Congenital Syphilis

[Teresam]

She had 2 healthy boys then between 1844 and 1855 three deaths all of girls aged about two and one girl who lived. There is also another dead child but when it died I have yet to find out. After 1855 4 more children who lived. In 1881 she was admitted to Hanwell Asylum, Religious mania is mentioned and she died in 1882 of Melancholis, Exhaustionand Diarrhoea.

[scousecan]

Hi folks I researched this (it's long but thorough) My source is the Merck's Manual. Hope it answers more questions! You will note the Pareitic form hits people in their forties and fifties!
Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum.
It begins with a painless sore at the infection site and, in the second stage, causes a rash, fever, fatigue, and loss of appetite. If untreated, syphilis can damage the heart, brain, spinal cord, and other organs.
Doctors usually do two types of blood tests—one to screen for and one to confirm the infection. Penicillin can eliminate the infection, but people can be reinfected.
Symptoms have three stages (primary, secondary, and tertiary), separated by periods when no symptoms occur (latent stages).
Syphilis is highly contagious during the primary and secondary stages. Infection is usually spread through sexual contact. A single sexual encounter with a person who has early-stage syphilis results in infection about one third of the time. The bacteria enter the body through mucous membranes, such as those in the vagina or mouth, or through the skin. Within hours, the bacteria reach nearby lymph nodes, then spread throughout the body through the bloodstream.
Syphilis can also be spread in other ways. It can infect a fetus during pregnancy (see Problems in Newborns: Some Infections of Newborns), causing birth defects and other problems. It can also be spread through contact with skin. However, the bacteria cannot survive long outside the human body.

Symptoms

With each stage, symptoms become progressively worse. If not treated, syphilis can persist without symptoms for many years and may damage the heart or brain, possibly leading to death. If detected and treated early, syphilis can be cured, and there is no permanent damage.

Primary Stage: A painless sore (called a chancre) appears at the infection site—typically the penis, vulva, or vagina. A chancre may also appear on the anus, rectum, lips, tongue, throat, cervix, fingers, or other parts of the body. Usually only one chancre develops, but occasionally, several develop. Symptoms usually start 3 to 4 weeks after infection but may start from 1 to 13 weeks later.

The chancre begins as a small red raised area, which soon turns into a painless open, deep sore. The chancre does not bleed and is hard to the touch. Lymph nodes in the groin usually swell and are also painless. About half of infected women and one third of infected men are unaware of the chancre because it causes few symptoms. Chancres in the rectum or mouth, usually occurring in homosexual men, are often unnoticed. The chancre usually heals in 3 to 12 weeks. Then, people appear to be completely healthy.

Secondary Stage: The bacteria spread in the bloodstream, causing a widespread rash, swollen lymph nodes, and, less commonly, symptoms in other organs. The rash typically appears 6 to 12 weeks after infection. About one fourth of infected people still have a chancre at this time. Usually, the rash does not itch or hurt. It varies in appearance. Unlike rashes caused by most other diseases, this rash commonly appears on the palms or soles. It may be short-lived or may last for months. Even without treatment, the rash eventually resolves, but it may recur weeks or months later. If a rash develops on the scalp, hair may fall out in patches, making it appear moth-eaten.

Raised bumps called papules (condylomata lata) may develop in moist areas of the skin, such as the armpits, genital area, and anus. These painful papules are very infectious. They may break open and weep. As they resolve, they flatten and turn a dull pink or gray. Mouth sores develop in more than 80% of people.

Secondary-stage syphilis can cause fever, fatigue, loss of appetite, and weight loss. About 50% of people have enlarged lymph nodes throughout the body, and in about 10%, the eyes become inflamed. About 10% of people have inflamed bones and joints that ache. In some people, the skin and whites of the eyes turn yellow (called jaundice) because hepatitis develops. Some have headaches or problems with hearing or vision because the brain, inner ears, or eyes are infected.

Latent Stage: After the secondary stage, people recover and have no symptoms for a time, which may last from years to decades. During this time, the infection is inactive (latent) and is not contagious. However, the bacteria are still present, and tests for syphilis are positive. The latent stage is classified as early (if the initial infection occurred within the previous 12 months) or late (if the initial infection occurred more than 12 months previously).

Tertiary Stage: Symptoms range from mild to devastating. Tertiary syphilis has three main forms: benign tertiary syphilis, cardiovascular syphilis, and neurosyphilis.

Benign tertiary syphilis usually develops 3 to 10 yrs after the initial infection. It is rare today. Soft, rubbery growths called gummas appear on the skin, most commonly on the scalp, face, upper trunk, and legs. They also often develop in the liver or bones, but they can develop in virtually any organ. They may break down, forming an open sore. If untreated, gummas destroy the tissue around them. In bone, they usually cause deep, penetrating pain. Gummas grow slowly, heal gradually, and leave scars.

Cardiovascular syphilis usually appears 10 to 25 years after the initial infection. The bacteria infect the heart and the blood vessels connected to it, including the aorta (the largest artery in the body). The following may result:

The wall of the aorta may weaken, forming a bulge (aneurysm). The aneurysm may press on the windpipe or other structures in the chest, causing difficulty breathing, a cough, and hoarseness.
The valve leading from the heart to the aorta (aortic valve) may leak.
The arteries that carry blood to the heart (coronary arteries) may narrow.

These problems can cause chest pain, heart failure, and death.

Neurosyphilis (which affects the brain and spinal cord) occurs during the first 5 to 10 years after infection. It develops in about 5% of all people with untreated syphilis. It occurs in the following forms:

Meningovascular: The arteries of the brain or spinal cord become inflamed, causing a chronic form of meningitis. At first, people may have a headache and a stiff neck. They may feel dizzy, have difficulty concentrating and remembering things, and have insomnia. Vision may be blurred. Muscles in the arms, shoulders, and eventually legs may become weak or even paralyzed. This form can cause strokes.
Paretic: This form usually begins when people are in their 40s or 50s. The first symptoms are gradual changes in behavior. For example, people may become less careful about personal hygiene, and their moods may change abruptly. They may become irritable and more and more confused. They may have delusions of grandeur. Headaches, insomnia, difficulty concentrating, poor judgment, and fatigue are common. Tremors may occur in the mouth, tongue, outstretched hands, or whole body. Usually, dementia eventually results.
Tabetic (tabes dorsalis): The spinal cord progressively deteriorates. Symptoms begin gradually, typically with an intense, stabbing pain in the legs that comes and goes irregularly. Walking becomes unsteady. People may feel like they are walking on foam rubber. People usually become thin. Erectile dysfunction is common. Eventually, people have difficulty controlling urination (incontinence) and may become paralyzed.
Diagnosis

Health care practitioners suspect primary syphilis if people have a typical chancre. They suspect secondary syphilis if people have a typical rash on the palms and soles. Laboratory tests are needed to confirm the diagnosis. Two types of blood tests are used:

Because people with primary or secondary syphilis can pass the infection to others, they must avoid sexual contact until they and their sex partners have completed treatment. If people have primary-stage syphilis, all their sex partners of the previous 3 months are at risk of being infected. If they have secondary-stage syphilis, all sex partners of the previous year are at risk. Such sex partners require a blood test for antibodies to the bacteria. If test results are positive, the sex partners need to be treated. Some doctors simply treat all sex partners without waiting for test results.

More than half of people with syphilis in an early stage, especially those with secondary-stage syphilis, develop a reaction 2 to 12 hours after the first treatment. This reaction, called a Jarisch-Herxheimer reaction, causes fever, headache, sweating, shaking chills, and a temporary worsening of the sores caused by syphilis. Doctors sometimes mistake this reaction for an allergic reaction to penicillin. Rarely, people with neurosyphilis have seizures or become paralyzed. Symptoms of this reaction usually subside within 24 hours and rarely cause permanent damage.

After treatment, examinations and blood tests are done periodically until no infection is detected. If treatment of primary, secondary, or latent-stage syphilis is successful, most people have no more symptoms. But treatment of tertiary-stage syphilis cannot reverse any damage done to organs, such as the brain or heart. People with such damage usually do not improve after treatment. People who have been cured of syphilis do not become immune to it and can be infected again.

Last full review/revision October 2008 by J. Allen McCutchan, MD, MSc


Congenital Syphilis

a multisystemic infection caused by Treponema pallidum and transmitted to the fetus via the placenta. Early signs are characteristic skin lesions, lymphadenopathy, hepatosplenomegaly, failure to thrive, blood-stained nasal discharge, perioral fissures, meningitis, choroiditis, hydrocephalus, seizures, intellectual disability, osteochondritis, and pseudoparalysis (Parrot's atrophy of newborn). Later signs are gummatous ulcers, periosteal lesions, paresis, tabes, optic atrophy, interstitial keratitis, sensorineural deafness, and dental deformities. Diagnosis is clinical, confirmed by microscopy or serology. Treatment is penicillin.

Overall risk of transplacental infection of the fetus is about 60 to 80%, and likelihood is increased during the 2nd half of the pregnancy. Untreated primary or secondary syphilis in the mother usually is transmitted, but latent or tertiary syphilis usually is not. In neonates, manifestations of syphilis are classified as early congenital (ie, birth through age 2 yr) and late congenital (ie, after age 2 yr).

Symptoms and Signs

Many patients are asymptomatic, and the infection may remain clinically silent throughout their life.

Early congenital syphilis commonly manifests during the first 3 mo of life. Manifestations include characteristic vesiculobullous eruptions or a macular, copper-colored rash on the palms and soles and papular lesions around the nose and mouth and in the diaper area, as well as petechial lesions. Generalized lymphadenopathy and hepatosplenomegaly often occur. The infant may fail to thrive and have a characteristic mucopurulent or blood-stained nasal discharge causing snuffles. A few infants develop meningitis, choroiditis, hydrocephalus, or seizures, and others may be intellectually disabled.
Late congenital syphilis typically manifests after 2 yr of life and causes gummatous ulcers that tend to involve the nose, septum, and hard palate and periosteal lesions that result in saber shins and bossing of the frontal and parietal bones. Neurosyphilis is usually asymptomatic, but juvenile paresis and tabes may develop.

[hepzibah]

The only way an unborn child could get syphillis was through the mother, who would almost undoubtedly have become infected by the father. Syphillis can remain dormant for years without symptoms, as others have said, so that some children could be born healthy, but would they carry the dormant syphillis, which would then be carried on to thier offspring later ? I have certainly never heard of cows ( the source of the smallpox vaccine) carrying syphillis, so any infection caused by a vaccine, would undoubtedly have come from a contaminated needle.

One thing I realized recently, after reading many gothic horror books in the past, which always seemed to feature a beautiful wife, who never left the house, and who always kept her face vieled, or who wore a mask, was based on the poor women who really did live like this, having been infected by thier libertine husbands. One popular cure being for the stricken male to have sex with a virgin!!! This featured in a series earlier this year, the name of which I cant quite remember; 'history cold case' or 'victorian cold case'? Very interesting program. Thank heavens we know and understand more about syphillis nowadays!

[hepzibah]

Oh, the other thing I meant to say: The double standards of the Victorians have some bearing on the infected needle scenario, as it was stated by some doctors of that time, that (nice or good) women could not get syphillis from men, ( thier husbands) but could only catch it from contact with an open wound or contaminated object. How convenient is that?

[scousecan]

No kidding! But don't forget sores could develop in the mouth so all the wives had to do was be kissed. Apparently Agatha Christie dealt with Paralysis of the Insane in her book Pocket Full of Rye, but she neglected to connect the dots to its connection to syphillis.
How convenient is that?! (The perpretrators get off scott-free...)

[hepzibah]

Yep ( kissing) - totally frightening! Have always felt I belonged in an earlier age, but on second thought..... I am not male bashing here, but I wonder how did men get such total power in days gone by, when it was women who really kept it all together ie childbearing and rearing, keeping the home together, etc.

[Ms Tarfgi]

Interesting thread. I've always been puzzled by a large gap (14 years) between my g grandfather and his next youngest sibling. There's no record of my g g grandfather having been at away, e.g. in the Napoleonic war. Is it possible that there were a succession of children who died of syphilis before my g grandfather came along? He seemed to have been fairly robust.

His parents however lived until 85 and 90 years old and both died of old age (they were paupers/ag labs too!). Is it possible that they never developed the Tertiary stage in the 41/49 years after my g grandfather's birth? The children would have been born in the early years of the nineteenth century, so no records if they did exist.