Syphilis and its cause 

Hello students and friends, today we are going to discuss syphilis, its cause, mode of spread, pathogenesis, stages, diagnosis, and treatment.

Let us discuss first what is syphilis and its cause?

• Syphilis is a sexually communicated disease caused by the bacteria Treponema pallidum.
• Due to unsafe sex practices, syphilis is occurring in developing countries like Canada, Russia, the USA, and England.
• If we talk about the size of the organism, it is very small. Its length is 6-20micrometer and diameter range of 18-20micrometer.
• Spirochete bacterium Treponema pallidum is the bacteria that is responsible for bacterial infection and causes syphilis.

Spirochetes

• Long, slender, helical tightly coiled bacteria.
• Gram-negative bacteria.

Treponema Pallidum

• It is a microaerophilic spirochete means it require less oxygen for their growth.
• It is gram-negative bacteria and doesn't see in gram stain.
• It is transmitted only amongst humans.
• 6-15 micrometer long and 0.1-0.2 micrometer wide.

Mode of the spread of syphilis

It is transmitted through unsafe sexual contact:

• When one partner is infected with syphilis he/she may cause syphilis to their partner also.
• Usually, the bacteria enter into the body through the damaged or broken skin/mucous membrane during sexual contact.
• It may be transmitted through the mouth, genitalia, or rectum through sexual contact or it can be transmitted by kissing also.
• If an infected partner kissed or made intimate contact with his non-infected partner then there are chances of transmission of syphilis to the non-infected partner also.

If we talk about non-sexual contact:

• Syphilis through non-sexual contact is rare.
• It involves transmission by infected blood transfusion through needle(horizontal transmission) and through the mother to the fetus during pregnancy(vertical transmission).

Pathogenesis

• During sexual contact, bacteria penetrate via skin and mucus membranes.
• It can also transmit through the placenta.
• Incubation period: 10-90 days(usually 21 days) before the manifestation of the initial stage.

How syphilis transmit?

The only way of transmission is through direct contact, it doesn't transmit through sharing clothes, and food.

If we talk about its type we describe its type on the basis of its stages.

Stages of syphilis

Congenital syphilis:

It is transmitted from the mother to child in the uterus.

2 stages are:

1. Early means in the first 2 years of the life of the child.
2. Late

Acquired syphilis:

It is transmitted through sex or blood transfusion.

2 stages are:

1. Early syphilis
2. Late syphilis

In early syphilis, there are 3 stages-

1. Primary
2. Secondary
3. Early latent.

In late or tertiary syphilis, there are 4 stages-

1. Neurological
2. Cardiovascular
3. Gummatous
4. Late latent

If we consider stages of syphilis depending upon the period after which the lesion occurs, there are manly 4 stages-

1. Primary stage
2. Secondary stage
3. Tertiary stage
4. Latent stage.

Primary syphilis-

The appearance of the chancre usually associated with regional lymph node enlargement.

Chancre: chancre is single, firm non-tender, raised red lesions.

• It progresses from macule to papule to ulcer.
• The ulcer can be seen on an anogenital site or at extra-genital sites like the mouth and lips.
• It lasts usually from 3-6 weeks.
• It usually heals without treatment.
• They are painless.
• The person is highly contagious.

If sufficient medication is not administered it progresses to the secondary stage.

Secondary syphilis

• Ordinarily occurs after 2-3 months following primary syphilis.
• It is characterized by rashes that arise from 2-8 weeks after the chancre develops and sometimes before it heals.
• If primary syphilis is left untreated, then it will lead to secondary syphilis.
• In the case of secondary syphilis, lymph nodes get enlarged, and with enlargement of the lymph nodes, cutaneous lesions in the skin on the palms and soles, which are painless are seen in the whole body.
• Lesions are symmetrical, pale, red, or pink.
• They are round and are distributed on the trunk and proximal extremities.
• Diameter= 5-10mm.
• Infection is spread throughout the body.

Tertiary syphilis

• If secondary syphilis is not treated then it will lead to tertiary syphilis.
• Usually develops after 2-3 years if secondary syphilis is not treated.
• Lesions are less infective.
• Bacterial organisms are difficult to detect.

Some complications of tertiary syphilis are:

1. Cardiovascular syphilis
2. Neurosyphilis
3. Benign tertiary syphilis.

Cardiovascular syphilis: Syphilitic aortitis is seen.

• This occurs from 10-40 years after infection.
• Affects the heart and blood vessels.
• Usually seen in 10% of patients with the tertiary disease.

Neurosyphilis syphilis: mainly symptomatic.

• Appears within few months of primary infection.
• It can appear after 20-30 years later also.
• Affects the nervous system.

Benign tertiary syphilis- includes Small bumps of tissue and fiber in the bone, skin, and mucous membrane(gummas).

• Gummas are nodular lesions and result from delayed hypersensitivity reaction.
• Usually, disappear after treatment with antibiotics.

The latent stage of syphilis

• If syphilis left untreated then it will lead to latent syphilis.
• The rash will go away in this stage.
• This period is brief as 1-year or it may vary from 5-20 years.
• During the latent stage, there is relapsing of the secondary stage of syphilis.
• If there is relapsing at the time of pregnancy then the infection will transfer to the newborn and he/she will birth with congenital syphilis.

It may occur between secondary relapses, and after the secondary stage.

• Lesions are not clinically visible.
• The host suppresses the infections here.

Diagnosis

• Asses a history of syphilis.
• The most recent serological test should be done for syphilis.
• The serological test for syphilis may not be positive during early primary syphilis.
• The antibody tests are always positive at the secondary stage.
• If we take laboratory diagnosis-
• Firstly we have to identify lesions of Treponema pallidum.

• Darkfield microscopy.
• Direct fluorescent antibody- Treponema pallidum(DFA-TP)[This is the most specific test].
• Serological tests-
• Non-treponemal tests.
• Treponemal tests(FTA-ABS, EIA).

Treatment

1. It is curable.
2. Signs and symptoms of secondary syphilis may go away on their own without any kind of treatment in 2-6 weeks.
3. If the right antibiotics are administered on time then it is curable.
4. We can give penicillin and other antibiotics[doxycycline, azithromycin, and ceftriaxone] to primary and secondary syphilis patients.
5. Penicillin is injected intravenously if the patient is suffering from neurosyphilis.
6. Damage through late syphilis can not be reversed.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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