Syphilis

Overview of Syphilis

Sexual health is an integral component of life. A number of diseases result from the lack of sexual hygiene. These diseases are prevalent in people having multiple sex partners. The World Health Organisation reports of 2015 suggest that nearly 498 million people were diagnosed with different types of sexual disease. These people mostly belonged to the age group of 15-49. A very common sexually transmitted disease is “Syphilis”. It is widespread among sex workers.

WHO conducted a survey in 34 different countries in the year 2008. They found that over 5% of the sex workers in these countries suffer from this disease. The global statistics by the Center for Disease Control and Prevention has shown that in the year 2012, 6 million new cases of Syphilis were reported.

What is Syphilis?

Syphilis is a type of sexually transmitted disease which is caused by the bacteria Treponema pallidum.

It is passed on from one person to another via sexual activities or through direct contact with the infected lesions of the patient.

The disease is also transmitted from a mother to her child during the breastfeeding period. It is a chronic systemic disease that may affect the central nervous system in the late stages.

Why is Syphilis known as the “great imitator”?

Syphilis is often called the “great imitator” since many of its symptoms are similar to the symptoms of other diseases. The Syphilis sore that develops after a primary infection closely resembles a zipper cut, an ingrown hair or some other type of benign lesion. These sores normally do not cause pain. In the second stage, skin rashes appear on the hands, palms, the sole of feet or throughout the body. These rashes may initially resemble chicken pox rashes. They do not cause itching or irritation. In some cases, the disease affects the eyes and cause irritation. This is called ocular syphilis and is confused with normal eye infections. This may even lead to blindness.

What causes Syphilis?

The primary causative pathogen of the disease is the Treponema pallidum. The general causes of the disease are as follows-

• Exposure to the Treponema pallidum during sexual intercourse or through direct contact with the skin lesions
• Having sex without protective devices
• Being sexually active from a very young age
• Sexual relationship with multiple partners
• Having sex with a partner having some communicable sexual disease like AIDS, Gonorrhoea, Chlamydia etc
• Sex with a partner of the same gender
• A history of sexually transmitted diseases
• Acquiring infection forcefully due to sexual abuse
• Transmission of the infection from the mother to the child during breastfeeding (vertical transmission)
• Transmission of the disease from the mother to the foetus in the pre-natal period (trans-placental transmission)
• Taking blood from a donor who has infections
• Sharing of needles with an infected person

What are the different stages of Syphilis?

Syphilis slowly progresses through a number of stages. The symptoms become more severe with each stage. These are given below-

Primary stage: This is the first stage of the infection which begins shortly after the incubation period (21 days). Single or multiple lesions called chancres may appear on the skin. These sores facilitate the entry of bacteria into the body. The sores are usually round and do not cause much pain. These rashes usually stay for 3-6 weeks. The infection may progress to the secondary stage if no treatment is done.

Secondary stage: This stage begins shortly after the primary lesions are gone. New sores appear inside the mouth, anus or vagina. These are known as mucous membrane lesions. They may also appear as reddish-brown rough spots on the palms or on the sole of the feet. These sores usually do not cause irritation or itching. With the progress of this stage, additional symptoms like baldness, swollen lymph nodes, sore throat, muscle soreness and fatigue may occur.

Late stage: This stage is also known as the “latent stage”. This is a recurrent form of Syphilis where the symptoms appear several years after the actual infection. The common symptoms are- loss of muscle coordination, numbness, blindness, and memory loss. In the end stage, serious damage to the internal organs (brain, liver, nerves, joints, bones, blood vessels) occurs that can even lead to death.

What are the types of Syphilis?

Syphilis normally has the following classification-

• Primary syphilis: It occurs in the genital regions in majority of the cases. The lesions primarily emerge as light pink papules. Later they grow into dark, reddish, rough lesions. In men, these lesions appear on the urethral meatus, prepuce or balanopreputial fold. In women, these lesions appear on the uterine cervix, vaginal wall and the labia minora.
• Secondary syphilis: In this case, symmetrical skin lesions usually form. Erythematous spots may appear which is known as “Syphilitic Roseola”. Clusters of papules also form on the face and nose. Many of these patients suffer from Adenomegaly, in which low grade fever, headache, renal disorders, malaise and loss of appetite occurs.
• Tertiary syphilis: Localised lesions on the skin and mucous membrane appear in this disease. Formation of destructive granuloma also occurs in this case. A single granuloma called “pseudochancre redux” appears on the genitals in men.
• Cardiovascular syphilis: Symptoms of this disease appear several years after the first occurrence of syphilis. The common complications are- aortitis, aneurysm and coronary osteum stenosis.
• Neurosyphilis: The meninges (protective membrane of the brain and the spinal cord) is attacked in this case. This causes abnormalities in the cerebrospinal fluid. Neurological symptoms arise in the late stages.
• Congenital syphilis: In this disease, the infections are present from birth. The new-borns usually acquire these infections from the mother mainly via breast milk.

Diagnosis

The following diagnostic tests are important-

• Genital swab
• CT scan
• Pap test

Treatment & Prevention

Syphilis can be treated with the help of antibiotics such as penicillin. Just in case the patient is allergic to penicillin, he/she will be treated with doxycycline or azithromycin.  It is important to refrain from sexual activities during the course of the treatment. Both the partners should complete their respective treatment routines to resume sexual activities.

Syphilis can be easily prevented. The most effective preventive measures include:

• Practice safe sex. Use latex condoms correctly each time you indulge in a sexual intercourse.
• One must refrain from sharing sex toys.
• Avoid sharing needles as the disease can spread via infected needles also.
• Get tested for STIs if your current or previous partner has been diagnosed with an STI.
• Practice monogamy. Having multiple sexual partners increases the risk of getting an STI.

References