Sexually Transmitted Infection (STI) caused by Treponema Pallidum bacteria is Syphilis. It is a common infection worldwide. The transmission occurs through direct contact with syphilitic chancres. The initial phase is a painless sore, which is also called a chancre. In most cases, early syphilis can be cured with a single dose of Penicillin. As people often fail to notice it, it becomes challenging to diagnose the infection.
What is Syphilis?
In the initial stage, the bacteria seem to be dormant for years before becoming active. As there are no visible symptoms, the only way is to get tested to identify them. If syphilis is left untreated for many years it may cause major damage to the heart and brain. It can also be passed on from an infected mother to her infant during childbirth or pregnancy.
Fortunately, this infection is easily curable in adults in the initial stage as there are many effective treatments available. The later stages can also be treated, but the organ damage caused by the disease is difficult to cure. Apart from the ones who are sexually active, people who are experiencing sexual violence can also get syphilis. On average it takes 21 days to get the symptoms after infection. But, it can also vary from 10 to 91 days. Syphilis also facilitates HIV transmission. The process of testing and diagnosing syphilis is straightforward.
Causes of Syphilis
The bacteria Treponema Pallidum causes Syphilis. Transmission usually happens during sexual activity but it can also spread through cuts on skin or through mucous membranes. Rarely, it spreads through direct unprotected close contact with an active lesion (for instance kissing) or infected mothers to infants during childbirth or pregnancy.
The infection is contagious during the primary and secondary stages. Sores also facilitate the transmission of HIV and the virus that cause AIDS.
Infection can’t be spread by using the same clothing, toilet seat, utensils, bathtubs, swimming pools, or hot tubs.
Chancre occurs on the genitals, vagina, rectum, anus, or mouth. It is transmitted when direct contact with these chancre occurs. Treponema Pallidum is also transmitted by blood transfusion. Endemic syphilis is transmitted by non-sexual communities (for instance living under poor hygiene). Having unprotected oral, anal, or vagina sex with the person who has syphilis or a person who is in the first two stages of infection can also spread the infection.
Syphilis in men and women
Symptoms in men and women are identical. The location of the primary stage sores differs. The chancre develops on the penile head or shaft for men. And for women, the chancre develops in the vagina, or on the vulva, or cervix.
Stages of Syphilis
Symptoms may vary in each stage and there is also the possibility of overlap among the stages.
- Primary/Early syphilis Symptoms
The first symptom of syphilis is a small sore called a chancre. Sore occurs wherever the bacteria enters the body (Rectum, genitals, or inside the mouth).
Most of the time only one chancre develops, in some cases, it may differ. The chancre is painless and hidden in the vagina or anus so, it’s difficult to notice them. This chancre lasts 3 to 6 weeks and it will heal on its own. And the transmission occurs when direct contact with a sore happens. This may occur during sexual activity or oral sex. Treatment will prevent this infection from moving to the next stage.
- Secondary syphilis symptoms
In this stage, rashes occur in different parts of the body but predominantly in the palms of the hands and the feet. Other symptoms include –
- white patches inside the mouth
- hair loss
- lesions in the groin
- weight loss
Like primary, secondary syphilis can also heal on its own. But without treatment, the infection may progress to the next stage. The secondary stage begins in 6 weeks to 6 months after a person is exposed to infection. This may last up to 3 months.
- Latent syphilis symptoms: This stage is latent or hidden as the infection does not have any noticeable signs or symptoms. This stage lasts for years and the infected person will continue to have syphilis even though there are no symptoms.
- Tertiary syphilis symptoms
This stage is life-threatening and can occur years or decades post the initial infection. About 15% to 30% of people who left the syphilis untreated enter this stage. This can affect many organs including the brain, heart, bones, eyes, liver, and nerves. Symptoms may vary depending on the organs affected. Possible symptoms include –
- heart disease
- neurological disorders
- memory loss
Other stages and symptoms
Neurosyphilis: Syphilis can affect the nervous system at any stage of infection and the infected person may experience headaches, dementia, changes in behavior, or even become paralyzed.
Ocular syphilis: This can affect almost any eye structure. But posterior uveitis and panuveitis seem to be common. Other symptoms include blindness, vision change, and a decrease in visual acuity.
Congenital syphilis: Infection can spread to infants during pregnancy or at the time of birth when the woman is infected. Babies with syphilis can be born too early or even die after birth.
How Syphilis is diagnosed?
Diagnosing the infection only based on symptoms is challenging because these symptoms emulate those from other infections or diseases. According to Planned Parenthood, it is recommended that sexually active people should test for STIs once a year. A blood test is a sure-fire way of diagnosing it. Or in some cases, a sample of fluid is taken from the open sores and tested.
How to test for Syphilis?
Syphilis testing is usually done on blood, body fluid, or tissue samples. A screening test helps to show the signs of it and other tests are done to confirm syphilis.
1) Venereal Disease Research Laboratory (VDRL) test
This test checks spinal fluid or blood for an antibody. These antibodies confirm the presence of the disease.
2) Rapid Plasma Reagin (RPR) test
This test also checks for the presence of antibodies.
3) Rapid Immunochromatographic test
This test is a rapid test, which helps to identify the antibodies that are specific to syphilis.
Test to confirm:
1) Enzyme Immunoassay (EIA) test
This test is used to confirm the presence of syphilis infection. When EIA is positive, it must be confirmed with VDRL OR RPR.
2) Treponema pallidum particle agglutination assay (TPPA)
This is an indirect agglutination assay used to detect antibodies against the causing agents and the test is not done on spinal fluids.
3) Microhemagglutination assay (MHA-TP)
This test is used to confirm the presence of syphilis.
4) Fluorescent treponemal antibody absorption (FTA-ABS) test
This blood test checks for the presence of antibodies to syphilis causing bacteria.
5) Darkfield microscopy
This test is used to identify the infection at the early stage. A special microscope is used to look for syphilis germ in the sample fluid or tissue from the open sores.
Apart from these tests, it’s better to get tested for other STIs including HIV, gonorrhea, and chlamydia.
Who should test for Syphilis routinely?
- A person who lives with HIV
- A person who is taking PrEP for HIV prevention
- Pregnant woman
- Sexually active men (MSM)
- Sex worker
Treatment for Syphilis
When it is identified in the initial stage it can be cured easily with just one dosage of Penicillin. If left untreated it may permanently damage the heart and brain even after the infection is gone. The damage caused by late syphilis is not possible to be reversed. A person who is allergic to Penicillin is advised to get other antibiotics like Doxycycline, Azithromycin, or Ceftriaxone.
A pregnant woman who is allergic to Penicillin has to undergo a process called Desensitization, which helps them to take drugs safely. A person who undergoes treatment must avoid sexual contact until all sores are healed. And, a person with syphilis needs to notify their partner, so they can be tested and treated if necessary.
Neither home remedies nor complementary therapies are available to cure this infection. It doesn’t come back on its own unless contact with someone who has syphilis infection occurs.
All pregnant women are advised to screen for syphilis and get treated if necessary to avoid congenital syphilis in offspring. It can also be transmitted by shared needles. Practicing safe sex can also prevent this infection.
As there are no vaccines for syphilis, the following ways may help to prevent the spread:
- Avoid recreational drugs
- Having one sexual partner
- To be monogamous or abstain
- Using a dental dam
- Avoiding intimate contact with someone infected
- Getting screened for STIs
Is Syphilis curable?
Yes, syphilis can be cured with antibiotics. Even in the later stage, it remains curable but may require a longer course of Penicillin. But the treatment can’t repair or reverse any damage that has already occurred, it prevents further damages.
What happens if syphilis is left untreated?
Syphilis can cause complications all over the body if left untreated. Treatment at the right time can prevent future problems.
- Small bumps called gummas may develop on skin, bones, or in any organs which destroy the tissue around them.
- Nervous system problems like brain damage, stroke, bladder incontinence headache, or even paralysis.
- Chances of getting HIV are increased.
- Cardiovascular problems like aneurysm and inflammation of the aorta can also damage the heart valves.
- The complication in pregnancy and childbirth.
Facts about Syphilis
Syphilis may remain a common disease worldwide. Tools for effective control have been established but it’s not implemented in all parts of the world. This seems to be hard to study. Because, unlike other bacteria, it can’t be grown in a lab. Other than humans, the only animal which is susceptible to syphilis is the rabbit. But it can also clear infection quickly. So, new rabbits must be infected regularly to maintain a strain of the bacteria that is causing syphilis. Secondly, Treponema Pallidum bacteria is so delicate, so it’s difficult to study it.
Other diseases causing bacteria are tough so, you can wash and dry them and then look at their extension under a microscope. Unfortunately, bacteria causing syphilis don’t sustain such rough treatment. This bacteria tends to break open and it makes it impossible to find out which proteins are expected to be on the outside of the bacteria.
The proteins outside the bacteria are the key to figure out how the immune system recognizes bacterial invaders and how vaccines work. Through genetic analysis, researchers found that Treponema Pallidum is a part of the Spirochete Phylum of bacteria which is spiral-shaped, it was closely related to other bacteria.
The researchers made the proteins and tested them. Indeed proteins mutate and hide from the immune system and they are not good candidates for vaccines. The outer membrane protein is essential for vaccines. Finally, the Uconn Health researchers were able to figure out them and planned to test them on rabbits to prove whether they could work as a vaccine.
The University of Connecticut Health researchers have planned to collaborate with researchers in the University of North Carolina to take up patients from Malawi, China, Lilongwe, and Guangzhou to ensure that syphilis they are studying represents worldwide. The proteins they have identified may end up as vaccines, so they want it to be benefited to people as much as possible.