Syphilis

Syphilis is one of the most common sexually transmitted bacterial infections. Syphilis may be difficult to spot and if not treated it can cause serious problems of the nervous system along with other organ systems. It also puts the person at a higher risk of acquiring HIV. Studies conducted across the world suggest that men who have sex with men (MSM) are at a greater risk of contracting Syphilis.

MSM and Syphilis

Various studies across the world suggest that Men who have Sex with Men including gay men and bisexual men are at a greater risk of acquiring Syphilis. WHO reports that, Syphilis infects 5% or more of MSM in at least 42 countries, 10% or more in 18 countries, and over 20% in 5 countries. There have been reports from some countries of increasing trends.       

How is Syphilis spread?

Syphilis begins as painless sores in or around genitals or mouth, and may later take different forms.

1.   Sexual Contact: Syphilis is most commonly spread when a person comes in direct contact with the infected part of their partner at the time of vaginal sex, anal sex or oral sex. Skin to skin touch of the genitals can also transmit the infection from one person to another.

2.   Congenital Syphilis: This may be transmitted from infected mother to her baby at the time of pregnancy or childbirth.

3.   Transfusion of infected blood is also known to cause the disease.

Syphilis, however, cannot be contracted through casual contact like sharing towels, toilet seats, casual hugging etc.

What are the symptoms?

Syphilis follows a progression of stages and takes different forms in different stages. It can last from weeks to years.

Primary Stage

Primary Syphilis takes the form of painless round headed grey or white sore in or around genitals or mouth. There can also be cases of multiple sores appearing in the affected area. It can take anything between 10 days to 6 weeks for sores to appear after the bacteria enter the body.

The sore(s) disappear without treatment after 3-6 weeks. However, untreated primary stage can lead to secondary stage of the disease.

Secondary Stage

This stage can begin at the time of healing of the sores or a few weeks after disappearance of the sores. It can take form of itchless rashes which may appear on palms or back side of the feet. Sometimes rashes may appear on other parts of the body and may even be unnoticeably faint. They may also be accompanied with lesions or sores in moist areas like mouth, underarms, vagina or anus.

Less common symptoms of this stage may include fever, swollen lymph glands, fatigue, weight loss, patchy hair loss or headaches.

These secondary stage symptoms disappear after a few weeks and may recur over a period of time. However, if left untreated, syphilis can then progress to more dangerous stages.

The primary and the secondary stages are the most infectious stages of syphilis when the chance of transmitting the infection to another person is highest.

Latent Stage

This stage is marked by absence of any telling symptoms of the infection even though the bacteria are still present in the body. This latent phase can continue for years without any signs of infection.

Tertiary Stage

This is a rare stage of syphilis arising out of untreated earlier stages. Around one in three people who are not treated may develop tertiary stage syphilis. This stage appears 10-30 years after contraction of the bacteria. It can affect multiple organ systems including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints and symptoms can vary depending on the affected organ. Tertiary stage syphilis can be fatal.

How does Syphilis affect a person?

Untreated Syphilis can lead to serious complications in more than 25% of the infected individuals. Further, there are two conditions that may arise at any stage of the disease.

Neuro Syphilis invades the nervous system and can cause a wide range of symptoms, including headache, altered behavior, and difficulty coordinating muscle movements, paralysis, sensory deficits, and dementia.

On the other hand, Ocular Syphilis affects the eyes and can manifest itself in symptoms like vision changes, decreased visual acuity, and even permanent blindness.

Syphilis also puts a person at a greater risk of acquisition and transmission of HIV.

For pregnant women syphilis can lead to complication in pregnancy, stillbirth or death of the newborn in a few days.

How is Syphilis Diagnosed?

Syphilis may be diagnosed in one or more of the following ways:

1.   Physical examination by the doctor

2.   Blood test to check for antibodies that are produced when a person is infected with Syphilis. A negative result does not necessarily mean that one does not have syphilis as the antibodies may not be detectable for three months after infection. Person may be advised to repeat the test in three months time.

3.   Venereal Disease Research Laboratory Test (VDRL) is a screening test for Syphilis.

4.   Swab Test may also be used to test the fluid from the sores to check the presence of the bacteria

Who should be tested for Syphilis?

Apart from persons experiencing the above symptoms, the following categories of people should get tested for Syphilis at appropriate times:

1.   Sexually active men who have sex with men

2.   Pregnant women

3.   Persons diagnosed with HIV

4.   Someone whose sexual partner is infected with Syphilis

5.   Someone who may have unprotected sex with multiple partners

Sexually active persons can discuss the risk factor with their health care provider.

How can Syphilis be prevented?

One can minimize the risk of Syphilis while maintaining a sexually active life by taking following measures:

1.   Have protected sex by using condoms and dental dams

2.   Maintain sexual relationship with a long term steady partner who has been tested to be uninfected

3.   Getting tested in case of any apprehension

To completely eliminate the risk of the disease one may either abstain from sexual activity or maintain a monogamous sexual relation with a partner tested to be uninfected by the disease

How is Syphilis treated?

Syphilis is a unique STI as it can be cured with a single dose of Penicillin. However, different preparations of penicillin in different quantities may be administered at different stages. Treatment will prevent disease progression, but it might not repair damage already done.

Some other alternative antibiotics may be used in case of allergy to penicillin. However, the data supporting the use of alternative to penicillin is limited.

Syphilis does not recur if treated properly. The treatment, however, does not banish the possibility of getting re-infected with the disease. Unless a person knows that their sex partner has been tested and treated, they may still be at risk of being re-infected by an untreated partner.

How common is Syphilis in India?

According a Times of India report from Aug 2017, doctors have reported a spike in Syphilis cases in India. According to the report “In 2011, the National Aids Control Organsiation (NACO) had announced that the country is on the verge of eliminating the bacterial infection. However, six years on, doctors say they are seeing a rise in those testing positive for syphilis among other sexually transmitted diseases, even as the prevalence of HIV is on the decline.”

References:

https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm

http://www.who.int/reproductivehealth/shortages-benzathine-penicillin/en/

https://www.nhp.gov.in/disease/syphilis