Syphilis: Symptoms, Risk factors, Diagnosis, and Treatment

Syphilis is a sexually transmitted chronic infection caused by Treponema pallidum.  Though most of the cases are acquired by sexual contact (oral, vaginal or anal) with the infectious lesions, it can also be transmitted via non-sexual modes, for instance- blood transfusion or from an infected mother by the fetus in utero. Syphilis may be congenital or acquired.

Symptoms:

Symptoms develop stagewise and the stages are:

1. PRIMARY SYPHILIS: The primary lesion occurs as the spirochete (T. pallidum) enters the body. It usually heals on its own, within 4-8 weeks, even in the absence of proper treatment.

2. SECONDARY SYPHILIS: This stage begins 6-8 weeks after the appearance of the primary lesion. It presents non-itchy rashes on the palms and soles.

3. LATENT SYPHILIS: With time, the stage of secondary syphilis is replaced by a latent period.

4. TERTIARY SYPHILIS: This stage usually takes 3-10 years or more to develop after the primary infection. It affects the skin, mucosa, bone, and joints.

5. QUATERNARY SYPHILIS It affects the heart and the nervous system. It is extremely rare.

RISK FACTORS 

• Unprotected intercourse
• Multiple sex partners
• Homosexuality
• Patients suffering from HIV

DIAGNOSIS

1. Non-treponemal tests

• Based on raised antibody titers that usually imply the disease activity in your body.
• These tests most often become non-reactive after proper treatment

The tests are as mentioned below:

• VDRL Test (Venereal Disease Research Laboratory Test)
• RPR Test (Rapid Plasma Reagin Test)

2. Treponemal tests

• Raised antibody titers have a very poor correlation with the disease activity
• These tests remain active for their entire lives, irrespective of treatment or disease activity

Various tests as listed below:

• FTA- ABS Test ( Fluorescent Treponemal Antibody-Absorption Test)
• Treponema Pallidum Hemagglutination ( TPHA)
• Treponema Pallidum Immobilization Test (TPI)

TREATMENT

• Penicillin is the preferred drug for Treponema pallidum even after 60 years.
• Primary and early latent stage- Benzathine
• Penicillin G (single dose of 2.4 mU IM)
• Tertiary stage and Late latent stage- Benzathine
• Penicillin G ( 2.4 mU IM weekly for 3 weeks)
• Tetracycline or doxycycline used in patients that are allergic to penicillin.
• The efficacy of the treatment provided is assessed by proper clinical evaluation and using VDRL or RPR test.

Sexual Health: Physical, Mental and Social well-being