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Syphilis

Syphilis – Causes, Diagnosis and its Treatment

 

Introduction

Syphilis is a sexually transmitted disease which is caused by a strain of bacteria known as Treponema pallidum. Up until the first quarter of the 20th century, syphilis was largely untreatable and was the cause of many deaths in adults as well as infants. But after the advent of penicillin, many treatment options of syphilis were developed and the disease was greatly controlled. However, off late, millions of people have been infected with syphilis due to unsafe sex practices, promiscuity and no use of condoms. Syphilis has also spread largely with the increase of HIV cases, mostly in developing countries.

Risk Factors

As Syphilis is primarily a sexually transmitted disease which can remain latent for years, without showing any symptoms; an infected person can unknowingly spread it to many others. As a result, the disease reaches epidemic proportions from time to time. In its primary and secondary stages, syphilis is manifested in the form of sores or rashes in the genital area. In tertiary stages, additional problems such as arthritis, dementia, blindness, impotence and damage to heart as well as brain cells can occur. Although syphilis doesn’t spread from social contact while at the time of sharing of clothes or utensils, caution has to be taken as risk of disease spread remains high.

Causes

The pallidum sub-specie of Treponema bacteria is the causal agent of syphilis disease. It is a spiral shaped, highly mobile bacterium. Pallidum strain is also responsible for the spread of yaws, pinta and bejel. Pallidum bacteria take more than 30 hours to multiply and have a very limited genome to sustain in an-organismic environment. Hence the bacterium cannot spread via shared objects or living spaces. There are only two ways in which syphilis can be transmitted –

  1. Unsafe sexual contact: As the bacteria can transfer through compromised skin surface, syphilis can spread via vaginal, oral and anal sex. The chances of disease are very high even when a small no. of bacteria come in contact with the skin and 50-60% of exposed individuals are likely to develop syphilis infection.
  2. 2.       From syphilis infected mother to foetus: Pallidum bacteria can also transfer through mucosal membranes. Thus it can get transmitted from an infected mother to her developing foetus during pregnancy. The disease can also be transmitted to the baby during childbirth.

Although syphilis can also be transferred through blood transfusions and blood derivatives such as plasma; it is a common medical practice to screen blood for syphilis infection before transfusion. Thus, this is the least likely cause of syphilis transmission.

Diagnosis

There are four stages of syphilis known to inflict humans – Primary, secondary, latent and tertiary.

  • In early or primary stage of syphilis, painless sores are formed between 10 days to three weeks and can heal without treatment and without leaving any scars.
  • The secondary stage lasts from one to three months and is accompanied by reddish sores and rashes on palms of hands or soles of feet. Other symptoms may include swollen lymph glands, fever, moist warts in groin region, weight loss and white patches in the mouth.
  • Latent syphilis is a stage which can remain in the body undetected and without manifesting any symptoms for as long as 46 years.
  • The tertiary stage is the most advanced and debilitating stage of syphilis which can have damaging effect on the nervous system, muscles joints and many other organs.

With diagnostic measures, the stage of infection can’t be determined and only presence of syphilis can be confirmed. As the bacterium is carried in body fluids and within sores on skin surface, two commonly adopted diagnostic procedures are –

  • Blood tests: Non treponemal and treponemal tests are conducted in sequence to first detect venereal diseases and then confirm the presence of syphilis. The treponemal pallidum particle agglutination (TPPA) and fluorescent treponemal antibody absorption test (FTA-Abs) are two confirmatory tests adopted. To diagnose presence of neurosyphilis, high protein levels and high number of leukocytes is to be detected in the cerebrospinal fluid.
  • Direct microscopic analysis: A time sensitive diagnosis can be performed by dark ground microscopy which requires the serous fluid within 10 minutes of extraction, while the bacterial cells are still alive. Other non-time sensitive tests are direct fluorescent antibody testing and nucleic acid amplification tests are more popular as they can be performed on samples without living bacterial cells and can still confirm infection.

Treatment for Syphilis

As syphilis is caused by a bacterial infection, it can be easily treated by antibiotic treatment. Early stages can be treated by a single dosage of intra muscular benzathine penicillin G. Doxycycline and tetracycline are alternative choices available for patients who are allergic to penicillin. In later stages of infection, intravenous administration of penicillin is required for a minimum of ten days to ensure neurosyphilis is also treated. Syphilis infected patients are recommended to abstain from intercourse until the disease is completely corrected.