ARTICLE HIGH LIGHTS:-
General introduction about syphilis
Mode of transmission of syphilis
Types and clinical features of syphilis
Diagnosis of syphilis
Treatment of syphilis
Prevention from syphilis
Complications of syphilis
INTRODUCTION AND CAUSES OF SYPHILIS:-
Syphilis is a sexually transmitted disease (STD) and it affects skin and mucous membrane of the external genitalia and sometimes mouth.
Syphilis is caused by TREPONEMA PALLIDUM, and this T. Pallidum is a gram negative bacteria. T. Pallidum is a obligate parasite which means it can’t survive outside of human body. It belongs to a group of bacteria i.e. SPIROCHETE, which is spiral in shape and this bacteria moves around by spinning or twisting.
MODE OF TRANSMISSION OF SYPHILIS:
Syphilis is transmitted in two ways:-
- Acquired syphilis:- in the acquired syphilis TREPONEMA PALLIDUM enters into the body via body fluids, and this can be happen as follow
(A) sexual contact with infected person including vaginal, anal or oral sex.
(B) it can also happen when people shares contaminated needles.
(C) direct contact with skin lesion of infected person either through cut or wound, because the lesion is filled with numerous treponema pallidum.
- Congenital syphilis:- if mother is suffering from syphilis then baby can be infected in uterus or during delivery of the child.syphilis can not be spread through toilet seats, door knobs, swimming pool, hot tubs, bath tubs, shared clothing or eating utensils.
TYPES OF SYPHILIS AND THEIR CLINICAL FEATURES:-
There are mainly two types of syphilis ACQUIRED SYPHILIS AND CONGENITAL SYPHILIS.
A] ACQUIRED SYPHILIS :- There are three stages of infection in acquired syphilis.
- 1) Primary syphilis (Early Localized):- it appears 1-3 weeks after treponema pallidum enters in our body or land on mucous membrane. During this stage T. Pallidum destroy the tissue and skin wherever they enters into the our body that results in the formation of SYPHILITIC CHANCER (=> this syphilitic chancre is painless and having hard base with raised borders and this lesion is filled with lots of T. Pallidum which can be spread onto other body parts of the same person as well as other individuals.)
In individuals who acquires syphilis through sexual contact , the primary chancer develop around the external genitalia; however for individual who acquires syphilis by physically touching the lesion or in some other way the primary chancer might appears on the hands or some other parts of body.
Syphilitic chancer typically heals without any treatment within weeks or months.
During healing some T. Pallidum enters into the nearby lymph nodes and lymph which causes regional lymphadenopathy; and it can enters into the blood stream through lymph.
If syphilis is acquired through blood transfusion then may not be a primary chancer formation.
- 2) Secondary Syphilis
Disseminated Stage:- It appears after 6-12 weeks after infection. During this stage Spirochetes enters into the blood stream which causes generalized lymphadenopathy, some spirochetes attached to endothelial cells and infect them which causes Non-itchy Maculopapular rash.
These rash starts from Trunk and spread around the arms, legs and eventually to the palms, genitalia, soles and mucous membrane. These rashes can sometimes be
> PUSTULAR (filled with pus)
> Papulosquamous:- which is hard and scaly
> Condylomata lata:- wart like lesion, which is smooth painless lesion and appearing on genitals, around anal and armpits region.
These all 3 variety of rashes can erupts all over the body, and the lesions are full of spirochetes which makes secondary stage MOST INFECTIOUS STAGE. Rashes of secondary syphilis usually resolves within weeks to months.Latent Phase (Dormant or Asymptomatic):- During this phase the spirochetes can mostly be found in the tiny capillaries of organ and tissues. It is again divided into early latent phase and late latent phase.
> Early latent phase:- it occurs within a years of infection, During this time spirochetes can re-enters into the blood so this makes spirochetes circulating in blood which causes symptoms of secondary syphilis.
> Late Latent phase:- it occurs generally after year of infection and spirochetes stay in tiny capillaries of organs and tissues.
- 3) Tertiary Syphilis:-
Few spirochetes which is found in capillaries of organ and tissues, due to our immune response it causes tremendous damage of cells in that organ or tissues.
In tertiary syphilis there is Type IV Hypersensitivity Reaction which means there is immune response which is mainly lead by T-Cells and they will cause phagocytes and releases Pro-Inflammatory cells such as
> TNF (Tumor Necrosis Factor)
> IL- 1 ( Interleukin 1 )
> IL- 6
All these cytokines together leads to swelling, edema, redness, warmth, fever.Pallidum has Three main antigens:
(a) Group specific antigens:- which is present on all treponemas.
(b) Species specific antigens:- which is specific to treponema pallidum.
(c) Cardio-lipin:- which is a lipid antigen and present in spirochetes as well as in cells of our body.Plasma cells involves in immune response by producing antibodies against these 3 antigens. In some cases the immune cells starts hurtle around and formed granulomatous lesion called GUMMA which having lots of different types of immune cells which is surrounded outermost by fibroblast. The tissue at the center of GUMMA lack of oxygen which lead to coagulation necrosis.In tertiary syphilis various organs get involved or damaged like
> Heart and Blood vessels – called cardiovascular syphilis, there is endarteritis which is inflammation of the VASA VASORUM & This VASA VASORUM supplies AORTA hence it also leads to Aortitis or Aortic Aneurysm.> Brain and Spinal cord – called Neuro syphilis, sometimes the spirochetes invade into the capillaries which is supplying to the anterior or front of the spinal cord. Which results- GENERAL PARESIS, which causes loss of sensation & weakness and sometimes paralysis of legs. If spirochetes gets enter into capillaries which supplying into brain then it can cause:-
slurred speech, altered behavior, memory loss, difficulty in co-ordinating muscles movements, paralysis.
> Syphilis can also affects Eye which will cause AGRYLL ROBBERTSON PUPIL,in which people losses LIGHT REFLEX, but it does have ACCOMODATION REFLEX which means the pupil constrict when by objects but does not constrict pupil with too much light.
B] CONGENITAL SYPHILIS: The spirochetes can infects the baby either via placenta or during the child birth in the birth canal.
> In early disease (within first 2 years age of baby) results can be still birth or dying in womb. The classic feature of early diseases includes:-
Maculopapular rash on the palm and soles.
SNUFFLES- Nose is blocked by increased secretions & these secretions contains spirochetes.
Baby may also have organ damage to the liver and spleen causing HEPATOSPLENOMEGALY & may also damage to eye as well like optic neuritis.
> In late stage (after 2 years age of child) the classic features includes:-
DIAGNOSIS OF SYPHILIS:
A) DIAGNOSIS OF ACQUIRED SYPHILIS:- Starts with identifying the spirochetes in fluid from CHANCRE & this can be done using DARK FIELD MICROSCOPY( the spirochetes light up in dark background- just like dust particles shines when the sunlight enters into the dark room through the small holes or windows).
Diagnosis is confirmed through serological test and some other test also performed like
1) Non Treponemal test:-
a) Rapid-Plasma Reagin test (RPR)
b) Vinereal Disease Research Laboratory Test (VDRL)
These 2 test detect anti-cardiolipin antibodies into the blood. As cardiolipin also stimulated by damaged cells in our body that’s why these two tests are not specific for syphilis.
2) Treponemal test:- it includes
> Treponema pallidum particle agglutination assay (TPPA)
> Fluorescent treponemal antibody absorbed (FTA-ABS)
these treponemal test detects antibodies that specifically target Treponema Pallidum.
B) DIAGNOSIS OF CONGENITAL SYPHLIS:- It is different than diagnosis of acquired syphilis test Diagnosis involves
> Non treponemal Serological titre
> from CSF Fliud – VDRL, cell count,
MANAGEMENT OF SYPHILIS:-
1) Penicillin is the drug of choice for all stages but dosage & duration varies with the stage of syphilis. When using penicillin there is occurance of JARISCH HERXHEIMER REACTION ( In this reaction spirochetes dies breaks & releases lots of Antigens, and this antigens leads to overcome of IMMUNE SYSTEM and due to this fever, sweating, muscles & joint pain which lasts for hours to few days.
The person who are allergic to Penicillin then DOXYCYCLIN can be used.
PREVENTION FROM SYPHILIS:-
Avoid any kind of sexual contact to an unknown person.
The second best option is be in a monogamous relationship with a partner free from disease.
Condoms may reduce risk, however the chancres may not covered by the condom and may be able to spread the infection even when a condom is used.
COMPLICATIONS OF SYPHILIS:- untreated syphilis can lead to other complications like:-
> Heart disease ( Cardiovascular syphilis)
> Nerve disease (Neuro syphilis)
> Aortic Aneurysms
> During pregnancy it can lead to Miscarriage, Stillbirth.
NOTE:- THIS ARTICLE IS FOR GENERAL AWARENESS ABOUT SYPHILIS NOT FOR SELF TREATMENT, SO KINDLY CONTACT TO YOUR NEAREST MEDICAL PROFESSIONALS BEFORE TAKING MEDICATIONS.