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Sexually transmitted infections

Syphilis Epidemiology STD

Epidemiology

Most cases of syphilis are transmitted by sexual intercourse. Syphilis can be spread by kissing, touching a person who has lesions on the lips, oral cavity, or any body area or accidental inoculation such as a needle stick.

The organism can be acquired by passage through the placenta to cause congenital syphilis, and by transfusion of fresh human blood. T. pallidum cannot survive longer than 24 to 48 hours in blood bank storage. Congenital syphilis is most frequently acquired in utero, transmission while passing through the birth canal is possible.

The patient is most infectious in the early stages of the disease. Moist lesions that are present in the primary and secondary stages are the most infectious. These are the chancre of primary syphilis and the oral mucous patchs, and the wartlike genital lesions called condyloma latum present in secondary syphilis. The disease becomes less infections after the end of the secondary stage. Most patient cannot spread syphilis by sexual contact 4 years after acquiring the illness.

The incidence has waxed and waned since the 1940s. Most cases today are found in southeastern United States. Syphilis is a human disease and like small pox could be eliminated.

Some infected individuals have no evidence of active disease. Effective disease control is accomplished by tracing contacts of recently exposed persons and following treated patients to prove that they are cured.

A disproportionate number of cases occurred in homosexual men before the 1980s. The incidence in this group decreased with the adoption of safer sex practices during the AIDS epidemic. A rapid increase occurred in heterosexuals, between 1986 and 1994 when the exchange of sex for drugs, such as crack cocaine became more prevalent.