Syphilis:

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum, a spiral-shaped microorganism known as a spirochete. The time from initial infection to the appearance of the first symptom (incubation period) is quite variable, ranging from 2 to 90 days.

Modes of Transmission:

Syphilis is primarily spread through:

• Mother-to-Child Transmission (Vertical Transmission): During pregnancy, an infected mother can transmit Treponema pallidum to her unborn child across the placenta. This is known as congenital syphilis and occurs during intrauterine life.

• Direct Contact with Infectious Discharges: The bacteria can be transmitted through direct contact with infectious bodily fluids, particularly from syphilis sores.

• Sexual Contact (Unprotected Sex): The most common route of transmission is through sexual activities, including vaginal, anal, and oral sex, without the use of barrier protection like condoms with an infected person.

Signs and Symptoms:

Syphilis progresses through distinct stages if left untreated, each with its own set of characteristic symptoms:

Primary Stage:

• Chancre Development: The hallmark of primary syphilis is the appearance of a chancre, a sore or lesion at the site where the bacteria entered the body. This typically occurs 10 to 90 days following initial exposure.

• Chancre Characteristics: The chancre is typically described as firm to the touch, painless, and superficial. It has an ulcerated surface and can persist for 4 to 6 weeks. Notably, it will heal spontaneously even without treatment, which can mislead individuals into thinking the infection has resolved.

• Painless Lymph Node Swelling (Lymphadenopathy): Painless enlargement of regional lymph nodes may develop in the area near the chancre, usually 1 to 2 weeks after the chancre appears. Because the chancre is often painless and may be in a less noticeable location, this primary stage can easily be missed.

Secondary Stage:

• Onset Timing: The secondary stage typically begins 1 to 6 months after the primary infection.

• Flu-like Symptoms: Individuals often experience a general feeling of illness, similar to the flu, including mild fever (pyrexia), headache, loss of appetite (anorexia), and sometimes unintentional weight loss.

• Generalized Rash: A distinctive reddish-pink rash appears, often described as systemic, meaning it can spread across the body. The rash commonly affects the trunk, limbs (extremities), palms of the hands, soles of the feet, and may also be present around the anus and vagina.

• Condylomata Lata: Flat, broad, whitish lesions can develop from the rash areas. These are known as condylomata lata and are highly infectious.

• Snail Track Lesions: Greyish-white patches may appear on the tongue, soft palate, and throat. These are sometimes referred to as snail tracks due to their appearance.

• Hair Loss (Alopecia): Temporary hair loss (alopecia) can occur during this stage.

• Positive Serological Tests: Blood tests for syphilis (serological tests) will be positive at this stage, confirming the infection.

• Duration and Latency: The secondary stage can last for up to 9 months. It is followed by a latent period, where outward clinical signs disappear.

Latent Period:

• Asymptomatic Phase: This is a period where the infection becomes inactive in terms of outward symptoms. Lesions disappear, and the individual generally feels healthy and well. However, the bacteria remain in the body.

• Natural Cure Potential: In some individuals, the body’s immune system may clear the infection during this latent phase, resulting in a natural cure. However, without treatment, the infection can progress to the tertiary stage in many cases.

Tertiary Stage (Late Syphilis):

• Late-Stage Manifestations: This stage can develop 1 to 10 years or even longer after the initial infection if left untreated. It affects major organ systems, particularly the cardiovascular system and the nervous system.

• Gummatous Syphilis (Gumma Formation): Swelling or tumor-like masses called gummas can develop in various tissues, including the skin, mucous membranes, and bones.

• Skin Ulceration: Ulceration of skin gummas can lead to chronic, non-healing ulcers.

• Cardiovascular Syphilis: Involvement of the cardiovascular system can result in serious conditions such as:

  • Aortic aneurysm (bulging of the aorta)

  • Aortic insufficiency (leaking heart valve)

  • Coronary artery disease (arteriosclerosis)

• Neurosyphilis: Spread to the nervous system can lead to a range of neurological complications, including:

  • Memory loss

  • Confusion

  • Mental disability (dementia)

  • General paresis of the insane (a historical term for neurosyphilis-induced psychosis)

• Other Tertiary Complications: Other potential consequences include:

  • Joint degeneration

  • Vision impairment or blindness (failing sight)

  • Hearing loss or deafness

Diagnosis:

Syphilis is typically diagnosed through blood tests:

• VDRL (Venereal Disease Research Laboratory) test: A non-treponemal test used for screening.

• RPR (Rapid Plasma Reagin) test: Another non-treponemal test, commonly used to confirm syphilis.

• Treponemal Tests: More specific tests like TP-PA ( T. pallidum particle agglutination assay) or FTA-ABS (fluorescent treponemal antibody absorption test) are used to confirm positive results from non-treponemal tests. Historically, Rahmtest and Wasserman tests were also used for syphilis detection.

Treatment:

• Penicillin Remains First-Line: Treponema pallidum has not shown significant resistance to penicillin, making it the primary treatment.

• Benzathine Penicillin G: The standard treatment is Benzathine benzylpenicillin administered intramuscularly. The dosage and duration depend on the stage of syphilis:

  • Primary, Secondary, and Early Latent Syphilis: A single dose of 2.4 million units (mu) is typically sufficient.

  • Late Latent and Tertiary Syphilis: 2.4 million units weekly for 3 weeks may be required.

• Erythromycin for Penicillin Allergy: For individuals with a confirmed penicillin allergy, erythromycin is an alternative. A typical regimen is 500mg orally every 6 hours for 2 weeks. Note: Erythromycin is generally less effective than penicillin for neurosyphilis and congenital syphilis.

• Partner Treatment: It is crucial to treat all sexual partners of an infected individual to prevent reinfection and further spread.

• Follow-up Blood Tests: Treated patients require regular blood tests at 3-month intervals to monitor treatment effectiveness and ensure the infection is cleared.

• Prenatal Syphilis Screening: To prevent congenital syphilis and adverse pregnancy outcomes, syphilis testing is recommended for all pregnant women during their first prenatal visit.

• Treatment of Infants Born to Syphilitic Mothers: Babies born to mothers diagnosed with or showing signs of syphilis should be treated promptly. Benzathine penicillin is commonly administered at a dose of 50,000 IU as a single intramuscular injection into the thigh (lateral aspect).

Education of Clients:

Patient education is vital for syphilis management and control:

• Medication Adherence: Emphasize the importance of drug compliance to ensure treatment success and prevent antibiotic resistance.

• Vertical Transmission Risk: Explain the risk of mother-to-child transmission and the importance of prenatal screening and treatment.

• Mandatory Treatment: Stress the necessity of completing treatment and attending follow-up appointments.

• Partner Management: Promote partner counselling and testing, including HIV testing, as syphilis and HIV co-infection are common.

• Prevention Strategies: Advise on abstinence during treatment and correct and consistent condom use to prevent future infections.

Effects of Untreated Syphilis in Pregnancy and Childbirth:

Untreated syphilis in pregnant women can lead to devastating consequences:

• Mid-trimester abortion: Spontaneous abortion, typically after 20 weeks of gestation.

• Premature labour: Increased risk of preterm birth.

• Intrauterine foetal death (IUFD): Stillbirth occurring before delivery.

• Intrauterine Growth Restriction (IUGR): Baby’s growth in the uterus is restricted.

• Stillbirth (Macerated): Birth of a deceased infant, often showing signs of tissue breakdown (maceration).

• Congenital Syphilis: Infant born with syphilis infection, leading to various health problems.

• Maternal Complications (Tertiary Syphilis): Pregnant women with untreated syphilis are also at risk of developing the tertiary stage complications, including:

  • Aortic aneurysm and insufficiency

  • Memory loss, confusion, mental disability, and general paralysis (neurosyphilis)

  • Coronary artery stenosis

  • Joint degeneration, vision impairment, and hearing loss

Basic Facts About STIs:

Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are infectious conditions caused by various microorganisms. The primary mode of transmission is through sexual contact, typically during unprotected sexual intercourse.

(The table summarizing common STDs, their etiological grouping, and clinical features, which was present in the original notes, is omitted here as per instruction to not include summaries.)