Syphilis Overview

Syphilis is a sexually transmitted disease, infectious and contagious, one of the most common sexually transmitted diseases caused by Treponema pallidum. The origin of syphilis is not very well known, in the past the explanation being that the disease was brought on the first trip by Christopher Columbus.

The disease should not be at all neglected because, over time, it may have serious consequences on the entire body, targeting especially the nervous system.

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In 1999 about 12 million people worldwide contracted syphilis, with over 90% of cases being registered in developing countries. After a dramatic decrease in the number of cases due to the availability of penicillin in the ’40s, with the start of the new millennium infection rates increased in many countries, infection being frequently associated with the human immunodeficiency virus (HIV).

This is in part attributed to unsafe sexual practices among men as intimate relations with men, increased promiscuity, prostitution and the tendency to use increasingly lower barrier protection means.

How is syphilis contracted?

Syphilis can be contracted due to unprotected sexual contact, by blood (transfusions or use of some contaminated instruments), via a Trans placental exchange during pregnancy from mother to child through kissing (if the infected person has a lesion in the mouth) or touching contaminated objects (the barber tools, medical instruments that were not sterilized).

The bacteria enters the body, usually through the mucous membranes, most commonly by those around the genitals and urinary tract. More rarely, it can penetrate through any wounds or cracks. If you are pregnant and infected with syphilis, the bacteria can cross the placenta and infect the fetus during any stages of the pregnancy or childbirth.

Note: Contrary to some misinformed opinions, syphilis is NOT contracted as a result of contact with filthy door handles, toilet seats, clothing, bath tubs, cups or utensils.

Syphilis Symptoms

The first sign of syphilis is a painless ulcer at the site where the germ has entered the body. The bacteria enter through the skin and mucous membranes and into the blood and lymphatic system, and passes through several stages in its evolution:

  1. Primary syphilis – not always has signs and even if they exist, they do not usually appear until 3 weeks after contamination. It is a feature of the mucosal lesion, a small lesion, red, hardened, rigid and painless to the touch.This ulcer is located in the penis, the glands, of the vagina or the lower part of the uterus (cervix). Other locations are possible: tonsils, lips, tongue.
    Chancre lasts between 28 and 42 days and then heals without treatment, leaving a thin scar. Chancre has healed but does not mean that the person is healed or is no longer contagious!
  2. Secondary syphilis – manifests at 4 to 10 weeks after the chancre appears multiple eruptions on the skin or mucous membranes rest: small pink spots on the skin and the mucous membranes of red-brown anus, glands, throat, tongue or lips.No more than 2 cm in diameter and often can be confused with other skin lesions.
    These lesions can be seen on the palms or soles, and on the abdomen or back. There are also other lesions such as alopecia, cervical adenopathy (an increase in size of the lymphatic nodes), and enlargement of the liver and spleen.Visible signs may disappear without treatment in 2-12 weeks, but the syphilis remains in the body and can be passed on.
  3. Latent syphilis (hidden) – this stage is reached when a person infected with syphilis did not follow any treatment. Usually this period lasts 1 year, but there are registered cases that lasted between 5 and 40 years.
    A pregnant woman found in latent stage can transmit the disease to the fetus (congenital syphilis), causing an abortion or giving birth to a dead child. It is an asymptomatic period which is usually discovered during a routine serological examination (prenuptial, prenatal).
  4. Tertiary syphilis (late) – it is by far the most fatal stage of the disease. May cause heartburn, touching the heart or the aorta leading to heart failure that can be deadly, it may cause mental disorders, nervous system disorders and even death.Also a worrying increase in the risk of HIV transmission and give complications in people infected with HIV by a more rapid development and frequent neurological complications, and impairing skeletal functions bringing with it spontaneous fractures.One of the complications of this stage is neurosyphilis — without treatment between 8 and 10% of those affected may have important neurological disorders up to 10 to 20 years after the onset of the infection.

    A quarter of those who were not treated are meningo-encephalitis victims. Treatment with antibiotics is strong enough to treat the infection and prevent a fatal evolution.

  5. Congenital syphilis – This stage aims mothers who do their duty to test for syphilis as soon as they become pregnant. If a future mother shows a primary or secondary syphilis this can affect the baby in quarter 2 and 3 of pregnancy, leading to serious birth defects after birth or even death.Congenital syphilis symptoms include: runny nose (secretion from the nasal cavity), the plant or contagious rash on the palms, anemia, retarded growth and development.

Syphilis Treatment

It is important to act promptly and without interruption of the treatment to achieve complete healing. The treatment consists of a dose of antibiotics, usually penicillin. If the disease has reached the stage of secondary syphilis, antibiotics will prevent further complications, but will not cure the injuries that have already occurred.

Prompt antibiotic treatment decreases the rate of complications and prevents further spreading of the infection. After it has been fully administered tests should be done to check whether the treatment was successful or not.

Important! Spouses or those whom you have had sexual intercourse in the last 2-3 months should be announced and screened for syphilis and for HIV. Remember that syphilis causes open lesions on the genitals that allow HIV to enter the body. For your safety it is recommended to repeat tests in the next two years.

How do I avoid contracting syphilis?

The people most at risk are those who have had unprotected sex, those who have more unprotected sex with an infected person or with multiple partners, prostitutes, those who are infected with HIV or have sexual contacts with persons infected with HIV, the gay community. As with other STDs, protection during intercourse has an important role.

Syphilis Testing

Routine syphilis diagnosis is based on serological methods available in most laboratories. Direct methods (microscopy with dark background, immunofluorescence, and inoculation of the animal) remain the preserve of specialized laboratories. Immune response to infection includes the production of antibodies against a wide variety of antigens, being involved both non-specific antibodies (anticardiolipin / reagine) and antitreponemic specific antibodies.

The first response is the demonstrable antitreponemic IgM antibodies that can be detected at the end of the 2 weeks from contracting the infection, IgG antitreponemic antibodies appear later in week four.

Thus, in the onset of clinical symptoms most patients manifest IgM and IgG antibodies. Nonspecific antibodies are positive after about 4 weeks of exposure to the infection. Associated HIV treatment can affect the immune response. The IgM antibodies decrease rapidly after adequate treatment in early syphilis, but IgG antibodies persist indefinitely.

Taking into account the immune response, serological tests for syphilis can be classified into two broad categories: 1. Tests highlight nonspecific antibody (non-treponemal tests):

  • VDRL – Venereal Disease Research Laboratory;
  • RPR – Rapid Plasma Reagin test.

2. Tests highlight specific antibodies (treponemal tests):

  • TPHA – Treponema pallidum Haemagglutination Assay – passive hemagglutination – detects antibodies to total IgG and IgM;
  • FTA-ABS – Fluorescent Treponema Antibody – Absorption IgG and IgM;
  • EIA – IgG and IgM.

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