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Many doctors are scurrying to textbooks and flocking to lectures to learn about the unusual ways the bacterial infection can damage organs at any age, from newborns to the elderly.

Specialists from pediatricians to pathologists have mistaken the sores of syphilis for cancers, abscesses, hemorrhoids, hernias and other conditions. Pediatricians have mistaken the sniffles than can result at birth from congenital syphilis for the flu. Other doctors have also mistaken different forms of syphilis for dizziness from Meniere's disease and multiple sclerosis.

Dr. William Schaffner 2d, who heads the department of preventive medicine at Vanderbilt University, described a case that mystified several specialists in Nashville.

A young man with a painless sore on his penis went to a doctor who, believing the man had cancer, took a biopsy that he sent to a pathologist for identification under the microscope. The pathologist was stumped and he sent the biopsy to a colleague: he diagnosed syphilis.

Syphilis is caused by Treponema pallidum, a spiral-shaped bacterium known as a spirochete. The microbe is most commonly spread by sexual contact, and the disease appears in three stages.

The first stage is characterized by a painless sore, a primary chancre, that usually appears 21 days after exposure. The edges of the sore are hard, like cartilage, and can appear anywhere there has been sexual contact, such as the penis, vagina, cervix, tongue and anus.

Untreated syphilitic sores disappear after two to six weeks. From six to eight weeks later, the spirochete spreads silently through the blood to cause the second stage. It often appears as a rash that may be accompanied by swollen lymph nodes throughout the body, a sore throat, weight loss, malaise, headache and loss of hair. The second stage of syphilis can also damage the eye, liver, kidney and other organs.

If untreated, the second stage of syphilis heals within two to six weeks. Then years to decades later it can damage the heart, aorta, bones and cause paralysis and dementia.

The symptoms from syphilis not only are transient but can vary greatly, which explains its reputation as the great imitator. And if a doctor misses the early stages, Dr. Schaffner said, "the patient becomes a biological time bomb waiting to develop tertiary syphilis."

Syphilis can also harm newborn babies through transmission of the spirochete from the mother to the fetus in pregnancy. A baby born with syphilis often has a runny nose and can have a rash and other symptoms that resemble an adult's secondary stage. Congenital syphilis can cause deafness, anemia and permament damage to the bones, liver and teeth.

But prompt and adequate treatment of the syphilitic mother with antibiotics usually prevents damage to the unborn baby, and treatment of an infant with syphilis generally prevents permanent damage.

Dr. Harold Neu said the infectious disease team he heads at Columbia-Presbyterian Medical Center in New York had recently found a number of mothers whose blood tests showed no evidence of syphilis yet who gave birth to babies with the disease.

The doctors found that the mothers had such a heavy infection that standard testing methods were unable to detect it. The problem was solved by modifying the laboratory technique, Dr. Neu said.

New cases of syphilis are at the highest level since 1949.

Dr. Willard Cates Jr., an expert at the Federal Centers for Disease Control in Atlanta, said the centers expected about 50,000 cases to be reported in 1990, as against 41,942 in 1949. The reporting of syphilis is the most reliable of all the sexually transmitted diseases.

Article by nytimes.com  

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