Syphilis, a sexually transmitted disease, is caused by the spirochete, Treponema pallidum (1). It is a thin coiled helix that lacks the enzymes needed to build complex molecules. Thus it relies on a host to survive. This Gram-Negative bacteria is aerobic or microaerophilic, and has the virulence factor of motility (7).
Many hypotheses have surfaced as to when and how the disease developed. Dating back to the 15th century in Europe, when Columbus came back to the New World, syphilis came about as a result of his men (7). Another hypothesis, dating before the 15th century, explains syphilis as a result of urban living. In any case, the incidence of syphilis has increased. About 70,000 infections of the spirochete occur every year in the United States. Around the world, 12 million new cases occurred in 1997. That same year, about 8,550 cases of primary and secondary syphilis were accounted for (8).
The method of transfer for syphilis is person-to-person contact during vaginal, oral, or anal sex (1). It is passed the easiest by a sore called a chancre (2). Through these sores, the bacterium spreads to the mucous membranes of the genital area, mouth, or anus of the partner (6). It cannot be spread by toilet seats, bath tubs, pools, or hot tubs (1).
Once the bacteria have entered the body, there is an incubation period of about 10 days before any signs can be observed (2). After the incubation period is over, the person will enter the first stage, which is called Primary Syphilis. During this stage, the symptom is the chancre. It appears within 10 to 90 days after exposure (2). This symptom usually goes unnoticed because it is small and painless (1). It will go away on its own, but if it is not treated, the infection enters the second stage, Secondary Syphilis. The first symptom in this stage is a rough, brown skin rash; it is usually detected on the palms of the hands, and the soles of the feet (1). Other symptoms include fever, fatigue, muscle loss, headache, sore throat, and patchy hair loss (1)(2). The symptoms will disappear over a period of one or two years, but will progress to the third stage if left untreated. The third stage, called Latency, develops anywhere from 2 to 30 years after infection (3). The disease no longer has symptoms or is contagious (2). However, without treatment can lead to serious consequences. Skin eruptions can occur, as well as complications of the nervous system (5). The bacteria may begin to damage the internal organs, which can include the brain, heart, liver, and blood vessels (1). Blindness and dementia can occur, as well as paralysis and numbness (1). The disease can also result in death. Pregnant women who go untreated can pass the bacteria to their unborn children. This can result in still birth, or a chance of an infected infant. Some symptoms in babies include skin sores, fever, jaundice, anemia, deformities, and rashes (6). Untreated infants could develop seizures and even die (2).
There are a few ways of diagnosing syphilis. Under a darkfield microscope, a doctor can take a look at the surface of the chancre sore (2). Blood tests are also used, although they may give a false-negative or false-positive result. At any rate, two blood tests are usually taken to promote accuracy. The blood screening tests are the VDRL (Venereal Disease Research Laboratory) or the RPR (Rapid Plasma Reagent); they look for certain antibodies (3). If there is a false-positive result, two different tests can be performed to confirm the infection. The FTA-ABS (fluorescent treponemal antibody-absorption) test and the TPHA (T. Pallidum hemagglutination assay) test also detect syphilis antibodies (1). A spinal tap can also be performed if a patient has had any damage due to the latency phase (3).
Penicillin is the usual treatment for syphilis. One dose can cure the disease if the infection has been present for only a year. If it has been longer than a year, larger doses are needed (1). For those who are allergic to penicillin, they have the option to use other antibiotics. Treatment with drug therapy will cure syphilis, but damage already done cannot be restored (2).
The easiest risk-free method of prevention is abstinence (3). Contact with sores must be avoided, although hidden sores may not be obvious (10). Condoms are strongly suggested during sexual intercourse (2). Detection and treatment of infections is a way of preventing the latter stages of the disease (2). A vaccine for the disease has not yet been discovered, but scientists are currently working on it (2). Some efforts are focused on developing new methods to increase the sensitivity of existing tests, and coming up with newer tests to diagnose syphilis (4). Scientists are also testing whether saliva and urine samples can be used as well as blood tests (2).
References
1. Centers for Disease Control and Prevention. "Some Facts about Syphilis." May 2001. URL: http://www.cdc.gov/stopsyphilis/SyphilisFact.htm accessed on 4/29/02.
2. National Institute of Allergy and Infectious Diseases. "Syphilis." July 1998. URL: http://www.niaid.nih.gov/factsheets/stdsyph.htm accessed on 4/29/02.
3. American Social Health Association. "Information to Live By: Syphilis." 2001. URL: http://www.ashastd.org/stdfaqs/syphilis.html accessed on 4/29/02.
4. Centers for Disease Control and Prevention. "Bacterial Sexually Transmitted Diseases (STDs) &endash; Syphilis." 2/10/00. URL: http://www.cdc.gov/ncidod.dastlr/gcdir/index.html#TPlink accessed on 4/29/02.
5. World Health Organization. "Sexually Transmitted Diseases." March 1996. URL: http://www.who.int/inf-fs/en/fact110.html accessed on 5/1/02.
6. The National Women's Health Information Center. "Syphilis." 1998. URL: http://www.4woman.gov/faq/syphilis.htm accessed on 5/1/02.
7. "BUGS" Index &endash; Organisms. "Treponema pallidum." 5/13/99. URL: http://www.medinfo.ufl.edu/year2/mmid/bms5300/bugs/trepalli accessed on 5/1/02.
8. National Institute of Allergy and Infectious Diseases. "STD Statistics." December 1998. URL: http://www.niaid.nih.gov/factsheets/stdstats.htm accessed on 5/1/02.