Syphilis is one of the most common sexually transmitted infections. It is caused by the microorganism Treponema pallidum (pale treponema). In the medical literature in the past, syphilis was often called “the great imitator”, due to the similarities in the manifestations of the disease with those of other diseases. Syphilis is characterized by passing through 3 stages – primary, secondary and tertiary syphilis. The disease is curable at every stage of its development, but once it occurs, the damage to the organs as a result of the infection cannot be restored, regardless of the treatment. The incidence of syphilis in Bulgaria has cyclically alternating episodes of increase and decrease in the number of infected . Peak incidence was recorded in the period 1994-2002, with the highest number of patients recorded in 1998 – 50 cases per 100,000 population. A characteristic feature of this “epidemic” is the sharp increase in the number of cases of congenital syphilis, which is becoming an increasingly serious problem for Bulgaria. From the annually registered 1-2 cases for the years before 1996, their number increased to 52 in 2002. In 2007, there was a slight decrease – 42 people, and in 2008, their number increased to 45. Ways of infection Via sexual contact – any form of intimate act can lead to the transmission of the disease, including vaginal, oral and anal sex. A person can be infected by a sick partner, regardless of whether he has visible manifestations of the disease. By blood – through the use of common injections by people who use intravenous drugs. The risk of transmission of the infection through transfusion of blood or blood products is low, since donor blood is subject to mandatory tests for blood-borne infections. Vertically – from a sick mother to the fetus through placental circulation. Symptoms The disease has an incubation period lasting on average 26 days, after which it enters its first stage. Primary syphilis It develops from 2-9 weeks after infection. It presents as a single, painless sore called a hard chancre. It can have different sizes. A few days after its appearance, the regional lymph nodes also increase – most often in the groin area. Due to the lack of pain, patients often underestimate the seriousness of the infection. The hard chancre is located most often in the genital area, but depending on the sexual practices, it is also possible to locate it on the lips, anus, oral mucosa, tongue, breasts, fingers and etc. If timely treatment is not applied, the changes undergo reverse development, and the disease passes into the next phase of development. Secondary syphilis A few months after the primary infection, reddish-pink rashes begin to appear all over the body. Rashes are not itchy, but provoke the appearance of other symptoms such as headache, hair and weight loss, general fatigue, temperature. Rashes are found in different areas – chest, back, abdomen,and their manifestation on the palms and soles is considered particularly characteristic. They usually go away in a few weeks or months, regardless of whether treatment is carried out or not. In secondary syphilis, changes in the mucous membranes can also appear. Characteristic for them is the appearance of sores covered with a whitish plaque. These are observed both on the genitals and on the anus and mouth. The changes are accompanied by complaints such as an increase in lymph nodes, inflammation of the throat and patchy loss of hair in the area of ​​the head and eyebrows. Latent stage Stage when there are no manifestations. Its duration depends on the immunological protection of the body, and most often it lasts from several weeks to several months. If no treatment is carried out during the first months of the second phase of the disease, there is a successive alternation of periods with rashes and symptom-free periods, which can continue years.Tertiary stage The third stage occurs usually 3-10 years after infection. Skin and mucous membrane manifestations are characteristic. The disease also attacks the central nervous system and leads to dementia, seizures, lack of balance and bouts of pain. Tertiary syphilis also affects the musculoskeletal system of the body. Gummy changes can develop in the bones, joints and muscles. From the internal organs, the liver, stomach, genitourinary system can be affected, but the cardiovascular system is most characteristic. The coronary and cerebral arteries can be involved in the process. The changes occur almost without symptoms and their discovery before the occurrence of serious complications is relatively rare. Unfortunately, the modern development of the disease shows that the percentage of people who reach this phase of the development of the infection is extremely low. In-depth knowledge of the clinical manifestations of tertiary syphilis, however, is essential for timely diagnosis and prevention of subsequent complications. Continued: diagnosis, treatment and prevention of the diseaseSkin and mucous membrane manifestations are characteristic. The disease also attacks the central nervous system and leads to dementia, seizures, lack of balance and bouts of pain. Tertiary syphilis also affects the musculoskeletal system of the body. Gummy changes can develop in the bones, joints and muscles. From the internal organs, the liver, stomach, genitourinary system can be affected, but the cardiovascular system is most characteristic. The coronary and cerebral arteries can be involved in the process. The changes occur almost without symptoms and their detection before the occurrence of serious complications is relatively rare. Unfortunately, the modern development of the disease shows that the percentage of people who reach this phase of the development of the infection is extremely low. In-depth knowledge of the clinical manifestations of tertiary syphilis, however, is essential for timely diagnosis and prevention of subsequent complications. Continued: diagnosis, treatment and prevention of the diseaseSkin and mucous membrane manifestations are characteristic. The disease also attacks the central nervous system and leads to dementia, seizures, lack of balance and bouts of pain. Tertiary syphilis also affects the musculoskeletal system of the body. Gummy changes can develop in the bones, joints and muscles. From the internal organs, the liver, stomach, genitourinary system can be affected, but the cardiovascular system is most characteristic. The coronary and cerebral arteries can be involved in the process. The changes occur almost without symptoms and their discovery before the occurrence of serious complications is relatively rare. Unfortunately, the modern development of the disease shows that the percentage of people who reach this phase of the development of the infection is extremely low. In-depth knowledge of the clinical manifestations of tertiary syphilis, however, is essential for timely diagnosis and prevention of subsequent complications. Continued: diagnosis, treatment and prevention of the disease