Syphilis

Syphilis

What is Syphilis?

Syphilis (syphilis) is a disease in the group of sexually transmitted diseases caused by a bacterium called Treponema Pallidum (T. Pallidum). Since this bacterium enters the body and spreads to other organs through the blood, it can cause great damage to vital organs.

Syphilis Symptoms

Syphilis (Syphilis) gives its symptoms in 10-90 days, an average of 21 days.

• Chankr (painless, smooth-surfaced, red, contact area genital sores)
• Colorless spots or streaks on the palms or soles
• Skin lesions
• Irritation of the mouth and throat
• Rash (rash)
• Hair loss

How Is Syphilis Transmitted

Syphilis (Syphilis) is usually transmitted from infected wounds (such as lips, oral cavity, breast or genitals) through vaginal, anal or orogenital sexual intercourse. Chancr, mucous patch and condyloma lata, which are early lesions of stage 1 and 2, are highly contagious.

In the first year of the infection, it is very contagious and has a 90% chance of contagion. In the following period, the contagiousness gradually decreases and at the end of the 4th year, the contagiousness does not generally remain. The transmission rate of untreated individuals with 1st and 2nd stage syphilis to their partners is around 50-75%.

There is a possibility of transmission of syphilis from a mother with syphilis to her baby. Transplacental infection is usually transmitted after the 18th week of pregnancy. However, the risk of fetal infection is highest in mothers with early syphilis.

Syphilis can be transmitted very rarely through blood transfusion because all donors (blood donors) are screened and T. pallidum bacteria cannot survive for longer than 24-48 hours in today’s blood bank storage conditions. It can also be transmitted by the use of common needles in those who use intravenous injectors (needles).

Syphilis test (Syphilis tests) The most commonly used laboratory tests in the diagnosis of syphilis are:

• Isolation of T. Pallidum from skin rash
• VDRL (Venereal Disease Research Laboratory)
• RPR (Rapid Plasma Reagin)
• Neson Test
• FTA-ABS Test
• FTA Test (Fluorescent Treponema Antibody)
• TPHA Test (Treponema Hemagglutination)

The most specific (reliable) among these tests are the FTA Test and the TPHA Test.

Serological tests are the only method that can be used for the diagnosis of latent and late syphilis. During syphilis, two types of antibodies are formed in the patient.

1-Treponemal tests

They are specific antibodies formed against the antigens of Treponema pallidum bacteria and serological tests are performed directly using T. pallidum antigens to detect them.

2-Nontreponemal tests

These antilipoidic antibodies, which are autoantibodies called reagin, formed against cell lipids damaged during the disease, give serological reactions with the water suspensions of lipid extracts obtained from mammalian animal tissues.

Stages of Syphilis

First stage syphilis (Primary Syphilis)

Complaints begin to appear between 10-90 days (mostly after the 3rd week) after sexual contact with a person with syphilis. In 95% of those who contract the disease, there is a single painless, limited, superficial and ulcerated lesion on a hard surface called “chancre” around the genital organ. Very rarely there are multiple lesions.

Chancr occurs on the skin of the penis or in the rectum in men, and in the vulva (external genital area) or rarely in the vagina, in the rectum in women. Lymph node swelling (lymphadenopathy) occurs in the inguinal region and disappears in 40-45 days.

Second stage syphilis (Secondary Syphilis)

It is the most contagious stage, entering this stage approximately 6 to 8 weeks after contracting the disease. This period, which starts approximately 2 months after the onset of the disease, can last up to the 3rd or 4th year. Skin rashes are seen at this stage. Itchy rashes that start on the chest or arms and legs spread to the skin, thus turning the insides of the hands and feet and the anus a dark red color.

Large, flat, whitish, wart-like lesions can be seen on the external genital area (Vulva) in women and on the testicles in men, these lesions are called “Condyloma Latum” (Condyloma Latum). These condylomas seen in syphilis are different from HPV condylomas. In addition, in the second stage of syphilis, fever, sore throat, weight loss, weakness, headache and enlarged lymph nodes can be observed.

Latent stage syphilis ( Latent Syphilis )

Although there are no clinical signs of the disease in the latent (hidden) stage, serological tests are still positive. This period is divided into early and late latent periods.

Early latent period;
The absence of signs of disease for up to two years despite carrying the disease.

Late latent period;
It is characterized by the absence of signs of disease for more than two years.

Separation of the early and late latent period is important for the contagiousness of the disease and its treatment. While treatment is provided with a single dose of long-acting penicillins in early latent syphilis, multiple injections are required in late latent syphilis. Half of the patients who pass into the latent period pass to the third stage, 25% remain in this stage, and 25% recover spontaneously.

Third stage syphilis (Tertiary Syphilis)

In patients whose treatment is neglected or whose definitive diagnosis cannot be made after syphilis infection, the third stage begins 1-25 years later. This phase can begin even after 50 years.

During this period of syphilis, soft swellings called “gom” occur due to damage to capillaries. Gums are swellings in tissue due to inflammation. Gums can occur anywhere in the body, including the skeletal system. Patients may develop meningitis, severe pain, paralysis and death due to nerve damage.

What is Congenital Syphilis? ( Congenital Syphilis )

Syphilis can be transmitted from mother to baby during pregnancy or childbirth, causing damage to the baby; this is called “congenital (congenital) syphilis”. If syphilis is detected during pregnancy, treatment with penicillin group drugs should be started.

What is neurosyphilis?

The neural involvement of syphilis is called “neurosyphilis”. Today, the incidence of neurosyphilis has decreased with the use of antibiotics. Neurosyphilis is the worst complication of syphilis.

Today, it is observed more frequently in patients with delayed diagnosis and treatment, in individuals with suppressed immune resistance or HIV-positive. Changes in mood, dementia (dementia), Tabes Dorsalis, partial or widespread paralysis may occur in people with involvements related to the nervous system.

Neurosyphilis can be diagnosed with leukocyte increase in CSF (Cerebral spinal fluid). Again, a definitive diagnosis can be made with VDRL or FTA-ABS tests from the cerebrospinal fluid. Every patient with HIV carrier should be screened for neurosyphilis from spinal fluid by performing a lumbar puncture.

What are the ways to prevent syphilis?

Although the use of condoms greatly reduces direct contact and transmission of the disease, it does not definitely prevent it. Because syphilis can also be transmitted from non-genital organs.

On the other hand, syphilis (syphilis) can be transmitted from toilets, by contact during daily activities or by sharing clothes. Avoiding polygamy, using condoms in relationships, not being in close contact with suspicious people and preferring hygienic toilets are among the precautions that can be taken.