1. What is syphilis?
  2. The different stages of syphilis
  3. How is syphilis transmitted?
  4. Diagnosis, treatment and prevention

What is syphilis?

Syphilis is a genital infection caused but the Treponema pallidum bacterium transmitted through unprotected oral, vaginal or anal sex. Thanks to the wide availability of effective diagnostic methods and to the treatment with antibiotics, there has been an overall decrease in syphilis even though its incidence is recently increasing both in developing countries and in some European countries. After Aids, syphilis is the sexually transmitted disease with the highest mortality rate but fortunately its prevalence in adolescents is not as high as other sexually transmitted diseases.

The different stages of syphilis

Syphilis causes ulcers and abrasions also facilitating HIV transmission. If not adequately treated, it can cause serious damage to the nervous system and to the arterial blood vessels, mental disorders and also death. Syphilis develops into different stages that usually show during the first year of infection. It starts with the first symptoms 14-20 days after the exposure to the bacterium with the appearance of a small wound or more small not painful pustules in the region where the bacterial infection starts. The wound heals by itself in 3-6 weeks but if the infection is not treated it evolves to the secondary stage that occurs after several weeks or months from the primary stage. Syphilitic papillomatosis, which is mainly a rash, appears in different areas like on the abdomen, palms of the hands and soles of feet but also genital or anal wounds may appear. Typical of this stage are also other symptoms like fever, discomfort, weight loss, sore throat, hair loss, swelling of the lymph nodes and fatigue. Once the symptoms of the secondary stage disappear, damages to internal organs like brain, nerves, eyes, heart, blood vessels, liver, bones and joints begin. During this stage, the patient loses its muscle control and can be subject to paralysis, mental confusion, gradual blindness and dementia. The damage can be so serious to cause death.

How is syphilis transmitted?

The infection can be transmitted to the foetus by an infected mother and can cause either death in the uterus or the birth of a baby with congenital syphilis. If during the four years prior to pregnancy the mother has been infected with syphilis, the risk of transmission is high. Syphilis is transmitted through contact, thus through wounds or ulcers that develop in the genital and rectal areas or in the mouth following sexual contact. It is easily transmitted during the primary stage because people are often unaware of the disease during such stage. Contagion cannot occur indirectly. Pregnant women can transfer the infection to the foetus during pregnancy.

Diagnosis, treatment and prevention

It is possible to have an immediate diagnosis of primary or secondary syphilis through a microscope examination of material taken from the patient’s wound. The Treponema bacterium has characteristic morphology and is recognisable using the optical microscope in dark field. The bacteria’s presence can also be shown in the blood with a simple serological test researching the antibodies already present in the earliest stages of the infection. Normally, two types of tests are carried out: those not specific for Treponema bacteria such as the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR), and Treponema-specific tests such as the Fluorescent Treponemal Antibody Absorbed (FTA-ABS) and the T. Pallidum Particle Agglutination (TP-PA).

The pathology is treated with penicillin antibiotics. The length of the treatment depends on the stage of the disease and on the patient’s clinical symptoms. In addition to the treatment with antibiotics, the infected subject must abstain from any sexual activity with new partners until the complete healing of wounds. A prior infection does not guarantee immunity against the bacteria, meaning that a recovered patient may be infected again. It is important to use adequate prevention tools such as condoms. Wounds and skin ulcers can transmit the infection during oral sex or any other skin contact with infected areas. Therefore, it is very important to pay attention to any symptom after risky, unprotected sexual intercourse. All patients that have been diagnosed syphilis are also required to take a HIV test.

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