagnosed?
Diagnosis of quaternary syphilis involves a combination of factors:
Medical history: A history of syphilis infection, or possible exposure to syphilis.
Physical examination: Assessing for symptoms suggestive of organ damage.
Blood tests: Serological tests (e.g., VDRL, RPR, FTA-ABS, TP-PA) to detect syphilis antibodies. Note that these tests may be less sensitive in late syphilis.
Lumbar puncture (spinal tap): To test the cerebrospinal fluid for neurosyphilis.
Imaging studies: X-rays, CT scans, MRI scans, and echocardiograms to assess for organ damage (e.g., aortic aneurysm, gummas in the brain or other organs).
Other tests: Depending on the symptoms, other tests may be needed to assess the function of specific organs (e.g., eye exam for ocular syphilis).
Timeline of Symptoms
The timeline of quaternary syphilis is highly variable, but generally follows this pattern:
Initial infection: Exposure to Treponema pallidum.
Primary syphilis: Appearance of a painless sore (chancre) at the site of infection, typically within 10-90 days.
Secondary syphilis: Skin rash, fever, sore throat, swollen lymph nodes, usually appearing weeks to months after the chancre heals.
Latent syphilis: A period with no symptoms, which can last for years.
Quaternary syphilis: Development of severe organ damage, typically 10-30 years after the initial infection. The exact timing and nature of the symptoms depend on which organs are affected.
Important Considerations
Quaternary syphilis is a serious and potentially life-threatening condition. Early diagnosis and treatment are essential to prevent further damage.
Treatment cannot reverse existing damage but can halt the progression of the disease.
Lifelong follow-up is often necessary to monitor for complications and manage symptoms.
Syphilis can be prevented through safe sex practices (e.g., using condoms) and regular screening, especially for individuals at high risk of infection.
Congenital syphilis can be prevented by screening and treating pregnant women with syphilis.
Individuals with HIV are at higher risk of developing more severe complications from syphilis, including neurosyphilis.