From the Research
Tertiary syphilis is generally not contagious, as the bacteria are present in much lower numbers in the body and are rarely found in lesions or bodily fluids by the time the disease reaches this stage. This makes transmission to others extremely unlikely. However, it's crucial to understand that tertiary syphilis represents advanced disease with potentially serious complications affecting multiple organ systems, including the heart, brain, and nervous system. The primary and secondary stages of syphilis are the most infectious, as noted in the study published in Microbial cell in 2016 1.
Anyone diagnosed with tertiary syphilis requires treatment regardless of contagiousness. The standard treatment is benzathine penicillin G, typically administered as 2.4 million units via intramuscular injection once weekly for three weeks. For patients with penicillin allergies, alternatives like doxycycline (100mg twice daily for 28 days) may be used, as suggested by a study in Clinical infectious diseases in 2006 2 and further supported by guidelines discussed in a 2015 publication in the same journal 3.
Even though the risk of transmission is minimal at this stage, sexual partners should be informed of the diagnosis, and anyone diagnosed with syphilis at any stage should be tested for other sexually transmitted infections, including HIV. The management of syphilis, including the treatment and screening strategies, has been discussed in various studies, including one published in the American family physician in 2012 4, emphasizing the importance of vigilance in screening high-risk patients and the role of penicillin as the drug of choice in all stages of infection.
Key points to consider in the management of tertiary syphilis include:
- The disease is rarely contagious at this stage due to the low presence of bacteria in the body.
- Treatment is necessary to address potential complications and is typically with benzathine penicillin G or alternatives for those with penicillin allergies.
- Screening for other sexually transmitted infections is recommended.
- Informing sexual partners of the diagnosis is important, despite the low risk of transmission at this stage.