Syphilis testing and treatment is the theme of today’s article.
Syphilis is caused by a organism known as tripping EEMA. Tripping EEMA pallidum is the full name, and this can be transmitted by sexual contact.
There are two mechanisms really. The first one is sexual contact. So it is an STD – sexually transmitted disease. But there’s another way and that’s from mother to baby. So those are the two molds of that you can transmit it now.
Syphilis, interestingly, has three different stages: there’s primary there’s secondary and those tertiary. And each of these stages has specific signs and symptoms, and I wanted to just briefly touch on them without getting everybody too confused.
Primary stage of Syphilis.
The primary stage of Syphilis is of course, the initial stage and the most characteristic symptom is a chancre, and the chancre essentially will present as a painless sore and it can occur anywhere. But the most common places in a man is the penis and a woman is the vulva and in both genders can be the lips or the mouth, and it’s very characteristic in in its appearance.
Secondary stage of Syphilis.
The secondary stage has quite a lot of symptoms that are nonspecific like fever, nausea and fatigue, but the more specific one is the rash that develops in particular on the palms, and I encourage you to look this up. Just type them into an internet search secondary, syphilis, rash and you’ll get this characteristic rash.
One thing that I really wanted to point out about this rash is that on everybody’s hand, we have these hand lines, but what’s characteristic about the syphilis rash? Is that the the lesions actually cross the hand lines and that’s actually very specific for secondary syphilis? So I encourage you to look that up, so you can get a clearer picture of what I’m referring to.
The third stage of syphilis
The third stage of syphilis, which is tertiary, syphilis, only happens if syphilis was not treated. If syphilis was treated never progresses to this stage. If it does progressed to this stage, that essentially means that the person has not been treated for years, because it takes a long time for tertiary syphilis to develop. And if it does develop, you have unfortunate CNS involvement, central nervous system.
And then there’s one aspect of tertiary Syphilis that I really wanted to touch on and that’s something called tabes dorsalis. Tabes dorsalis is a rather tragic and unfortunate complication that can occur in tertiary syphilis, and that is that you have the slow, progressive degeneration of the nerves and that can lead to tremendous Pain in the legs. It can also lead to gate ataxia when the person is not able to walk properly.
There’s several other sensation related abnormalities as well. So if that happens, it’s actually pretty pretty severe, pretty tragic.
So how do you diagnose syphilis?
Interestingly, has a long list of diagnostic tests, and what always struck me about syphilis is how the tests are all abbreviations. Each of these abbreviation stands for something very, very long and I’ll of course, tell you what each of these are. They are essentially as rapid Plasma reagent, that’s the test, that’s the first test.
Vdrl is venereal disease. Research lab, that’s actually the name of the test, and these are the blood tests that are done most commonly. Then the next two are a little bit more specific they’re. Actually, testing antibodies. The first one is fluorescent, treponemal, antibody absorption, that’s what it stands for and the next one is micro, hemagglutination assay for antibodies to trip anemic pallidum. The good news is on licensing exams.
Syphilis testing and treatment
They’Ll actually give you the abbreviation, so you don’t necessarily have to memorize what it stands for, but if you can learn why it stands for that’s great, so let’s jump to the treatment. Well, the treatment is penicillin and, in particular, the type of penicillin known as benzathine penicillin and it’s given as an ion shot an IM injection, and that is essentially the penicillin G. If you really want to get specific now before I jump to the clinical vignettes, there’s one very important reaction that can happen if someone with syphilis is treated with that penicillin, and it’s called big long name here
Gerak’s herxheimer reaction or ghr. However, you want to pronounce it now for Syphilis testing and treatment. What happens is that this is basically now, let’s say, six to 12 hours after someone is given penicillin for treatment of syphilis they’ll develop some rather unfortunate symptoms, such as malaise fever, headache, sweating, etc. Now the good news is that it usually goes away. It goes away about 24 hours or so, if you really want to help the person you can just give some antipyretics such as aspirin, so that’s important than that.
I’Ve seen that tested several times on the licensing exams, so I wanted to mention that so, let’s uh jump to some clinical vignettes now 39 year-old woman Gravatt of 4 para 3, comes to the physician for a prenatal visit. She knows about Syphilis testing and treatment so she tell her doctor that her last menstrual period was eight weeks ago. She had has had no abdominal pain or vaginal bleeding.
She has no medical problem. The exam is unremarkable, except for an 8-week size. Non-Tender, uterus, prenatal labs are sent a rapid plasma. Reagent test comes back as positive and a confirmatory micro hemagglutination assay for antibodies to trip anemic pallidum MH 8 TP also comes back as positive, which of the following is most appropriate pharmacotherapy. Well, you saw these big long tests being written out.
So that’s good, and no doubt if they’re, both positive, this woman has indeed syphilis and the treatment of choice for stiff syphilis is always an IM shot of penicillin G, so that would be d next one patient is referred to a neurologist because of a taxi. The neurologist diagnoses, degeneration of the dorsal columns and dorsal roots of the spinal cord, which has caused impaired inception and locomotor ataxia, which of the following organisms most likely caused this pattern of damage.
Syphilis testing and treatment
Well, what this patient essentially has developed is something known as tabes dorsalis and the tabes dorsalis is part of tertiary syphilis that can occur years later, if someone is not treated for syphilis during the primary phase or secondary phase, and essentially what they’re asking for in this Question is what organism in the organism, as we know that causes syphilis of strip edema pallidum. So that’s what that is, and finally, 25 year old male develops a painless ulcer on the glans of his penis after an appropriate exam.
You diagnose primary syphilis and freedom, with 2.4 million units of benzathine penicillin intramuscularly in a single dose eight hours later, while you are working at the evening clinic, he returns because he has a fever of 100 point 6 bad headache which he rarely gets, and he says He aches all over which of the following would be most appropriate at this time. Well looks like he’s, got some myalgia or malaise he’s definitely got fever.
He’S got a headache. He had syphilis and was given penicillin. So this is that famous herxheimer reaction and the good news is that it usually goes away in about 24 hours. So you just reassure the patient and if you need to you, can just give something for the fever like a salicylate. So the answer would be e reassurance and antibiotics.
Do I Have Syphilis? Signs and Symptoms of Syphilis Hi, my name is Dr. Rebecca Kuhn. I’m an HIV/AIDS clinician. Welcome to “Do I Have Syphilis? Signs and Symptoms of Syphilis.” Syphilis is a common sexually transmitted infection that can cause serious illness. Having an active syphilis infection increases the risk you will get HIV or give HIV to someone else. HIV is incurable and can be fatal.
If you are a pregnant woman, syphilis increases the risk that the pregnancy will end in miscarriage, death of the baby at birth or in infancy, or permanent disabilities for your baby. Fortunately, syphilis can be diagnosed with a blood test and cured with antibiotics.
You can have syphilis without knowing it. The symptoms are not always noticeable. If you think you may have been exposed to or infected with any sexually transmitted infection, see a doctor and get tested whether or not you have any symptoms.
Syphilis testing and treatment
All pregnant women should be checked for syphilis, HIV, and other sexually transmitted infections. How Is Syphilis Transmitted? Syphilis is usually transmitted by vaginal, oral, or anal sexual contact. The second most common way syphilis is transmitted is from mother to child during the pregnancy, or during delivery. You can also get syphilis by kissing on or near a syphilis sore or by touching an infected area on the person. Symptoms of Syphilis Soon after infection, a sore develops that is usually round, hard, raised, and painless. Usually the sore is on the genitals, hands, or mouth. Usually, there is just one, but sometimes there can be multiple sores. Without treatment, the sore will usually heal within three to six weeks. In many people with syphilis, lymph nodes near the sore will swell up, especially if the sore is near the genitals.
Lymph nodes are small balls in your neck, underarms, groin, and knees that help fight infections. Even after the initial sore has healed, your lymph nodes may stay enlarged. Without treatment, the infection will usually develop into secondary syphilis between three and six weeks after the sore appears. At this stage, you may have flu-like symptoms, a sore throat, feel tired, lose your appetite, or have swollen lymph nodes. Most commonly, you will have a rash of red or pink spots on your body. The spots may become similar to a pimple or a mark. The spots will often appear on the sides of your body, your arms, or your genitals or on the palms of your hands or the soles of your feet. You may also get white or gray spots on your mouth or genitals. A few people will lose patches of hair from their scalp, beard or eyebrows. You may also develop problems with your kidneys, eyes, liver, bones, or joints; meningitis; or deafness.
In the final stage of syphilis, you may develop spots on your body, most commonly on the skin, bone, or liver. The skin spots may turn into ulcers. You may also develop dementia, paralysis, and damage to the spinal cord and brain. At any stage of syphilis, you may also develop meningitis, headaches, nausea, vision and hearing problems, dizziness, memory and speech problems, irritability, and delusions with Syphilis testing and treatment.
Syphilis in Pregnant Women
If you are a woman who is pregnant or who may become pregnant, it is vital that you be tested for syphilis. The United States Centers for Disease Control and Prevention recommends that all pregnant women be tested for syphilis and other sexually transmitted infections including HIV, chlamydia, and Hepatitis B. The World Health Organization recommends that all pregnant women be tested for syphilis the first time they visit their doctor and a second time in the third trimester as well as tested for HIV and checked for symptoms of other sexually transmitted infections. If you are pregnant, have syphilis, and don’t get treated, more than two-thirds of the time, your pregnancy will have a poor outcome. Therefore the knowlage about Syphilis testing and treatment is important.
Without Syphilis testing and treatment, there is a one in four chance that you will have a miscarriage or that your baby will be born dead, and more than one chance in ten that your baby will die as an infant. Even if your baby survives, it may have syphilis and may be permanently disabled even after it is treated. By getting tested for syphilis and treated if you need it, you can protect your own health and your baby’s health too. So if you are pregnant, talk to your doctor right away, get tested for syphilis and HIV, and follow the doctor’s instructions. Syphilis testing and treatment If you have syphilis, your doctor will give you antibiotics. Do not have sex until your doctor says you are cured. Getting Your Sexual Partners Syphilis testing and treatment and Treated for Syphilis If you have a sexually transmitted infection, it is important that all of your current and recent sexual partners be tested and treated as well. If you aren’t comfortable telling a current or past sexual partner that you were diagnosed with a sexually transmitted infection, in many places, you can give the public health service the names and contact information of your partners and the public health service will ask your partners to get tested without revealing your name.
Preventing Syphilis by Syphilis testing and treatment The ways to reduce your risk of syphilis include: abstaining from sex being mutually faithful with a partner who has been tested and is known not to have syphilis using a condom correctly every time you have sex, every way you have sex. Using a condom is always a good idea and can greatly reduce the risk of transmitting many sexually transmitted infections. However, syphilis can occur in and be transmitted from parts of the body that are covered by a condom as well as parts of the body that are not covered by a condom. Using a condom can only reduce the risk of transmitting syphilis if the infected part of the body, or the part of the partner’s body that touches it, are covered by the condom. See a Doctor Watching a article is no substitute for seeing a doctor and being evaluated in person. If you are feeling ill, have any signs or symptoms of disease, or think you may have been exposed to a sexually transmitted infection, see a doctor and be evaluated in person. For AIDSarticles.org, this is Dr. Rebecca Kuhn..
Welcome to the Syphilis testing and treatment project echo, I’m Kent, Andrew and I’d like to turn it over to Bryan. Would our medical director to introduce our guests great? It’S a pleasure to have Jane Russell with us today. Dr. Matsu is professor of medicine and medical director of the Seattle, STD and HIV prevention, training center and she’s going to talk to us about HIV and suppose today, great thanks a lot Brian.
Syphilis testing and treatment
It’S really really fun to be here, and I think I recognize some familiar faces on the screen there so from various AET C updates over the Syphilis testing and treatment years. So I’ll go ahead and get started talking about one of my favorite topics. There are several people in the room here. I think you’ve seen a lot of syphilis in the last several years and could probably give a talk. But let’s just go ahead and do some really quick, brief review and then I’ll give you some updates that I think relates specifically to the HIV infected patients and the people that you’re seeing in your clinics. So just a reminder: when people talk about the stages of syphilis, this slide tries to show you those in a pretty straightforward way. When you see somebody who has a genital ulcer, typically on the genitals, although as we’ll talk about later, it actually can’t occur.
Anyplace on the body, that’s actually an ulcer, that’s called a chancre and that’s the primary phase of syphilis, and usually that means you’ve acquired it within the last three weeks. Basically up to the last three months. Bottom line of Syphilis testing and treatment is that it means a pretty recent acquisition. If that’s untreated in a subset of people, you can go on to develop a secondary phase and that’s the phase that I think people are having the hardest time missing in practice. Right now I was just in Boise last week talking to a bunch of providers there and they told me about a number of young gay men who they have seen as referrals for rashes that were missed actually as secondary syphilis, so always good to think in a Young gay man, when you see a rash absolutely in our setting about secondary syphilis, remember that in the secondary phase you can see a whole bunch of other symptoms, including fever, neurologic symptoms.
You can see hepatitis, you can see lymph adenopathy all kinds of interesting things, and it really means that the infection is disseminated and very contagious that setting that’s not treated. People will generally resolve very few people actually get incredibly ill during a secondary phase unless they have serious, neurologic involvement, it sort of goes into latency. You have no symptoms and then, eventually, many years later, you can have in an otherwise healthy person.
Bad outcomes from Syphilis testing and treatment such as the bone disease and the cardiac disease that we hear about and know from a lot of historical records. We call latent syphilis the phase without any signs or symptoms, and if we think that was acquired in the last year, that’s early syphilis. If it was acquired, we think greater than a year ago, that would be termed latent syphilis and except less and as we’ll talk about the reason. That’S important is that you treat early syphilis different than you treat latent syphilis and we’ll look at that in a second. So, just to remind you and because I can’t get through a lunch talk with that, I’m sharing some Syphilis testing and treatment info here. I just want to remind you of a couple of things.
This is the primary stage, pretty classic Shanker’s. These photos just remind me to say that they can occur not only in a typical location, so the bottom photo. There is a perianal Shanker, and that was a young man who we saw in STD clinic who was referred to us after being treated for genital herpes. For that Shanker, so just remember when you see sort of a raised, indurated lesions with that border, the base is often clean. It’S not often very pure Yulin and classically it’s not tender. You really should think about it.
Syphilis testing and treatment
We classically thinking of these think of these leases as being single, but you can see in the top photograph there on the penile shaft and the coronal sulcus, there are actually dual lesions and those are both syphilitic chancre x’. The other major point to remind you is that you cannot make this diagnosis on the basis of the appearance and complaints alone. Although I said it’s classically painless, it’s usually not tender, it’s usually not pure Yulin, etc, etc.
You really can’t tell this from herpes or even shank weed which we don’t see anymore for sure the only time you can really be sure you know what a genital ulcer lesion is is, if you see a vesicle, that’s really classic for genital herpes, but really for This it could be any one of the three so protein manifestations, I think many of you are familiar, especially now with the classic findings in the secondary stage.
The generalized rash, typically maculopapular pustular a reminder, though, that I have seen some really interesting rashes. Lately, we’ve been confused with things that look like eczema in a more discrete distribution around the neck, for example, in an older man. I’Ve also seen some disseminated: vesicular rashes, that people thought were for sure a viral kind of disseminated infection like vzv, zoster or herpes. So really any rash, particularly if it involves the hands, the palms and the soles deserves your attention.
Secondary syphilis also has some other features that I can show you in the next slide. Condyloma Lata and mucus patches – and I think I already mentioned that this is the type of phase that has a lot of associated or can have a lot of associated secondary manifestations fever, malaise, lymph, adenopathy, etc, and also 25 % of people can have recurrent secondary symptoms. After they get better if they’re not treated, that can actually come back so know that that does occasionally occur, and then these are just some examples. Again.
I’Ve seen patients mistreated in fact have gotten cryotherapy liquid-nitrogen for these with providers thinking that they were genital warts and you can see looking at those photographs. It’S not really that far-fetched, particularly in the top one, but those are condyloma Lata, and these are basically incredibly dense. Accumulations of the Treponema and a local reaction they’re highly contagious.
They tend to be in any moist body sight. I’Ve seen them actually under the breasts in women and the lay being women but classically in the perianal area because of those characteristics and they they look. A little bit like warts but they’re, typically more flat-topped and a little bit more fleshy. So if you see something that does not look exactly like your classic verrucas wart, then I would definitely think about this. These are also very classically, missed a lot of people. Don’T this, they think that they, maybe fungal infections, geographic tongue, app, this ulcers, you name it, but these are mucus patches, and these are basically the same thing as condyloma Lata except they occur in the mouth.
Syphilis testing and treatment
They are also very highly contagious, and for those of you who have access to dark field, probably none of you, I think, there’s only one dark field microscope in our entire region, which is in our STD clinic these days. Just remember, even if you had it, you couldn’t use the dark field on these lesions because you have oral trepan EEMs in your mouth. Normally that aren’t syphilis. So you might see those and think you have syphilis, which wouldn’t be good. But if you see lesions that look funky like this you’re, not sure what they are, you should always be taking a good sexual history, but this would make you even perhaps more inclined to do that and then, of course, near syphilis, something that we are all very Concerned about we’ve seen a lot of and we’ve seen some myths, cases of sometimes people, think of neurosyphilis, just as meningitis, but actually there’s a whole spectrum of neurologic involvement.
You can see with this pathogen Treponema pallidum pallidum. It has a very strong propensity for the central nervous system. Our psychiatric colleagues are here and are very aware that this can happen. The meningitis that happens can be asymptomatic, which is one of the reasons we used to really emphasize doing routine, lumbar puncture on patients with HIV and syphilis. We have backed off from that now as I’ll talk about or you can see a chronic or acute active meningitis. Clearly, that invasion of the central nervous system in the form of meningitis is more common in people with HIV, and it is more common. If you have a very high titer of your syphilis serology and/or, you have a low cd4 less than 250, typically or 350.
You can also have some other manifestations too, when Angie vascular syphilis can prevent as a stroke, I’ve seen a couple of patients in the hospital over the years, who had a stroke and then had their RP are tested by an astute clinician that turned out. That was what was going on classically. The old generalized paresis of the Insane is the perennial ANCA Menace disease that you can see and then tabes dorsalis. Those last two are really uncommon and mostly occur after many many years in the UH naitch’ IV, uninfected patient, okay.
So, let’s shift a management after that really quick background. One of the big questions that people have particularly HIV care setting is when you should consider performing a lumbar puncture in a person with syphilis. Well, this slide just points out that anybody, regardless of their HIV status, who has serological evidence of syphilis, should get an LP if they have any neurological symptoms, and I would emphasize that this includes ocular symptoms or auditory symptoms. One of the big things that we are seeing is I’ll mention subsequently is that people can have hearing loss and prevent with vent with very subtle, cranial nerve, eight or eighth cranial nerve dysfunction. They can have mild facials, so cranial nerve, seven. Those are the two that I would really think about quite a bit. Certainly ocular findings, as I’ll show you, I think in the next slide, should prompt concern anybody who has evidence of tertiary syphilis. We don’t really see that too much, although we have seen a few patients with HIV who have central nervous system.
Gummys and those are basically very big concretions of syphilis in the central nervous system of the brain, and then anybody who doesn’t respond appropriately to antibiotic therapy, and we can talk about what that is in a moment now. Syphilis and the HIV infected patients has been problematic and the CDC treatment guidelines have kind of gone back and forth over the years and you’ll also find quite a lot of debate. If you talk to some experts in this area versus others, I think a couple of points that are really worth knowing, and these are really emphasized in the 2010 CDC STD treatment guidelines which I’ve cited at the bottom of the slide. Is that seeing this invasion in early syphilis so remember that first, secondary phase in particular occurs pretty commonly whether or not you have HIV or whether or not you have neurologic symptoms?
And so, if you LP and everybody came in with secondary syphilis, you would find a lot of asymptomatic abnormalities in the CSF and we really don’t know what that means. Some people think that that should always be treated at nerve as neurosyphilis other people, including the CDC, have come down on the side. As saying you know, there really have not been that many adverse outcomes associated with this as far as we can tell, and so what the CDC recommends right now is to not perform LP in HIV. Infected patients unless neurologic symptoms are present recognizing that, if you are patient, fits into that group that has an R P R in particular of greater than or equal to 1 to 32 or a low cd4 or less than 350 you’re going to have to have an Enhanced suspicion for the possibility that they may have neurosyphilis, so the bottom line is what they’re telling you here is that they want you to avoid a lot of unnecessary LPS because performing those LPS treating these quote-unquote asymptomatic.
Syphilis testing and treatment
Abnormalities has not really been shown to affect better outcomes in the long term that very, very intense focus of debate. I would say some people here at the University of Washington strongly disagree with these recommendations, and that might be something for us to talk about. At some point, so I think these are the three approaches you could think about. First of all, you couldn’t LP everybody who has HIV regardless of stage, and that actually was the stance that was advocated in the prior version of the CDC STD treatment guidelines. You could also perform an LP using that algorithm that I mentioned, based on the CD for less than 350 or the high titer and then treat if the white count is elevated or the VDRL and the CSF is reactive. Remember the CSF VDRL is insensitive. It’S only positive and about 50 % of people when we think have neurosyphilis. So all you may have is a lymphocyte predominant, plio psychosis and if that’s the case, you probably want to treat it and then the last option is to LP only if symptoms or signs indicate CNS involvement, and that is the current CDC guidance which I myself, I Confess do tend to do the caveat. I think with that last bullet is it requires a careful history and examination can’t just sort of eyeball the patient and say the neuro exam is grossly normal.
You really have to do a good assessment of auditory function. Talk to the patient about their hearing do a decent visual exam, ideally do a famas Coupee and do a good exam of reflexes and mortar and sensory function, and particularly, as I said before, the cranial nerves – and this is just an example of I think, a couple Of papers that have come out, there’s been a lot of studies now mostly case series talking about how common some of these findings are. This is a nice case series of over 500 patients with HIV. In France, they looked at basically syphilis prevalence in that population. They had a pretty low prevalence, 4 %, not tiny, but of those who did have early syphilis, 20 % had ocular involvement and they showed some of the findings here. Remember the ocular involvement in syphilis is neurosyphilis because you’ve got optic nerve involvement and it can be pan uveitis. You can see retinitis uveitis, so a number of problems and then finally, let’s just chat about treatment so penicillin.
Sometimes, when I do these syphilis talks, I really feel like STDs are in the dark ages, because penicillin has been preferred for the treatment of syphilis pretty much since the advent of penicillin in the 1940s, and we really haven’t changed our primary recommendation at all and we, Like to use it is, if possible, for all stages so that I mentioned before on that earlier slide. The difference is really in the dosing. If you have early syphilis, so the chancre of primary secondary syphilis that looks disseminated or early latent, then you can get away with a single dose of intramuscular benzathine penicillin, that’s long-acting! Penicillin! You don’t want to use other injectable penicillin. Formulations they’ve changed the labeling. So that’s not so problematic as it used to be, but there are others, particularly the one.
That’S used to treat strep throat occasionally, but you don’t want to use that and you don’t want to use as a therm ice and we were excited about a zero for a while. It doesn’t have some activity against syphilis, but it is not hasn’t borne out because of resistance, and then, if you’ve got late latent disease, you need to extend that treatment to three doses. Given weekly of been supplying benzathine penicillin. Now, remember. You always want to split this dose up one injection in each buttock, because it really hurts it’s very thick and it’s it’s not a pleasant situation. What, if you can’t use penicillin, you can use all doxycycline and ceftriaxone and those are listed there. There are optional regimens.
Actually also, I didn’t mention four primary and secondary syphilis. You can use these two drugs for 14 days for those and then for a longer duration for the late latent. I think there’s some that I mean there is some literature suggesting that they’re equivalent. I would say the data are not great and if you can help it, you really do want to try to use penicillin and then just to finish up neurosyphilis treatment. I think most of you know that the standard of therapy is aqueous penicillin given intravenously. We have increasingly used propane penicillin given with probenecid orally four times a day, because you can do that in the outpatient setting. It does require that people come in for an injection every day, which requires a lot of effort on everybody’s part. And then, if you want to, you can use ceftriaxone, but you’ve got to give that IV daily 10 to 14 days.
So really not a lot has evolved in the options for neurosyphilis treatment, so just to wrap it up and hopefully get a discussion going. I would just ask you to remember to have a very low index of suspicion for neuro invasive disease in our patients. We clearly has seen a lot of syphilis as you’ve heard in this group, we’re seeing a lot of neuro invasive disease, low threshold for performing the LP based on a careful neurologic history and examination. You don’t have to treat HIV infected folks any differently than HIV. Uninfected people, you can use the standard treatment and then to follow up for treatment, though you do want to get serologies more frequently in HIV, infected people.
You want to get them quarterly for the first year, every six months for the second year. You always want to use the same serology you used to make the diagnosis, and you want to see a four-fold decline in the titer by six months. That means two titers dropped, so 1.28 goes down to 132 and that really is ideally what you want to see by a year, most people should be negative or very, very low, and certainly by two years, you’d like to see it Conn I’m going to stop there. I think and just leave you with this slide, which gives you some resources to look up some of this stuff and you can always contact us if you have questions so thanks.
Syphilis is a fascinating, sexually transmitted infection. It’S caused by a bacterium referred to as Treponema pallidum Treponema pallidum. It’S part of this genus of bacteria referred to as Japanese, sometimes you’ll hear it referred to as a Treponema, or it can also be referred to as a spirochete. A spirochete, which is the name for a group of bacteria that literally look like a spiral. So it looks like this when you inspect a sample, that’s been infected with syphilis under a microscope and we’ll talk more about that in a separate video and what makes syphilis very interesting today, so I’ll put syphilis or this spirochete on my y-axis and I’ll make time.
Our x-axis will see that syphilis dropped over the years until about the year 2000, when it actually started going up again so I’ll label. Right here is about 2000, so the rate of syphilis infection has been increasing slowly in recent years and the group that’s seen the greatest rise in incidents are men who have sex with men. So, let’s take a better look at syphilis and figure out how its spread from one person to another and, as you might recall, this process is referred to as transmission, so a sexually transmitted infection is transmitted from one person to another and, of course, with an STI. The most common mode of transmission is sex that includes oral sex, vaginal sex and anal sex and childbirth is a very important mechanism of transmission as well.
Now the interesting thing about syphilis is that it can only live within the cells of human beings, which means that if we cured everyone on the planet that had syphilis, we could effectively eradicate the disease, but the trick with syphilis is identifying it when it occurs. Sir, William Osler, the person that many consider to be the father of modern medicine called syphilis the great imitator, because it can masquerade as a variety of different disorders and we’ll talk about why that is in a minute. But the trick with syphilis is to try and identify with Syphilis testing and treatment what stage a person is infected with.
Syphilis testing and treatment
So, let’s go through the different stages, starting with the point when a person is infected, it will take about three weeks so all right here, three weeks so three weeks before they show any symptoms, and this first stage in which they begin to show Syphilis testing and treatment is referred To as primary syphilis primary syphilis so with primary syphilis, the majority of your symptoms will occur at the site of contact or where the infection is directly spread. That means that the organs initially affected will be your genital organs. So, let’s take a look at our friend right here, this poor guy, that’s going to have all the different signs and symptoms of syphilis. So let’s take a look at a zoom in of his genital organs. Primary syphilis will have two main features: the most classic thing and I’ll abbreviate right here, primary syphilis, so the first of the two classic things you’ll see is what’s referred to as a chancre, a chancre which just means a lesion that can occur on the shaft or On the tip of the penis in a female, this would occur on the cervix and it’s a fairly gruesome, looking ulcer.
It’S very indurated, and so you’ll see these edges right here. So I’m trying to imply that it’s a very deep indurated lesion, which looks bad. But the interesting thing about the chancre is that it’s painless, which is an important distinction to make between syphilis and another STI referred to as chancroid, where you’d see a chancre. But this one will definitely be pain. The other thing that you might see is what’s referred to as lymph adenopathy, lymph, adenopathy or el-ad, and that just means that the lymph nodes that you have commonly the regional ones located near the genital tract, so the inguinal lymph nodes that are along the crease here. Along the waistline they’re going to be larger and they may even be painful, so you’ll have inguinal lymph adenopathy, so this lymph adenopathy and the chancre tend to heal in about 3 to 6 weeks, whether you give this person treatment or not, and after that they’ll further Progress over the course of about nine weeks to secondary syphilis, secondary syphilis and I’ll just write secondary for now now its secondary syphilis.
This spirochetes spreads from the genital tract to the bloodstream and starts to cause more systemic symptoms Syphilis testing and treatment. So symptoms you see elsewhere than just in the genitals and because white blood cells will go chasing after syphilis in second very syphilis. So this is how I’ll abbreviate secondary syphilis right here. One of the first things you might see in secondary syphilis because of the white blood cells attacking the trepan E is fever. And if you take a look down here, I’ve drawn a blood vessel where you’ve got the endothelial cells. That line a blood vessel over here drawn out. So let’s say that the Treponema seeds into a blood vessel here and one of the characteristic things about syphilis, is that it likes to invade these endothelial cells, and so you might see them inside here now. White blood cells will respond to this infection and attack syphilis. With a vengeance and they’ll do this by swallowing up the syphilis, they can also cause cell death for the infected endothelial cells through a process called apoptosis or they’ll release these compounds into the bloodstream.
These cytokines that are supposed to signal to the body that it’s under attack and these compounds are called cytokines, so I’ll label that right here these are cytokines that will, to a certain extent, tell cells what to do so. Cytokines can trigger cells to undergo apoptosis and die, but they can also travel through the bloodstream and up here to the brain where they can signal the brain to raise the body temperature resulting in a fever. And this is one of the classic features that occurs when white blood cells are attacking some invading pathogen all under this process, referred to as inflammation. Another result of that can include more lymph adenopathy, so you’ll have swelling of the lymph nodes that may occur regionally or even elsewhere in the body, but more locally, with secondary syphilis at the genitals. Now, instead of the painless Shanker, we may start to see these large warts known as condyloma Lata, condyloma Lata or, if you’re referring to a single one of these warty lesions, you can refer to them as a condylomata layton.
So this looks like a large white wart that likes to form on mucous membranes, which means the tip of the penis or the cervix, or the vaginal wall in a woman or even on the inside of the mouth. And what these represent are the syphilis bacteria that are actively fighting the white blood cells that are there, and these tend to be painless. As and finally one of the last classic symptoms, you’ll see with secondary syphilis. Is this very characteristic skin rash? That’S referred to as a macula, so macula, meaning just flat maculopapular, which means ironically, raised so either a flat or a raised rash, a maculopapular rash that occurs all over the body as you’ll see down here, but one of the things that makes this rash very unique To syphilis is that it’ll appear on your palms and even the soles of your feet, which is something that very few diseases can do. Usually, rashes will occur elsewhere in the body all over anywhere, but not on your palms or your soles that actually cuts down the differential Syphilis testing and treatment to a few things and keep in mind.
It’S not going to be just a single lesion that characterizes this rash you’re, going to see a bunch of these occurring on your palms, your soles, your arms, your belly all over, and this just represents the trapa neem spreading to the layers of your skin and the White blood cells, they’re fighting them so they’re, essentially a result of inflammation as well, alright, so after secondary syphilis, these symptoms will go away and they’ll take also about three to six weeks to heal and within two years of this initial infection, we’ll arrive at a stage Referred to as early latent syphilis early latent syphilis, and when we say that syphilis has become latent. That indicates that we have no symptoms, so there are no symptoms and I’ll abbreviate symptoms as SX.
The same holds true for the next stage of syphilis, which is referred to as late latent syphilis. So here we have no symptoms, but the other differences are that early latent syphilis is more likely to have a relapse of symptoms, so more likely to relapse, but also early latent syphilis is more contagious than late latent syphilis, and these two points makes sense because early Latent syphilis is closer in time to the point when we had our initial infection because it happens within two years, whereas late latent syphilis will occur after two years, so after two years of the initial infection. So, if we’re at the two year and one day mark after we’ve had our initial infection – and we don’t have symptoms anymore, that means we are in late latent syphilis.
Professor Dave again, let’s learn about Syphilis testing and treatment. Syphilis has been around for a long time. Though there’s some debate regarding where and when it first appeared, historians can at least agree that the first well-documented outbreak of syphilis occurred in Italy in 1495. Back then, we didn’t have antibiotics, or any effective treatment, for that matter. Before penicillin was discovered, the painful symptoms of syphilis, including genital sores, abscesses and ulcers all over the body, and severe pains, were treated with mercury or other mostly ineffective home Syphilis testing and treatment. This meant that on top of the painful symptoms, many patients died of mercury poisoning. Let’s learn a bit more about this disease and its modern treatment now. First let’s talk about what syphilis actually is, it is a bacterial infection caused by Treponema pallidum that’s spread most commonly through sexual contact, but it can also be passed from a pregnant woman to her baby.
Syphilis testing and treatment
These bacteria are thin, tightly coiled spirochetes, which are gram-negative, motile, spiral bacteria. They have pointed, straight ends with flagellae on each end, which allow them to move around. These organisms are difficult to grow in the lab and too thin to observe with a light microscope, so scientists have analyzed their genome to figure out what types of proteins or virulence factors they may use to cause damage. While scientists have identified a few proteins that are associated with virulence, precisely how these proteins are involved remains to be determined. Ultimately, the tissue destruction and lesions observed in syphilis cases are caused by a patient’s immune response to infection. The disease follows a progression of stages that can last for weeks, months, or even years. The initial or primary phase is characterized by one or more skin lesions called chancres, which mark where the bacteria entered the body. These chancres are painless and might occur in locations you don’t regularly examine, and hence might not notice, and then heal within three to six weeks even without treatment.
However, without adequate Syphilis testing and treatment, the infection will progress to the secondary stage. In the secondary phase, the bacteria have spread through the blood, causing prominent skin lesions or rashes over the entire surface of the body. In some cases, these rashes are so faint that they’re not noticeable, but in others, large, raised gray or white lesions may form. In some patients, the infection may cause a sore throat, swollen lymph glands, fever, weight loss, or fatigue. If the disease isn’t treated in the secondary stage, it will progress to the latent phase of the disease, in which there are no visible symptoms at all, which can last for years. In rare cases, tertiary syphilis can develop 10-30 years after the initial infection, affecting multiple organ systems. This can be fatal. At any of the above stages, syphilis can infect the nervous system or eyes, causing a wide range of potentially serious symptoms. In infected pregnant women, untreated syphilis can cause infant death in up to 40% of cases.
For the babies that survive, they’re at risk of seizures, developmental delays, or death, if they aren’t treated so its important to know about Syphilis testing and treatment. Despite its long history, syphilis is quite ommon. The World Health Organization estimates that there were 18 million syphilis cases worldwide in 2012, with 5.6 million new cases occurring in adults between the ages of 15 and 49. In the U.S. alone, CDC estimates there were over 115,000 new cases of syphilis in 2018. Syphilis is typically diagnosed using blood tests and treated with penicillin or other antibiotics. Any sexually active person can get syphilis through unprotected sex, so health care providers recommend using condoms and getting regularly tested for STDs. However, since the bacteria are extremely labile and unable to survive exposure to drying or disinfectants, syphilis cannot be spread through contact with inanimate objects like toilet seats..
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