A skin condition , also known as cutaneous condition , is any medical condition that affects the integumentary system —the organ system that encloses the body and includes skin , nails , and related muscle and glands . The major function of this system is as a barrier against the external environment.
118-474: Syphilis ( / ˈ s ɪ f ə l ɪ s / ) is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum . The signs and symptoms depend on the stage it presents: primary, secondary, latent or tertiary. The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration usually between 1 cm and 2 cm in diameter) though there may be multiple sores. In secondary syphilis,
236-400: A fast heart rate . It is caused by cytokines released by the immune system in response to lipoproteins released from rupturing syphilis bacteria. Penicillin is an effective treatment for syphilis in pregnancy but there is no agreement on which dose or route of delivery is most effective. In 2012, about 0.5% of adults were infected with syphilis, with 6 million new cases. In 1999, it
354-615: A sexually transmitted disease ( STD ) and the older term venereal disease ( VD ), is an infection that is spread by sexual activity , especially vaginal intercourse , anal sex , oral sex , or sometimes manual sex . STIs often do not initially cause symptoms, which results in a risk of transmitting them on to others. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease , as it includes cases with no symptomatic disease . Symptoms and signs of STIs may include vaginal discharge , penile discharge , ulcers on or around
472-421: A skin biopsy which yields histologic information that can be correlated with the clinical presentation and any laboratory data. The introduction of cutaneous ultrasound has allowed the detection of cutaneous tumors, inflammatory processes, and skin diseases. The skin weighs an average of 4 kg (8.8 lb), covers an area of about 2 m (22 sq ft), and is made of three distinct layers:
590-761: A suffumigation . It was also treated by ingestion of mercury compounds. Once the disease had gained a strong foothold, however, the amounts and forms of mercury necessary to control its development exceeded the human body's ability to tolerate it, and the treatment became worse and more lethal than the disease. Nevertheless, medically directed mercury poisoning became widespread through the 17th, 18th, and 19th centuries in Europe, North America, and India. Mercury salts such as mercury (II) chloride were still in prominent medical use as late as 1916, and considered effective and worthwhile treatments. The first-line treatment for uncomplicated syphilis (primary or secondary stages) remains
708-490: A French invasion ( Italian War of 1494–98 ). Since it was claimed to have been spread by French troops, it was initially called the "French disease" by the people of Naples. The disease reached London in 1497 and was recorded at St Bartholomew's Hospital as infecting 10 out of the 20 patients. In 1530, the pastoral name "syphilis" (the name of a character) was first used by the Italian physician and poet Girolamo Fracastoro as
826-611: A classification based on location (for example, conditions of the mucous membrane ), morphology ( chronic blistering conditions ), cause ( skin conditions resulting from physical factors ), and so on. Clinically, the diagnosis of any particular skin condition begins by gathering pertinent information of the presenting skin lesion(s), including: location (e.g. arms, head, legs); symptoms ( pruritus , pain); duration (acute or chronic); arrangement (solitary, generalized, annular , linear); morphology ( macules , papules , vesicles ); and color (red, yellow, etc.). Some diagnoses may also require
944-618: A condom is effective in limiting exposure, some disease transmission may occur even with a condom. Both partners can get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect. Some treatment facilities use in-home test kits and have
1062-432: A diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet. There may also be sores in the mouth or vagina. Latent syphilis has no symptoms and can last years. In tertiary syphilis, there are gummas (soft, non-cancerous growths), neurological problems, or heart symptoms. Syphilis has been known as " the great imitator " because it may cause symptoms similar to many other diseases. Syphilis
1180-942: A disease may result from even light contact from fluid carriers like venereal fluids onto a mucous membrane. Some STIs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding. Healthcare professionals suggest safer sex , such as the use of condoms , as a reliable way of decreasing the risk of contracting sexually transmitted infections during sexual activity, but safer sex cannot be considered to provide complete protection from an STI. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles , needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk. It
1298-464: A district in Paris formerly known as "Le Clapiers". This is where the prostitutes were to be found at that time. Prior to the invention of modern medicines, sexually transmitted infections were generally incurable, and treatment was limited to treating the symptoms of the infection. The first voluntary hospital for STIs was founded in 1746 at London Lock Hospital . Treatment was not always voluntary: in
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#17327653335351416-399: A form of chemotherapy , elemental mercury had been used to treat skin diseases in Europe as early as 1363. As syphilis spread, preparations of mercury were among the first medicines used to combat it. Mercury is in fact highly anti-microbial: by the 16th century it was sometimes found to be sufficient to halt development of the disease when applied to ulcers as an inunction or when inhaled as
1534-402: A higher risk of HIV infection. There is evidence that vaginal dapivirine probably reduces HIV in women who have sex with men, other types of vaginal microbicides have not demonstrated effectiveness for HIV or STIs. There is little evidence that school-based interventions such as sexual and reproductive health education programmes on contraceptive choices and condoms are effective on improving
1652-504: A mortal sin in medieval times. It remains mysterious why the authors of medieval medical treatises so uniformly refrained from describing syphilis or commenting on its existence in the population. Many may have confused it with other diseases such as leprosy ( Hansen's disease ) or elephantiasis . The great variety of symptoms of treponematosis, the different ages at which the various diseases appear, and its widely divergent outcomes depending on climate and culture, would have added greatly to
1770-461: A mortality rate of 8% to 58%, with a greater death rate among males. The symptoms of syphilis have become less severe over the 19th and 20th centuries, in part due to widespread availability of effective treatment, and partly due to virulence of the bacteria. With early treatment, few complications result. Syphilis increases the risk of HIV transmission by two to five times, and coinfection is common (30–60% in some urban centers). In 2015, Cuba became
1888-441: A number of reasons: Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of
2006-417: A pregnant woman may be passed on to the infant before or after birth. Sexually transmitted infections include: Twenty-seven different viruses have been identified in semen. Information on whether or not transmission occurs or whether the viruses cause disease is uncertain. Some of these microbes are known to be sexually transmitted. Many STIs are (more easily) transmitted through the mucous membranes of
2124-416: A public perception during the 1960s and 1970s that they have ceased to be a serious medical threat. During this period, the importance of contact tracing in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts, in turn, STI clinics could effectively suppress infections in the general population. In
2242-561: A serious epidemic in Naples beginning as early as 1495. Contemporaries believed the disease sprang from American roots, and in the 16th century physicians wrote extensively about the new disease inflicted on them by the returning explorers. Most evidence supports the Columbian origin hypothesis. However, beginning in the 1960s, examples of probable treponematosis —the parent disease of syphilis, bejel , and yaws —in skeletal remains shifted
2360-418: A single area (a patch) or may be in several places. Some distributions correlate with the means by which a given area becomes affected. For example, contact dermatitis correlates with locations where allergen has elicited an allergic immune response. Varicella zoster virus is known to recur (after its initial presentation as chicken pox ) as herpes zoster ("shingles"). Chicken pox appears nearly everywhere on
2478-446: A single dose of intramuscular benzathine benzylpenicillin . The bacterium is highly vulnerable to penicillin when treated early, and a treated individual is typically rendered non-infective in about 24 hours. Doxycycline and tetracycline are alternative choices for those allergic to penicillin; due to the risk of birth defects , these are not recommended for pregnant women. Resistance to macrolides , rifampicin , and clindamycin
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#17327653335352596-470: A single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders approximately 0.3–3.0 cm in size. The lesion may take on almost any form. In the classic form, it evolves from a macule to a papule and finally to an erosion or ulcer . Occasionally, multiple lesions may be present (~40%), with multiple lesions being more common when coinfected with HIV. Lesions may be painful or tender (30%), and they may occur in places other than
2714-520: A slow doubling time of greater than 30 hours. The bacterium is known for its ability to evade the immune system and its invasiveness. Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her baby; the bacterium is able to pass through intact mucous membranes or compromised skin. It is thus transmissible by kissing near a lesion, as well as manual , oral , vaginal , and anal sex . Approximately 30% to 60% of those exposed to primary or secondary syphilis will get
2832-496: A taboo. The magnitude of its morbidity and mortality in those centuries reflected that, unlike today, there was no adequate understanding of its pathogenesis and no truly effective treatments. Its damage was caused not so much by great sickness or death early in the course of the disease but rather by its gruesome effects decades after infection as it progressed to neurosyphilis with tabes dorsalis . Mercury compounds and isolation were commonly used, with treatments often worse than
2950-415: A third of infected people develop tertiary disease. People with tertiary syphilis are not infectious. Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gummas , which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect
3068-465: Is Albrecht Dürer 's Syphilitic Man (1496), a woodcut believed to represent a Landsknecht , a Northern European mercenary . The myth of the femme fatale or "poison women" of the 19th century is believed to be partly derived from the devastation of syphilis, with classic examples in literature including John Keats ' " La Belle Dame sans Merci ". Sexually transmitted infection A sexually transmitted infection ( STI ), also referred to as
3186-575: Is benzathine benzylpenicillin injected into a muscle . In those who have a severe penicillin allergy , doxycycline or tetracycline may be used. In those with neurosyphilis , intravenous benzylpenicillin or ceftriaxone is recommended. During treatment people may develop fever, headache, and muscle pains , a reaction known as Jarisch–Herxheimer . In 2015, about 45.4 million people had syphilis infections, of which six million were new cases. During 2015, it caused about 107,000 deaths, down from 202,000 in 1990. After decreasing dramatically with
3304-619: Is a notifiable disease in many countries, including Canada, the European Union , and the United States. This means health care providers are required to notify public health authorities, which will then ideally provide partner notification to the person's partners. Physicians may also encourage patients to send their partners to seek care. Several strategies have been found to improve follow-up for STI testing, including email and text messaging of reminders for appointments. As
3422-469: Is a layer of fat between the dermis and underlying fascia . This tissue may be further divided into two components, the actual fatty layer, or panniculus adiposus , and a deeper vestigial layer of muscle, the panniculus carnosus . The main cellular component of this tissue is the adipocyte , or fat cell. The structure of this tissue is composed of septal (i.e. linear strands) and lobular compartments, which differ in microscopic appearance. Functionally,
3540-454: Is advised to assure maximal protection. The development of vaccines to protect against gonorrhea is ongoing. Condoms and female condoms only provide protection when used properly as a barrier, and only to and from the area that they cover. Uncovered areas are still susceptible to many STIs. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin; therefore, properly shielding
3658-595: Is also associated with miscarriage . The main dental defects seen in congenital syphilis are the peg-shaped, notched incisors known as Hutchinson's teeth and so-called mulberry molars (also known as Moon or Fournier molars), defective permanent molars with rounded, deformed crowns resembling a mulberry . Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative , highly mobile bacterium. Two other human diseases are caused by related Treponema pallidum subspecies, yaws (subspecies pertenue ) and bejel (subspecies endemicum ), and one further caused by
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3776-562: Is believed to have infected 12 million additional people, with greater than 90% of cases in the developing world . It affects between 700,000 and 1.6 million pregnancies a year, resulting in spontaneous abortions , stillbirths , and congenital syphilis. During 2015, it caused about 107,000 deaths, down from 202,000 in 1990. In sub-Saharan Africa , syphilis contributes to approximately 20% of perinatal deaths . Rates are proportionally higher among intravenous drug users , those who are infected with HIV , and men who have sex with men. In
3894-475: Is directed at a person's risk, the situations in which risk occurs, and the use of personalized goal-setting strategies. The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. Not all sexual activities involve contact: cybersex , phone sex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk. Although
4012-503: Is divided into early latent and late latent stages. Early latent syphilis is defined by the World Health Organization as less than 2 years after original infection. Early latent syphilis is infectious as up to 25% of people can develop a recurrent secondary infection (during which bacteria are actively replicating and are infectious). Two years after the original infection the person will enter late latent syphilis and
4130-586: Is effective at reducing the transmission of syphilis. The CDC states, "The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected." Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected. The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women, while
4248-442: Is most commonly spread through sexual activity . It may also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis . Other diseases caused by Treponema bacteria include yaws ( T. pallidum subspecies pertenue ), pinta ( T. carateum ), and nonvenereal endemic syphilis ( T. pallidum subspecies endemicum ). These three diseases are not typically sexually transmitted. Diagnosis
4366-552: Is most effective if provided in a nonjudgmental and empathetic manner appropriate to the person's culture, language, gender, sexual orientation, age, and developmental level. Prevention counseling for STIs is usually offered to all sexually active adolescents and to all adults who have received a diagnosis, have had an STI in the past year, or have multiple sex partners . Vaccines are available that protect against some viral STIs, such as hepatitis A , hepatitis B , and some types of HPV . Vaccination before initiation of sexual contact
4484-425: Is not as infectious as the early phase. The latent phase of syphilis can last many years after which, without treatment, approximately 15-40% of people can develop tertiary syphilis. Tertiary syphilis may occur approximately 3 to 15 years after the initial infection and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment,
4602-553: Is not generally possible to contract syphilis through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing. This is mainly because the bacteria die very quickly outside of the body, making transmission by objects extremely difficult. Syphilis is difficult to diagnose clinically during early infection. Confirmation is either via blood tests or direct visual inspection using dark field microscopy . Blood tests are more commonly used, as they are easier to perform. Diagnostic tests are unable to distinguish between
4720-446: Is often present. Ceftriaxone , a third-generation cephalosporin antibiotic , may be as effective as penicillin-based treatment. It is recommended that a treated person avoid sex until the sores are healed. In comparison to azithromycin for treatment in early infection, there is lack of strong evidence for superiority of azithromycin to benzathine penicillin G. For neurosyphilis, due to the poor penetration of benzathine penicillin into
4838-477: Is possible to be an asymptomatic carrier of sexually transmitted infections. In particular, sexually transmitted infections in women often cause the serious condition of pelvic inflammatory disease. Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis , trichomonas , gonorrhea, chlamydia , herpes , hepatitis , and HIV . No procedure tests for all infectious agents. STI tests may be used for
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4956-411: Is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to their partner without the health care provider first examining the partner. In term of preventing reinfection in sexually transmitted infection, treatment with both patient and the sexual partner of patient resulted in more successful than treatment of the patient without
5074-423: Is used for each act of intercourse, as multiple usages increase the chance of breakage, defeating the effectiveness as a barrier. In the case of female condoms, the device consists of two rings, one in each terminal portion. The larger ring should fit snugly over the cervix and the smaller ring remains outside the vagina, covering the vulva. This system provides some protection of the external genitalia. The cap
5192-412: Is usually made by using blood tests ; the bacteria can also be detected using dark field microscopy . The Centers for Disease Control and Prevention (U.S.) recommends for all pregnant women to be tested. The risk of sexual transmission of syphilis can be reduced by using a latex or polyurethane condom . Syphilis can be effectively treated with antibiotics . The preferred antibiotic for most cases
5310-669: The Ebers Papyrus ( c. 1550 BCE ) and the Hebrew Bible / Old Testament (8th/7th C. BCE). Not all STIs are symptomatic , and symptoms may not appear immediately after infection. In some instances a disease can be carried with no symptoms, which leaves a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to infertility , chronic pain or death. The presence of an STI in prepubescent children may indicate sexual abuse . A sexually transmitted infection present in
5428-420: The World Health Organization (WHO) recommends all women be tested at their first antenatal visit and again in the third trimester . If they are positive, it is recommended their partners also be treated. Congenital syphilis is still common in the developing world, as many women do not receive antenatal care at all, and the antenatal care others receive does not include screening. It still occasionally occurs in
5546-401: The central nervous system , those affected are given large doses of intravenous penicillin G for a minimum of 10 days. If a person is allergic to penicillin, ceftriaxone may be used or penicillin desensitization attempted. Other late presentations may be treated with once-weekly intramuscular benzathine penicillin for three weeks. Treatment at this stage solely limits further progression of
5664-591: The cerebrospinal fluid in the setting of a known syphilis infection. Dark field microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. Hospitals do not always have equipment or experienced staff members, and testing must be done within 10 minutes of acquiring the sample. Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody (DFA) and polymerase chain reaction (PCR) tests. DFA uses antibodies tagged with fluorescein , which attach to specific syphilis proteins, while PCR uses techniques to detect
5782-494: The developing world . There is often shame and stigma associated with STIs. In 2015, STIs other than HIV resulted in 108,000 deaths worldwide. Globally, in 2015, about 1.1 billion people had STIs other than HIV/AIDS. About 500 million have either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million have genital herpes, and 290 million women have human papillomavirus . Historical documentation of STIs in antiquity dates back to at least
5900-408: The eccrine and apocrine glands . The dermis contains two vascular networks that run parallel to the skin surface—one superficial and one deep plexus—which are connected by vertical communicating vessels. The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing. The subcutaneous tissue
6018-414: The ectoderm , which is chemically influenced by the underlying mesoderm that forms the dermis and subcutaneous tissues. The epidermis is the most superficial layer of skin, a squamous epithelium with several strata : the stratum corneum , stratum lucidum , stratum granulosum , stratum spinosum , and stratum basale . Nourishment is provided to these layers via diffusion from the dermis, since
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#17327653335356136-438: The epidermis , dermis , and subcutaneous tissue . The two main types of human skin are glabrous skin , the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin. Within the latter type, hairs in structures called pilosebaceous units have a hair follicle , sebaceous gland , and associated arrector pili muscle. In the embryo , the epidermis, hair, and glands are from
6254-437: The papillary dermis and the reticular dermis . The superficial papillary dermis interdigitates with the overlying rete ridges of the epidermis, between which the two layers interact through the basement membrane zone. Structural components of the dermis are collagen , elastic fibers , and ground substance also called extra fibrillar matrix. Within these components are the pilosebaceous units, arrector pili muscles, and
6372-495: The penis , vulva , rectum , urinary tract and (less often—depending on type of infection) the mouth , throat , respiratory tract and eyes . The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body. The amount of contact with infective sources which causes infection varies with each pathogen but in all cases,
6490-449: The 1980s, first genital herpes and then AIDS emerged into the public consciousness as sexually transmitted infections that could not be cured by modern medicine. AIDS, in particular, has a long asymptomatic period—during which time HIV (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to others—followed by a symptomatic period, which leads rapidly to death unless treated. HIV/AIDS entered
6608-687: The Americas and Europe. Approximately two billion people worldwide have been infected with the hepatitis B virus. The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples in the Italian War of 1494–98 . The disease may have originated from the Columbian Exchange . From Naples, the disease swept across Europe , killing more than five million people. As Jared Diamond describes it, "[W]hen syphilis
6726-637: The US, Canada, the UK, Australia and Europe, primarily among men who have sex with men. Rates of syphilis among US women have remained stable during this time, while rates among UK women have increased, but at a rate less than that of men. Increased rates among heterosexuals have occurred in China and Russia since the 1990s. This has been attributed to unsafe sexual practices, such as sexual promiscuity, prostitution, and decreasing use of barrier protection. Left untreated, it has
6844-492: The United States about 55,400 people are newly infected each year as of 2014. African Americans accounted for almost half of all cases in 2010. As of 2014, syphilis infections continue to increase in the United States. In the United States as of 2020, rates of syphilis have increased by more than threefold; in 2018 approximately 86% of all cases of syphilis in the United States were in men. In 2021, preliminary CDC data illustrated that 2,677 cases of congenital syphilis were found in
6962-414: The United States from Haiti in about 1969. Recognition that AIDS threatened a global pandemic led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection. Macule Conditions of
7080-587: The United States there were 19 million new cases of sexually transmitted infections in 2010. In 2010, 19 million new cases of sexually transmitted infections occurred in women in the United States. A 2008 CDC study found that 25–40% of U.S. teenage girls has a sexually transmitted infection. Out of a population of almost 295,270,000 people there were 110 million new and existing cases of eight sexually transmitted infections. Over 400,000 sexually transmitted infections were reported in England in 2017, about
7198-559: The absolute number of cases is not large, new ones are continually discovered, most recently in 2015. At least fifteen cases of acquired treponematosis based on evidence from bones, and six examples of congenital treponematosis based on evidence from teeth, are now widely accepted. In several of the twenty-one cases the evidence may also indicate syphilis. In 2020, a group of leading paleopathologists concluded that enough evidence had been collected to prove that treponemal disease, almost certainly including syphilis, had existed in Europe prior to
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#17327653335357316-473: 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 human immunodeficiency virus (HIV). This is believed to be partly due to unsafe drug use, increased prostitution , and decreased use of condoms . Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary, and may also occur congenitally . There may be no symptoms . It
7434-554: The bacterium responsible for treponematosis is rare in skeletal remains and fragile, making it notoriously difficult to recover and analyze. Precise dating to the medieval period is not yet possible but work by Kettu Majander et al. uncovering the presence of several different kinds of treponematosis at the beginning of the early modern period argues against its recent introduction from elsewhere. Therefore, they argue, treponematosis—possibly including syphilis—almost certainly existed in medieval Europe. Despite significant progress in tracing
7552-526: The confusion of medical practitioners, as indeed they did right down to the middle of the 20th century. In addition, evidence indicates that some writers on disease feared the political implications of discussing a condition more fatal to elites than to commoners. Historian Jon Arrizabalaga has investigated this question for Castile with startling results revealing an effort to hide its association with elites. The first written records of an outbreak of syphilis in Europe occurred in 1495 in Naples, Italy , during
7670-602: The developed world, as those most likely to acquire syphilis are least likely to receive care during pregnancy. Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries. Point-of-care testing to detect syphilis appeared to be reliable, although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies. The CDC recommends that sexually active men who have sex with men be tested at least yearly. The USPSTF also recommends screening among those at high risk. Syphilis
7788-522: The diagnosis. Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s). With regard to morphology, the initial lesion that characterizes a condition is known as the "primary lesion", and identification of such a lesions is the most important aspect of the cutaneous examination. Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing "secondary lesions". However, with that being stated,
7906-496: The disease and has a limited effect on damage which has already occurred. Serologic cure can be measured when the non-treponemal titers decline by a factor of 4 or more in 6–12 months in early syphilis or 12–24 months in late syphilis. One of the potential side effects of treatment is the Jarisch–Herxheimer reaction . It frequently starts within one hour and lasts for 24 hours, with symptoms of fever, muscle pains, headache, and
8024-399: The disease via sexual contact also led to victims being infected with a massive bacterial load from open sores on the genitalia. Adults in higher socioeconomic groups then became very sick with painful and debilitating symptoms lasting for decades. Often, they died of the disease, as did their children who were infected with congenital syphilis. The difference between rural and urban populations
8142-460: The disease. The causative organism, Treponema pallidum , was first identified by Fritz Schaudinn and Erich Hoffmann , in 1905. The first effective treatment for syphilis was arsphenamine , discovered by Sahachiro Hata in 1909, during a survey of hundreds of newly synthesized organic arsenical compounds led by Paul Ehrlich . It was manufactured and marketed from 1910 under the trade name Salvarsan by Hoechst AG . This organoarsenic compound
8260-499: The disease. Its infectivity is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected. Most new cases in the United States (60%) occur in men who have sex with men; and in this population 20% of syphilis cases were due to oral sex alone. Syphilis can be transmitted by blood products , but the risk is low due to screening of donated blood in many countries. The risk of transmission from sharing needles appears to be limited. It
8378-409: The epidermis is without direct blood supply. The epidermis contains four cell types: keratinocytes , melanocytes , Langerhans cells , and Merkel cells . Of these, keratinocytes are the major component, constituting roughly 95% of the epidermis. This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through
8496-482: The fearsome and sordid status of sexually transmitted infections in those centuries. According to a 2020 study, more than 20% of individuals in the age range 15–34 years in late 18th-century London were treated for syphilis. At the time the causative agent was unknown but it was well known that it was spread sexually and also often from mother to child. Its association with sex, especially sexual promiscuity and prostitution , made it an object of fear and revulsion and
8614-427: The first country to eliminate mother-to-child transmission of syphilis. Paleopathologists have known for decades that syphilis was present in the Americas before European contact. The situation in Europe and Afro-Eurasia has been murkier and caused considerable debate. According to the Columbian theory, syphilis was brought to Spain by the men who sailed with Christopher Columbus in 1492 and spread from there, with
8732-451: The genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally in men who have sex with men (34%). Lymph node enlargement frequently (80%) occurs around the area of infection, occurring seven to 10 days after chancre formation. The lesion may persist for three to six weeks if left untreated. Secondary syphilis occurs approximately four to ten weeks after
8850-468: The genitals , and pelvic pain . Some STIs can cause infertility . Bacterial STIs include chlamydia , gonorrhea , and syphilis . Viral STIs include genital warts , genital herpes , and HIV/AIDS . Parasitic STIs include trichomoniasis . Most STIs are treatable and curable, of the most common infections; syphilis, gonorrhea, chlamydia, and trichomoniasis are curable, while HIV/AIDS and genital herpes are not curable. Some vaccinations may decrease
8968-530: The human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails ). While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described. Classification of these conditions often presents many nosological challenges, since underlying causes and pathogenetics are often not known. Therefore, most current textbooks present
9086-591: The infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems. Until the 1990s, STIs were commonly known as venereal diseases , an antiquated euphemism derived from the Latin venereus , being the adjectival form of Venus , the Roman goddess of love. However, in
9204-534: The infection. It may occur early, being either asymptomatic or in the form of syphilitic meningitis ; or late as meningovascular syphilis, manifesting as general paresis or tabes dorsalis . Meningovascular syphilis involves inflammation of the small and medium arteries of the central nervous system. It can present between 1–10 years after the initial infection. Meningovascular syphilis is characterized by stroke, cranial nerve palsies and spinal cord inflammation . Late symptomatic neurosyphilis can develop decades after
9322-576: The lack of standardization of basic dermatologic terminology has been one of the principal barriers to successful communication among physicians in describing cutaneous findings. Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below. "Configuration" refers to how lesions are locally grouped ("organized"), which contrasts with how they are distributed (see next section). "Distribution" refers to how lesions are localized. They may be confined to
9440-513: The leading causes of death in present-day Sub-Saharan Africa . HIV/AIDS is transmitted primarily via unprotected sexual intercourse. More than 1.1 million persons are living with HIV/AIDS in the United States , and it disproportionately impacts African Americans . Hepatitis B is also considered a sexually transmitted infection because it can be spread through sexual contact. The highest rates are found in Asia and Africa and lower rates are in
9558-464: The most typical deformities, for example, is a collapsed nasal bridge called saddle nose . Salmon discovered that it appeared often in medieval illuminations , especially among the men tormenting Christ in scenes of the crucifixion. The association of saddle nose with men perceived to be so evil they would kill the son of God indicates the artists were thinking of syphilis, which is typically transmitted through sexual intercourse with promiscuous partners,
9676-464: The opinion of some towards a "pre-Columbian" origin. When living conditions changed with urbanization, elite social groups began to practice basic hygiene and started to separate themselves from other social tiers. Consequently, treponematosis was driven out of the age group in which it had become endemic. It then began to appear in adults as syphilis. Because they had never been exposed as children, they were not able to fend off serious illness. Spreading
9794-492: The optic nerve , uveitis , and interstitial keratitis . The acute symptoms usually resolve after three to six weeks; about 25% of people may present with a recurrence of secondary symptoms. Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having had the classical chancre of primary syphilis. Latent syphilis is defined as having serologic proof of infection without symptoms of disease. It develops after secondary syphilis and
9912-486: The original infection and includes 2 types; general paresis and tabes dorsalis. General paresis presents with dementia, personality changes, delusions, seizures, psychosis and depression. Tabes dorsalis is characterized by gait instability, sharp pains in the trunk and limbs, impaired positional sensation of the limbs as well as having a positive Romberg's sign . Both tabes dorsalis and general paresis may present with Argyll Robertson pupil which are pupils that constrict when
10030-428: The penis with a properly worn condom from the vagina or anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact. This can be avoided simply by not engaging in sexual contact when presenting open, bleeding wounds. Other STIs, even viral infections, can be prevented with
10148-669: The person focuses on near objects ( accommodation reflex ) but do not constrict when exposed to bright light ( pupillary reflex ). Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that develop over the first couple of years of life include enlargement of the liver and spleen (70%), rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higouménakis' sign , saber shin , or Clutton's joints among others. Infection during pregnancy
10266-487: The person return the test for follow-up. Other facilities strongly encourage that those previously infected return to ensure that the infection has been eliminated. Novel strategies to foster re-testing have been the use of text messaging and email as reminders. These types of reminders are now used in addition to phone calls and letters. After obtaining a sexual history, a healthcare provider can encourage risk reduction by providing prevention counseling . Prevention counseling
10384-400: The population of 332 million in the United States. Syphilis was very common in Europe during the 18th and 19th centuries. Flaubert found it universal among 19th-century Egyptian prostitutes. In the developed world during the early 20th century, infections declined rapidly with the widespread use of antibiotics , until the 1980s and 1990s. Since 2000, rates of syphilis have been increasing in
10502-496: The possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, such as Treponema pallidum particle agglutination assay (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). Treponemal antibody tests usually become positive two to five weeks after the initial infection and remain positive for many years. Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes ) and high protein levels in
10620-493: The post-classical education era the euphemistic effect was entirely lost, and the common abbreviation "VD" held only negative connotations. Other former euphemisms for STIs include "blood diseases" and "social diseases". The present euphemism is in the use of the initials "STI" rather than in the words they represent. The World Health Organization (WHO) has recommended the more inclusive term sexually transmitted infection since 1999. Public health officials originally introduced
10738-411: The presence of specific syphilis genes . These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis. As of 2018, there is no vaccine effective for prevention. Several vaccines based on treponemal proteins reduce lesion development in an animal model but research continues. Condom use reduces the likelihood of transmission during sex, but does not eliminate
10856-414: The presence of syphilis in past historic periods, definitive findings from paleopathology and aDNA studies are still lacking for the medieval period. Evidence from art is therefore helpful in settling the issue. Research by Marylynn Salmon has demonstrated that deformities in medieval subjects can be identified by comparing them to those of modern victims of syphilis in medical drawings and photographs. One of
10974-416: The prevailing more judgemental view and published her own research on improving sex education and maternity care. The first effective treatment for a sexually transmitted infection was salvarsan , a treatment for syphilis. With the discovery of antibiotics , a large number of sexually transmitted infections became easily curable, and this, combined with effective public health campaigns against STIs, led to
11092-739: The primary infection. While secondary disease is known for the many different ways it can manifest, symptoms most commonly involve the skin , mucous membranes , and lymph nodes . There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles. The rash may become maculopapular or pustular . It may form flat, broad, whitish, wart-like lesions on mucous membranes, known as condyloma latum . All of these lesions harbor bacteria and are infectious. Other symptoms may include fever , sore throat , malaise , weight loss , hair loss , and headache . Rare manifestations include liver inflammation , kidney disease, joint inflammation , periostitis , inflammation of
11210-443: The recommended method of diagnosis for gonorrhea and chlamydia. This can be done on either urine in both men and women, vaginal or cervical swabs in women, or urethral swabs in men. Screening can be performed: In the case of rape, the person can be treated prophylacticly with antibiotics. An option for treating partners of patients ( index cases ) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy , which
11328-436: The risk of certain infections including hepatitis B and few types of HPV . Safe sex practices such as use of condoms , having smaller number of sexual partners, and being in a relationship in which each person only has sex with the other also decreases STIs risk. Comprehensive sex education may also be useful. STI diagnostic tests are usually easily available in the developed world , but they are often unavailable in
11446-450: The risk. The Centers for Disease Control and Prevention (CDC) states, "Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected. However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom." Abstinence from intimate physical contact with an infected person
11564-407: The same as in 2016, but there were more than 20% increases in confirmed cases of gonorrhoea and syphilis. Since 2008 syphilis cases have risen by 148%, from 2,874 to 7,137, mostly among men who have sex with men . The number of first cases of genital warts in 2017 among girls aged 15–17 years was just 441, 90% less than in 2009 – attributed to the national HPV immunisation programme. AIDS is among
11682-658: The second half of the 19th century, the Contagious Diseases Acts were used to arrest suspected prostitutes. In 1924, a number of states concluded the Brussels Agreement , whereby states agreed to provide free or low-cost medical treatment at ports for merchant seamen with STIs. A proponent of these approaches was Nora Wattie , OBE, Venereal Diseases Officer in Glasgow from 1929, encouraged contact tracing and volunteering for treatment, rather than
11800-576: The sexual and reproductive health of adolescents. Incentive-based programmes may reduce adolescent pregnancy but more data is needed to confirm this. Specific age groups, persons who participate in risky sexual behavior, or those have certain health conditions may require screening. The CDC recommends that sexually active women under the age of 25 and those over 25 at risk should be screened for chlamydia and gonorrhea yearly. Appropriate times for screening are during regular pelvic examinations and preconception evaluations. Nucleic acid amplification tests are
11918-501: The sexual partner. There is no difference in reinfection prevention whether the sexual partner treated with medication without medical examination or after notification by patient. In 2008, it was estimated that 500 million people were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus (HPV). STIs other than HIV resulted in 142,000 deaths in 2013. In
12036-410: The skin and its appendages, as well as the mucous membranes, forms the cornerstone of an accurate diagnosis of cutaneous conditions. Most of these conditions present with cutaneous surface changes termed "lesions," which have more or less distinct characteristics. Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm
12154-439: The skin, bone, and liver, but can occur anywhere. Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complication is syphilitic aortitis , which may result in aortic aneurysm formation. Neurosyphilis refers to an infection involving the central nervous system . Involvement of the central nervous system in syphilis (either asymptomatic or symptomatic) can occur at any stage of
12272-514: The stages of the disease. Blood tests are divided into nontreponemal and treponemal tests. Nontreponemal tests are used initially and include venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) tests. False positives on the nontreponemal tests can occur with some viral infections, such as varicella (chickenpox) and measles . False positives can also occur with lymphoma , tuberculosis , malaria , endocarditis , connective tissue disease , and pregnancy . Because of
12390-442: The stratum spinosum to the stratum corneum, where cells are continually shed from the surface. In normal skin, the rate of production equals the rate of loss; about two weeks are needed for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum. The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections,
12508-417: The subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source. Diseases of the skin include skin infections and skin neoplasms (including skin cancer ). In 1572, Geronimo Mercuriali of Forlì , Italy , completed De morbis cutaneis ('On the diseases of the skin'). It is considered the first scientific work dedicated to dermatology . The physical examination of
12626-497: The term sexually transmitted infection , which clinicians are increasingly using alongside the term sexually transmitted disease in order to distinguish it from the former. Strategies for reducing STI risk include: vaccination, mutual monogamy , reducing the number of sexual partners, and abstinence. Also potentially helpful is behavioral counseling for sexually active adolescents and for adults who are at increased risk. Such interactive counseling, which can be resource-intensive,
12744-485: The title of his Latin poem in dactylic hexameter Syphilis sive morbus gallicus ( Syphilis or The French Disease ) describing the ravages of the disease in Italy. In Great Britain it was also called the "Great Pox". In the 16th through 19th centuries, syphilis was one of the largest public health burdens in prevalence , symptoms, and disability, although records of its true prevalence were generally not kept because of
12862-470: The treponemal diseases is pinta , a skin disease and therefore unrecoverable through paleopathology.) Ancient DNA (aDNA) holds the answer, because just as only aDNA suffices to distinguish between syphilis and other diseases that produce similar symptoms in the body, it alone can differentiate spirochetes that are 99.8 percent identical with absolute accuracy. Progress on uncovering the historical extent of syndromes through aDNA remains slow, however, because
12980-438: The use of latex, polyurethane or polyisoprene condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms but are still too large to pass through latex or synthetic condoms. Proper male condom usage entails: In order to best protect oneself and the partner from STIs, the old condom and its contents are to be treated as infectious and properly disposed of. A new condom
13098-400: The very closely related Treponema carateum , pinta . Unlike subspecies pallidum , they do not cause neurological disease. Humans are the only known natural reservoir for subspecies pallidum . It is unable to survive more than a few days without a host . This is due to its small genome (1.14 Mbp ) failing to encode the metabolic pathways necessary to make most of its macronutrients. It has
13216-503: The voyages of Columbus. There is an outstanding issue, however. Damaged teeth and bones may seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to an endemic form of treponemal disease instead. As syphilis, bejel, and yaws vary considerably in mortality rates and the level of human disease they elicit, it is important to know which one is under discussion in any given case, but it remains difficult for paleopathologists to distinguish among them. (The fourth of
13334-469: Was confirmed in trials in 1943, at which time it became the main treatment. Many famous historical figures, including Franz Schubert , Arthur Schopenhauer , Édouard Manet , Charles Baudelaire , and Guy de Maupassant are believed to have had the disease. Friedrich Nietzsche was long believed to have gone mad as a result of tertiary syphilis , but that diagnosis has recently come into question. The earliest known depiction of an individual with syphilis
13452-506: Was developed after the cervical diaphragm . Both cover the cervix and the main difference between the diaphragm and the cap is that the latter must be used only once, using a new one in each sexual act. The diaphragm, however, can be used more than once. These two devices partially protect against STIs (they do not protect against HIV). Researchers had hoped that nonoxynol-9 , a vaginal microbicide would help decrease STI risk. Trials, however, have found it ineffective and it may put women at
13570-433: Was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months," rendering it far more fatal than it is today. Diamond concludes, "[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." Gonorrhea is recorded at least up to 700 years ago and associated with
13688-505: Was first noted by Ellis Herndon Hudson, a clinician who published extensively about the prevalence of treponematosis, including syphilis, in times past. The importance of bacterial load was first noted by the physician Ernest Grin in 1952 in his study of syphilis in Bosnia. The most compelling evidence for the validity of the pre-Columbian hypothesis is the presence of syphilitic-like damage to bones and teeth in medieval skeletal remains. While
13806-407: Was referred to as "the great imitator" by Sir William Osler due to its varied presentations. Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person. Approximately 2–6 weeks after contact (with a range of 10–90 days) a skin lesion, called a chancre , appears at the site and this contains infectious bacteria. This is classically (40% of the time)
13924-449: Was the first modern chemotherapeutic agent . During the 20th century, as both microbiology and pharmacology advanced greatly, syphilis, like many other infectious diseases, became more of a manageable burden than a scary and disfiguring mystery, at least in developed countries among those people who could afford to pay for timely diagnosis and treatment. Penicillin was discovered in 1928, and effectiveness of treatment with penicillin
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