It is common knowledge that syphilis is a sexually transmitted infection whose major route of transmission is via sexual contact with infected lesions during oral, vaginal or oral sex as the organism passes through broken skin or intact mucous membranes. However, not many people are aware that the infection can also be transferred from a pregnant woman to her unborn foetus resulting in what is called congenital syphilis in the baby. Furthermore, statistics have shown that roughly 30 – 60% of those exposed to primary or secondary syphilis will contract the infection. Also, it has been observed that syphilis is most prevalent in South and Southeast Asia, followed closely by subSaharan Africa.
This article contains basic information you need to have as far as syphilis is concerned.
1. Syphilis is primarily spread through sexual contact
The organism responsible for syphilis is Treponema pallidum which is solely a human pathogen. Hence, syphilis can only be contracted from humans. T. pallidum is very unstable and unable to survive drying or exposure to disinfectants, thus rendering transmission through toilet seats, clothing or regular daily activities virtually impossible. However, indulgence in risky behaviours such as unprotected sex with infected persons and intravenous drug abuse is more likely to lead to the disease. Syphilis has been found to be very common among men who have sex with men. Another route of transmission is from an infected mother to her unborn foetus during pregnancy.
2. Syphilis can present in various ways
Sir William Osler described syphilis as the ‘great imitator’ since it can manifest in several ways, depending on the stage at which it is detected – primary, secondary, latent or tertiary.
At the primary stage which usually begins about 3 weeks after exposure to the organism, a skin lesion (chancre) appears at the point of contact. It is usually a single, firm, painless and nonitchy ulcer around the genitals, although it may be multiple or painful in some cases. After this stage, the person develops secondary syphilis which may manifest as nonitchy maculopapular or pustular rashes all over the body, including the palms and soles. Take note that all these lesions harbour the organism and are infectious. The person may also experience fever, weight loss, headache and sore throat at this stage. Following this, the patient then progresses to a latent phase of apparent wellness in which there are no symptoms of disease eventhough there is serologic proof of infection. Lastly, about a third of untreated people enter the tertiary stage where they are no longer infectious. Here, the organism has already spread to the central nervous and cardiovascular systems leading to neurosyphilis and cardiovascular syphilis respectively, both of which can lead to serious complications
3. How is syphilis diagnosed?
Confirmation of syphilis is done either through blood tests or direct visual inspection under the microscope. Nontreponemal blood tests including venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) can be done initially and the result is then confirmed using treponemal tests such as fluorescent treponemal antibody absorption test (FTA-Abs) or treponemal pallidum particle agglutination (TPHA). Alternatively, serous fluid may be collected from the ulcer and visually inspected for treponema pallidum using dark ground microscopy.
4. Syphilis is treatable
Intramuscular injection of benzathine penicillin G remains the first line agent for the treatment of secondary syphilis. No wonder the incidence dropped drastically following the introduction of penicillin in the 1940s and 1950s. However, in patients who are allergic to penicillin, other good alternatives include tetracycline, erythromycin, azithromycin and ceftriaxone, depending on the stage of the infection.
5. Syphilis can be prevented
As a sexually transmitted infection, the primary goal of syphilis prevention is to limit its spread by educating people on the need to avoid harmful indiscriminate sexual practices. Abstinence and faithfulness to one partner are key. Consistent and correct use of condoms also significantly reduces risk of contracting the disease, although this method is not fail-proof.
The Centres for Disease Control and Prevention recommends a long term, mutually monogamous relationship with an uninfected partner. Finally, pregnant women are supposed to undergo screening for syphilis early in pregnancy and get treated if necessary to prevent transmitting the infection to their babies.