This is an ancient disease, described in Chinese medical texts as long ago as 2,000 B.C. Yet it is still with us today. As a matter of fact, the United States sustained a syphilis epidemic from 1986 to 1990.

Since then, rates of syphilis have fallen to the lowest levels ever reported in this country. In 1999 only 6,657 cases of primary and secondary syphilis were recorded, and most of them were confined to the Southern region of the United States. In fact, with 80 percent of all counties reporting no cases, the Centers for Disease Control and Prevention believe they can essentially eliminate the disease in the U.S. by the year 2005.

In the meantime, however, syphilis remains a serious problem for minorities. For example, the rate of syphilis in African Americans is 44 times higher than it is in whites.

• Risk factors
• Signs and symptoms
• Cause
• Incubation period
• Possible health effects
• Diagnosis
• Treatments
• Follow-up
• Prevention
• Pregnancy

• Risk factors: You are more likely to get syphilis if you or your partner have multiple or casual sexual partners. From one act of unprotected sex with an infected partner, you have a 30 percent chance of getting syphilis.

• Signs and symptoms: Syphilis is marked by three stages: Stage 1 (Primary syphilis): This stage is characterized by a painless sore with hard, cartilage-like edges. It can appear anywhere on the body where there has been sexual contact, such as the vulva, vagina, cervix, anus, tongue, or on a man's penis or scrotum. If untreated, the sore(s) will disappear in three to eight weeks. This chancre sore is highly infectious. Stage 2 (Secondary syphilis): Six to eight weeks later, syphilis in the blood can cause a non-itchy rash, swollen lymph nodes, sore throat, weight loss, headaches, hair loss, and a general feeling of unwellness. Sores which can look like herpes sores or genital warts, can also appear in moist areas. If left untreated, these symptoms will disappear in two to six weeks. Stage 3 (Latent syphilis): Years to decades later, 20 percent to 30 percent of people infected with syphilis will experience complications such as damage to the eyes, ears, heart, and bones; paralysis; mental derangement, and death.

• Cause: A spiral-shaped bacterium, Treponema pallidum, is responsible for syphilis infections. It is most often spread during sexual intercourse, but can also be spread through transfusions if the tainted blood has not been properly screened.

• Incubation period: Although the first stage of syphilis can show up three weeks after infection, it has been known to take up to 90 days.

• Possible health effects: Syphilis can damage the eyes, liver, kidneys, and other organs. The open sores are also ideal ports of entry for organisms that cause diseases such as Acquired Immune Deficiency Syndrome (AIDS), Herpes Simplex Virus (HSV), and Human Papillomavirus (HPV). Within 24 hours after treatment for early stages of the disease, 60 percent of patients experience what is called a "Jarisch-Herxheimer reaction" which can cause headache, flu-like symptoms, and flushed lesions. There is no proven way to prevent this reaction, and it usually goes away without complications within 24 hours.

• Diagnosis: Diagnosis is made by taking a fluid sample from a primary or secondary sore, or from a nearby lymph node, and examining it under a microscope. Blood tests are also used to detect syphilis.

• Treatments: Although many diseases have become resistant to the drugs first used against them, syphilis still responds to the old standby, penicillin. It is 98 percent effective at all stages of the disease, but the dosage and length of treatment will depend on the disease stage and the symptoms. People allergic to penicillin are often treated with doxycycline (Doryx, Vibramycin, others), 100 milligrams orally twice a day for two weeks, or tetracycline (Achromycin), 500 milligrams orally four times a day for two weeks. These drugs are not as effective as penicillin, but do cure over 90 percent of cases. Another option for treatment of early syphilis is a single 2 gram dose of azithromycin (Zithromax). However, this treatment is typically reserved for patients who are allergic to penicillin or are afraid of needles.

• Follow-up: Blood tests are done after three months and then at six months. A spinal tap to test cerebrospinal fluid for secondary syphilis is recommended one year after treatment. Relapses of syphilis are more often due to reinfection than to failure of treatment, which is rare.

• Prevention: Because of the seriousness of untreated syphilis infections, all sex partners exposed must be notified. Here is a guideline for identifying at-risk partners:

• If you have primary syphilis, contact all partners you've had during the three months prior to first noticing your symptoms;

• If you have secondary syphilis, contact all partners you've had during the six months prior to first noticing your symptoms;

• If you have latent syphilis, contact all partners you've had during the year prior to first noticing your symptoms.

• Abstain from sex until tests show you can no longer spread the infection. To avoid infection or reinfection, use latex condoms for each act of penetration (vaginal, anal, or oral).

• Pregnancy: Congenital syphilis (infection before birth) can be fatal for the developing baby. If the baby survives, deafness, anemia, and permanent damage to bones, liver, and teeth are all possibilities. Sometimes these symptoms do not appear until the child is a teenager.

• If a woman has had syphilis for more than four years, chances are low that the baby will be infected. If she has been infected more recently, especially during her pregnancy, congenital syphilis is likely.

• The reaction to treatment, the Jarisch-Herxheimer reaction, may induce early labor or cause fetal distress. It's more important to get treatment than to avoid this possibility.