Lues venerea - love search - is the technical name for one of the oldest venereal diseases. In the mid-nineties, when it was almost eradicated, the number of new cases in recent years has become worryingly global. Pathogens are treponemes, spiral-shaped rod bacteria that live only on humans and are predominantly transmitted by direct mucosal contact.

Of microbes and humans

"Lustseuche spreads", "Lues on the rise again", "syphilis outbreak in Greater Aachen" - the reports in newspapers, on websites and in the reports of the Robert Koch Institute (RKI) draw a gloomy picture. An almost forgotten infection spreads again. Although the "hard chick" concerns more homosexuals or men who have sex with other men ("MSM"), but he comes in a quarter of the cases in heterosexuals.

High risk of infection

It is worrying that syphilis is easy to transmit and so often interpreted as an indicator of a general increase in sexually transmitted diseases or unprotected sex. In addition, it increases the likelihood that at the same time HIV sufferers also transmit the AIDS virus or that syphilis sufferers are infected with the AIDS virus.

Unlike many other sexually transmitted diseases, the majority of patients are infected in Germany. So not the travel fever leads to the spread, but rather an increase of the disease in endangered milieus and from there its transmission into the rest of the population. Man is the only reservoir - outside of their human host, the pathogens have only a short chance of survival. Therefore, they are transmitted to the child almost exclusively during sexual intercourse or from mother to mother, less often without sexual contact in cramped communities with poor sanitary conditions or when sharing syringe sets.

Education, prevention with condoms, regular blood tests at the endangered and adequate therapies are therefore essential to minimize the risk of infection.

Hard facts and dark numbers

At the end of the last millennium, the World Health Organization estimated that around 12 million people worldwide contract syphilis each year. As a significant increase in new cases has been observed in many countries in recent years, the current figures are likely to be even higher. In Tanzania, almost 50% of deaths are due to maternal lues infection of the unborn child!

Syphilis is anonymously notifiable in Germany. In 2004, an average of 4.1 new cases per 100, 000 inhabitants were reported to the RKI, which corresponds to an increase of 14% on the previous year. For this purpose, one assumes a dark figure of unreported cases of about 30-40%. Sad frontrunners are big cities like Frankfurt and Cologne, but also in rural areas and border areas the incidence is increasing.

The fact that the infection is increasing again among heterosexuals is partly attributed to a globalization of prostitution. Particularly drug-addicted and foreign (especially from Eastern Europe and the Balkan countries) prostitutes are more likely to be exposed to unprotected traffic and often have poorer access to the health system. However, women account for only about 10% of those infected and are partially infected by bisexual men.

Experts express concern that the reduction of public health structures in recent years has led to a significant increase in the risk of infection. In many places, persons from high-risk groups are no longer or only very hard to reach - only passive help is offered and networking between the public health service, drug-help and substitution systems is considered insufficient.

Symptoms and stages

A distinction is made between an acquired form (syphilis acquisita) and a congenital form transmitted in the bloodstream during pregnancy (syphilis connata). The latter is associated with an increased miscarriage rate and neonatal mortality and malformations. The acquired syphilis is untreated, a chronic disease that occurs in several phases:

  • Early syphilis: Approximately 3 weeks after infection, a painless, reddened and oozing ulcer is found at the site of entry of the pathogen, which is very contagious. Three weeks later, lymph nodes in the area can be felt as a single, hard, agile, painless swelling. Several weeks later, general symptoms such as fever, skin rashes, general lymph node swelling, headache and body aches occur. After weeks to months, this primary stage passes into the secondary stage and it shows growths in the genital and anal areas, which are highly infectious. After about 2 years, the symptoms usually disappear and the disease can only be detected in the blood.
  • Late syphilis: In rare cases, the pathogens in untreated individuals spread throughout the body and after about 5 years, there are changes to the skin, mucous membranes and organs (so-called gums), which lead to the destruction of the tissue. The neurosyphilis manifests itself years and decades later in the brain and spinal cord and has a variety of discomforts ranging from changes in personality to visual, sensory and gait disorders result. In addition, it can lead to changes in the main artery with the mortal danger of a tear. In the late stage, syphilis is no longer infectious.

Proof and therapy

The diagnosis is made by smearing of secretions from the skin lesion or a lymph node and the detection of the pathogen under the microscope. Various tests can be carried out in the blood, with which one can prove a disease (also after years) and which can verify the activity, thus treatment neediness of the infection as well as the therapy success.

Fortunately, less toxic substances than the mercury used in the past and the arsenic-containing salvarsan developed in 1909 are available for treatment today. The therapy is carried out with penicillin, the duration depends on how long the disease already exists - in the early syphilis up to two weeks, otherwise 3-4. The dose is given as an injection into the muscle or as an infusion. Mandatory is the co-treatment of the sexual partner. Therapy success is checked with a blood test.

In a nutshell

  • In principle, the pathogen can enter the body at any point where the skin or mucous membrane is damaged.
  • The infection is predominantly due to unprotected sexual intercourse or transmission from the pregnant woman to the unborn child.
  • Frequently changing, unprotected intercourse, especially with men, increases the risk of infection.
  • Condoms (with spermicides), urinating and washing with soap and water immediately after sexual intercourse provide some protection.
  • A quick and complete cure by means of antibiotics is possible, otherwise it can come years later to serious complications up to the death.
  • The sexual partners must be treated.
  • You can always get infected with syphilis.
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