The infection of syphilis occurs on the instant of inoculation, as in the case of tetanus. This is important, as upon it depends the question of early local treatment. While excision of the primary sore, or even of an area which might have become infected during exposure, and before the actual formation of the chancre, has been often practised and urged by some, experience has shown that it has little to commend it, since the general experience is that it does not prevent the development of the disease.
In its tendency syphilis is constantly progressive and destructive, although it often behaves in a capricious manner, sometimes when under efficient treatment and generally when treatment is inefficient. It is usually more virulent in the dissipated and those who are weakened by inheritance or poor constitutions, or by other disease. One reads in literature on the subject about the malignancy of some cases and the benignancy of others. Some cases seem to have a malignant aspect, while others run an unusually mild course, so much so as to raise the question whether the patient had syphilis. As far as the nature of the parasitic cause is understood, this would depend on differences in the make-up of the individual rather than in the actual virulence of the germ. In the extremes of life individuals are more susceptible. When implanted upon a tuberculous constitution it sometimes renders the tuberculous lesions more active; whether it acts as a mixed infection is not definitely known. Tuberculous lymph nodes frequently break down during the course of secondary syphilis, and consumptive patients grow rapidly worse. Syphilis, like alcohol, tends to play havoc with the bloodvessel walls, and their combined effects in this direction are greatly to be deprecated and should be prevented.
The Lesions and Secretions which Convey Infection.
—As far as acquired syphilis is concerned absolute contact is necessary between the infecting material and the infected area, while upon the latter must exist some abrasion of the surface. Chancres and the early eruptions or mixed lesions have been proved to be absolutely virulent. The genitalia of both sexes are frequently the site of wart-like lesions referred to as condylomas, which are usually kept more or less moistened by the secretion of the parts, and are fruitful sources of contagion. The discharging lesion of those suffering from syphilitic disease should be regarded as capable of transmitting it, while during the primary and secondary stages the blood and lymph should be regarded as probable sources of danger.
Inoculation with the blood of patients during these stages has been known to be successful. How long the blood retains its power of infection is uncertain; it is usually regarded as free from it when the disease is latent.
The natural and physiological secretions of various organs, e. g., saliva, milk, perspiration, tears, and urine, are not generally believed to be capable of transmitting the disease. The semen of syphilitic men may reproduce the disease by heredity but not by direct inoculation. It is possible under these circumstances for the father to transmit the disease to the ovum without previously infecting the mother; such infection of the ovum by diseased spermatozoa is quite different from the infection of the ovum by the mother who has acquired the disease, the father having escaped it.
In a general way it may be held that secretions of organs, or even of lesions, which are non-specific, are not contagious except as they happen to be mixed with blood or with disintegrated portions of actual syphilitic lesions; thus, for instance, vaccinal lymph might be safely taken from a syphilitic subject if there were absolutely no admixture of blood. But the difficulty of securing pure lymph is such as to make its use inadvisable because of its danger.
Suppuration frequently complicates syphilitic lesions. This is to be regarded as in the nature of a secondary and pyogenic infection. It has not been established that the germ of syphilis is by itself a pyogenic organism.
Gonorrhea or chancroid is often simultaneously contracted with syphilis, with resulting clinical complications that are perplexing as well as difficult to treat. The contagion of chancroid acts promptly, as will be stated in the chapter on Chancroid; and so it may happen that the sore which begins as a chancroid is gradually converted into a true chancre, the change taking place so gradually that it is difficult to state when it begins or is completed. In this way result the so-called mixed sores, which may give rise to so much doubt that the surgeon feels it wise to wait for some secondary manifestations before deciding that syphilis has been acquired. Confusion is often created by preliminary treatment which the local lesion has received previous to its examination by the surgeon. Patients, especially in the lower walks of life, frequently go to a druggist or to someone who will cauterize the sore and thus mask its characteristics to a degree which makes prompt diagnosis impossible. Again, patients are often uncertain regarding the matter of time, which is of great importance; thus the sore which appears within a few days after exposure may be chancroidal, while one which comes on twenty or thirty days afterward may be syphilitic. These periods, however, afford little help when there have been repeated exposures, by which confusion may be caused; but an accurate and complete personal history will be helpful toward a correct diagnosis.