FACTS ABOUT SYPHILIS

  • Syphilis is curable.
  • Syphilis is increasingly spread among same-sex individuals.
  • About 107,000 people die of syphilis globally every year.
  • Syphilis can be spread by deep kissing.
  • The first sign of syphilis is a firm, painless, non-itchy small sore, called a chancre.
  • More than 5% of sex workers are infected with syphilis in 18 of 31 reporting countries for 2017.
  • About 1 million pregnant women had an active syphilis infection in 2016.
  • More than 95% of antenatal care attendees were tested for syphilis in 26 of 84 countries reporting for 2017.

OVERVIEW

Syphilis is a highly infectious disease, mainly spread through sexual activity; anal, vagina or oral sex. It is caused by a spirochete bacteria known as; Treponema Pallidum, commonly abbreviated as T. pallidum.

Ideally, this disease is almost always spread through sexual activity. Yet, we need to note that, that is not the only mode of transmission. An infected mother may also spread the infection during pregnancy or at birth. It can also spread through deep kissing or close bodily contact.
It usually affects the genital area, lips, mouth, or anus of both men and women. Syphilis starts as a painless sore on these areas of the body.

Syphilis regarded as a tricky disease. As Sir William Osler once put it, “Syphilis is a great imitator”. This is due to its ability to mimic other disease symptoms.
Though this disease can cause very serious complications if left untreated, the good news is it is relatively easy to cure with the right medication.
There are 4 main stages of Syphilis; each stage presents with distinct associated symptoms.

Transmission

Syphilis is highly contagious, spreading from an infected person to the other via skin or mucous membrane contact. The bacteria enter the body via mucous membranes, such as those in the vagina or mouth, or through the skin. The bacteria then reaches nearby lymph nodes and spreads to other parts of the body via the bloodstream.

 

  • Infection is usually spread through sexual contact.
  • From an infected mother to the child during pregnancy or childbirth.
  • Deep kissing.
  • Close bodily contact. However, it is rare because the bacteria cannot survive long outside the human body for long.
  • It cannot be transmitted by sharing clothes, utensils or lavatories with infected persons.

SIGNS AND SYMPTOMS

There are 4 main stages of Syphilis (primary, secondary, latent and tertiary), each stage with its unique symptoms. You may be infected with syphilis and not notice any symptoms for a long time because the bacteria can lie dormant in the body for years. Symptoms progress with each stage. Presenting symptoms depends on the stage of the disease, but the stages can overlap and does not always progress in the same order.

 

Primary Syphilis

Primary syphilis is the first stage of the infection after direct sexual contact with the infectious lesions of another person.

Symptoms usually develop from 1 to 13 weeks (<90days) after infection, but usually starts after the first 3weeks.

  • The first sign of syphilis is a firm, painless, non-itchy small sore, called a chancre. Many people fail to notice the chancre because, as mentioned earlier, it’s usually painless, and it may be hidden within the vagina or rectum. The chancre usually resolves on its own within 3-6 weeks with or without treatment. The most common location of the chancre in women is the cervix, the penis in men who have sex with women and in the anal region of men who have sex with men.

 

Secondary syphilis

Primary syphilis progresses to secondary syphilis within 9 weeks after infection. The infection spreads to other parts of the body. The presentation of secondary syphilis includes:

  • Rash, usually involving the palms and soles of the feet.
  • Fever, fatigue, loss of appetite, and weight loss.
  • Condylomata lata: The development of painless, mucosal, warty-lesions around the genitals or in the mouth.
  • More than half of patients with secondary-stage syphilis have enlarged lymph nodes throughout the body especially in the inguinal (groin) region.
  • Hair loss may also be seen if a rash develops on the scalp, creating patches.

At this stage, syphilis even without treatment eventually resolves, but it may recur weeks or months later.

 

Latent syphilis

During this stage, the bacteria is latent (inactive) but still present. Due to the absence of an active infection, the patient becomes asymptomatic (showing no symptoms).

The latent stage is grouped into early (i.e if the initial infection occurred within the previous 12 months) or late (if the initial infection occurred more than 12 months previously).

The infection is more contagious in the early stages than the late stages and a patient is more likely to relapse in this stage.

Whiles in the late stage, there are often no symptoms of infection.

 

Tertiary syphilis

This is a very rare stage of syphilis and only develops in long-standing untreated syphilis, with the ability to affect multiple organs. It can even develop after years, to decades after the initial infection.

At this stage many organs are affected including:

  • Neurosyphilis: which refers to an infection involving the brain. This may lead to disorders such as mental illness, memory loss, meningitis, stroke and other neurological problems.
  • Heart and blood vessels which may lead to heart diseases.
  • Soft, non-cancerous growths (gummas) which usually affect the skin, eye, ear, bone, and liver, but can occur anywhere.

 

CONGENITAL SYPHILIS

Syphilis, which spreads from a mother to a child during pregnancy or childbirth is known as congenital (born with) syphilis. Most babies born with syphilis usually have no symptoms. Some symptoms may include a rash on the palms of their hands or the soles of their feet. With time the infection affects other organs and results in:

  • Skin rashes
  • Severe anemia
  • Hepatomegaly (enlarged liver)
  • Jaundice (yellowish discoloration of the skin and mucous membranes such as the sclera of the eye)
  • Bone abnormalities
  • Brain (neurological) disorders
  • Heart problems

Congenital syphilis is common in the developing world, because of lack of antenatal care and screening for STIs. Congenital syphilis in newborns are often identified and avoided when early maternal screening and treatments are performed. Syphilis can be prevented if mothers are screened early during pregnancy and treated immediately if the disease is suspected.

DIAGNOSIS

Confirmation is not by symptoms only, but by a series of tests. Nonetheless, diagnostic tests are unable to distinguish between the stages of the infection. The following are some of the tests done to confirm the infection.

Blood tests

  1. Treponemal-Specific Tests

This test mainly helps determine antigen-antibody reactions to T.pallidum. Thus, it is a confirmatory test for syphilitic patients with a reactive nontreponemal test. This includes:

  • The enzyme immunoassay (EIA) test for anti-treponemal IgG which can also be used for screening.
  • T. pallidum hemagglutination (TPHA) test,
  • Micro hemagglutination test with T. pallidum antigen,
  • Fluorescent treponemal antibody-absorption test (FTA-abs),
  • Enzyme-linked immunosorbent assay.

 

  1. Nontreponemal Tests

  • VDRL Test and Rapid Plasma Reagin Test.

Usually, in a Syphilis infection, there is the production of non-specific antigens that react with cardiolipin. Again, there are limitations to the accuracy of this test, such as false positive reactions due to pregnancy, infections and autoimmune disorders but it is a relatively reliable test that can indicate the requirement of confirmatory tests

 

Direct Tests

Direct testing of fluid from a chancre may be used to make a quick diagnosis. An example of this test is:

 

  • Dark Field Microscopy

It is known by far as the most specific diagnostic technique for syphilis, in the presence of an active chancre. Certain factors limit the accuracy of its effectiveness. This test is done by getting a sample of fluid from a skin sore or lymph node and examining it using a specially equipped light microscope. The bacteria appear bright against a dark background, which makes them easier to identify.

 

✓ In the primary or secondary stages, syphilis can be diagnosed using Dark field microscopy.

✓ In the latent stage, blood tests (treponemal and nontreponemal) are used to diagnose syphilis.

✓ In the tertiary stage, diagnosis is mostly based on symptoms and antibody test results.

COMPLICATONS

Most complications are as a result of the progressive nature of the infection. It is usually due to late diagnosis and delay in treatment. Some of the complications are;

  • Risk of HIV infection: People infected with syphilis are about 2-5 times more prone to the risk of HIV transmission, with an increasing susceptibility rate in patients with secondary syphilis
  • Brain disorders: Neurosyphilis and ocular syphilis, where the infections spread to the brain and eye respectively, are a potential concern in individuals with syphilis. This may result in symptoms such as headache, paralysis, numbness, and changes in vision and blindness.
  • Heart and blood vessel disorders
  • Soft, non-cancerous growths (called gummas) which affect the skin, bone, and liver, but can occur anywhere.
  • Miscarriage, stillbirth or death of a newborn within a few days after birth.

RISK FACTORS

  • Engaging in unprotected sex

  •  Having sex with multiple partners or with partners who have other sex partners.

    • Homosexual men are at an increased risk if they engage in same-sex activities

    • A person infected with other STIs especially HIV.

PREVENTION

As of 2018, there is no vaccine for syphilis. To help prevent the spread of syphilis, the following measures can be taken:

 

  • Abstinence
  • Regular and correct use of condoms
  • Avoiding unsafe sex practices with multiple sex partners or with partners who have other sex partners.
  • People who have been diagnosed and treated for syphilis should avoid sexual contact with others until chancres are healed
  • Getting tested regularly
  • Screening of all pregnant women for the disease.

TREATMENT

It is easier to treat if diagnosed early. Since syphilis is caused by a bacteria, the mainstay of treatment is the use of antibiotics. Benzathine benzylpenicillin (long-acting Penicillin G) given by injection into the muscle is the recommended antibiotic for primary, secondary, and early latent syphilis. In cases of allergy to penicillin, other antibiotics may be used. These antibiotics include doxycycline, azithromycin, and ceftriaxone, to name a few.

Doses of antibiotics are increased if the patient is in the tertiary stage.Some complications of Syphilis are treated by administering antibiotics in 4 hours intervals for about 2 weeks.

Another form of penicillin is given by injection into a muscle once a week for up to 3 weeks.

To avoid late diagnosis, sexual partners of people who are diagnosed with syphilis have to be tested and potentially treated. Sex partners exposed to syphilis within the past 90 days should be treated for it without waiting for test results.

After treatment, examinations and blood tests should be done periodically to ensure no relapse of the infection.

An individual can be infected again after treatment if he/she has sex with an infected person.

EPIDEMIOLOGY

Statistically, WHO has it that, syphilis infected 12 million people in 1999 with greater than 90% of cases in the developing world. In 2008, about 10.6 million cases of syphilis were recorded globally, also affecting between 700,000 to 1.6 million pregnancies annually. In Sub-Saharan Africa, Syphilis contributed to about 2% of perinatal deaths.

Syphilis in pregnancy is the second leading cause of stillbirth globally and also results in prematurity, low birth weight, neonatal death, and congenital syphilis.

In 2015, Syphilis was recorded to have infected 45.4 million people worldwide with 6 million new cases. And causing about 107,000 deaths.

 

The Incidence of syphilis for the WHO African Region

The WHO African region comprises of 46 countries with an estimated population of about 348.4 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 3.4 million cases of syphilis.
  • Prevalence: 14.3 million with syphilis.

 

The Incidence of syphilis for the WHO American Region

The WHO American region comprises of 35 countries with an estimated population of about 476.9 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 2.8million cases of syphilis.
  • Prevalence: 6.7 million with syphilis.

 

The Incidence of syphilis for the WHO South-East Asian Region

The WHO South-East Asian Region comprises of 11 countries with an estimated population of about 945.2 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 3.0 million cases of syphilis.
  • Prevalence: 12.3 million with syphilis.

 

The Incidence of syphilis for the WHO European Region

The WHO European Region comprises of 53 countries with an estimated population of about 450.8 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 0.2 million cases of syphilis.
  • Prevalence: 0.3 million with syphilis.

 

The Incidence of syphilis for the WHO Eastern Mediterranean Region

The WHO Eastern Mediterranean Region comprises of 23 countries with an estimated population of about 309.6 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 0.6 million cases of syphilis.
  • Prevalence: 1.6 million with syphilis.

 

The Incidence of syphilis for the WHO Western Pacific Region

The WHO Western Pacific Region comprises of 37 countries with an estimated population of about 986.7 million of adults between ages of 15 to 49 as of 2008.

  • Incidence: about 0.5 million cases of syphilis.
  • Prevalence: 1.2 million with syphilis.

 

The estimated number of cases is likely to be much higher than the figures provided. This is because there are unreported and undiagnosed infections due to asymptomatic infections.