Unmasking Syphilis: stages, diagnosis, treatment and prevention

 

Introduction to syphilis

Syphilis is a sexually transmitted infection caused by the bacterium treponema pallidum subspecies pallidum. The signs and symptoms of vary depending in which of the four stages It presents (primary, secondary, latent, and tertiary). Syphilis is caused by a spirochete bacterium treponema. Microscopically treponema pallidum appears as fine, spiral (8 to 24 coils). They are not cultivatable with any consistency in artificial laboratory media outside the host. T. pallidum are extremely susceptible to a variety of physical and chemical agents. However, they may remain viable for up to 5 days in tissue specimens removed from diseased animals and from frozen specimen.

What is syphilis?

Syphilis is a chronic, systemic, sexually transmitted infection (STI) caused by the bacterium Treponema pallidum subsp. pallidum. It has been recognized for centuries and remains a major public health concern because, if untreated, it can progress through multiple stages and cause severe complications affecting multiple organs (heart, brain, eyes, nerves, bones, and skin).

Stages of syphilis

Untreated syphilis is chronic disease with sub-acute symptomatic periods separated by a symptomatic intervals, during which the diagnosis can be made serologically.  The progression of untreated syphilis is generally divided in to stages. Initially, T. pallidum penetrates intact mucous membranes or enters the body through tiny defects In the epithelium.

1.     Primary syphilis:

At the end of the incubation period, a patient develops a characteristics primary inflammatory lesion called a chancre at the point of initial inoculation and multiplication of the spirochetes. Generally it is relatively painless and commonly located around the genitalia, but in about 10% of cases lesions may appear almost anywhere else on the body e.g. throat, lip and hands.

2.     Secondary syphilis:

Within 2 to 8 weeks after the appearance of the primary chancre, a patient may develop the sign and symptoms of secondary syphilis when organisms gain access to the circulation from the infected site. The secondary stage is characterized by a generalized illness that usually begins with symptoms suggesting a viral infection headache, sore throat, low-grade fever and occasionally nasal discharges.

3.   Latent syphilis

After resolution of untreated secondary syphilis, the patient enters a latent non-infectious stages in which diagnosis can be made only by serologic method. During the first 2-4 years of infection, one fourth of patients will show relapses of manifestation of secondary syphilis. During these relapses, patients are infectious, and underlying spirochetemia may be passed translucently to the fetus. 

4.  Tertiary syphilis

The first manifestations of late syphilis are usually seen from 3-10 years after primary infection. About 15% of untreated syphilitic individuals eventually develop late begins syphilis characterized by the presence of destructive granulomas. Untreated patients 10% develop cardiovascular manifestations.

5.  Congenital syphilis

Congenital syphilis is caused by maternal spirochetemia and transplacental transmission of the microorganism usually after 18 weeks of gestation. Congenital syphilis is diagnoses in three fourths of the cases in patients over 10 years of age. Early congenital syphilis appears either at birth or up to two years of age.

How to transmission syphilis

Syphilis is transmitted when Treponema pallidum (the bacteria that causes syphilis) passes from one person to another. The main routes of transmission are:

1. Sexual contact:

Through vaginal, anal, or oral sex with an infected person. Bacteria enter the body through small cuts or mucous membranes in the genital area, rectum, lips, or mouth.

2. Mother-to-child transmission (congenital syphilis):

An infected pregnant woman can pass syphilis to her baby during pregnancy or childbirth. This can cause stillbirth, premature birth, or severe illness in the newborn.

3. Blood-related transmission:

Through transfusion of unscreened blood (now rare due to testing). Sharing contaminated needles or equipment.

Tests for syphilis

Serologic procedures for syphilis include the flowing. Nontreponemal method e.g. Venereal disease research laboratory (VDRL) and the rapid plasma regain (RPR) procedures.Treponemal methods e.g. fluorescent treponema pallidum antibody absorption and microhemagglutination treponema pallidum.

1. Nontreponemal methods

Nontreponemal methods are screening tests for syphilis that detect regain antibodies. They are inexpensive and useful for diagnosis and monitoring treatment response, but they are not specific and may give false positive results. Common examples are VDRL, RPR, and TRUST.

2. Treponemal methods

Treponemal methods are specific tests used to confirm the diagnosis of syphilis. They work by detecting antibodies that are directed specifically against antigens of Treponema pallidum, the causative organism of syphilis. Unlike nontreponemal tests, treponemal methods are more accurate and less likely to give false positive results. Common examples include the Fluorescent Treponemal Antibody Absorption (FTA-ABS) test, the Treponema pallidum Hemagglutination Assay (TPHA), and various enzyme immunoassays (EIA). These tests are mainly used for confirmation after an initial positive screening test and generally remain positive for life, even after successful treatment.

Haw to treatment syphilis

The treatment of syphilis mainly relies on antibiotics, with penicillin being the drug of choice. A single intramuscular injection of benzathine penicillin G is usually sufficient to treat early syphilis, while later stages may require multiple doses at weekly intervals. For patients who are allergic to penicillin, alternatives such as doxycycline or azithromycin may be used, although penicillin remains the most effective option, especially in pregnant women. Successful treatment not only cures the infection but also prevents complications and transmission to others. Follow-up with blood tests is important to ensure that the infection has been completely cleared and to monitor for any signs of relapse.

Conclusion

In conclusion, syphilis remains a serious but preventable and curable disease. With early detection, proper treatment, and public awareness, its spread can be controlled and its severe complications avoided. The key to ending the burden of syphilis lies in education, safe practices, and timely medical care.