A review on syphilis

Syphilis is a sexually transmitted disease (STD). if untreated it can be highly contagious. It is caused by an organism Treponema pallidum, a spirochete which can penetrate intact mucous membrane and also produce systemic infections. May also affect the central nervous system as well as cardiovascular system.
Use of modern mechanical contraceptives can prevent its infection among couples. a time to time counseling with physician or pharmacist is helpful to prevent such diseases.

 

Etiology;

Syphilis is a disease common among sexually transmitted diseases (STDs), caused by a spirochete, an organism Treponema pallidum. its organism can invade any tissue or organ of the body causing acute, chronic or contagious syphilis. Sexual activities usually play a role in transmitting the infection. But if the mother has syphilis (congenital syphilis) then the fetus may get infected during the birth or if a patient receives donated blood contaminated with T.pallidum then he may become infected. The man is the only naturally occurring host for T.pallidum.

 

Epidemiology;

Its peak incidence occurs in the age group of 20-24 years. more common in man than women, twice the males as females are reported to have syphilis, a reflection of high incidence among male homosexuals and bisexuals. In addition to being highly contagious, syphilis is a major concern because if untreated it can progress to a chronic systemic disease which can be fatal or seriously disabling.
 

Pathophysiology;

T.pallidum can rapidly penetrate intact mucous membranes or abraded skins and before the appearance of primary lesions, within a few hours it enters the lymphatic system and blood to produce systemic infection and metastatic foci. The average incubation period of syphilis is 21 days, however, its period depends up to the size of inoculums and it ranges from 10-90 days. Primary syphilis is manifested by a single usually raised and indurated lesion which appears at the site of inoculation. The lesion is known as a chancre and heals spontaneously in 2-6 weeks. The chancre is an infectious lesion. Approximately after the six weeks when chancre has healed, secondary syphilis appears and is manifested by a symmetrical maculopapular rash and non-tender generalized lymphadenopathy. The rash subsides in 2 to 6 weeks and the patient enters the latent stages which can be only detected by serological testing. A tertiary syphilis is produced on about one-third of untreated patients which is characterized by the presence of gummas on any part of the body or degeneration of central nervous system or cardiovascular system.

 

Clinical presentation;

1. The typical primary chancre begins as a papule which rapidly becomes eroded and forms an ulcer. The chancre is most commonly found on the external genitalia or the anal canal but can be found anywhere. It is painless if located on the genitals. Typical primary lesions are common.
 
2.secondary syphilis is characterized by the appearance of non-pruritic, red or pink macules on the trunk and proximal extremities. In about 1-2 months red popular lesions widespread and may involve palms, soles, face and scalp, perianal region, vulva, breast, scrotum and inner thighs, axilla and the skin under the breast, papules enlarge and become eroded to produce broad,  gray-white moist gray-white highly infectious lesions called condyloma lata. Superficial mucosal erosions called mucous patches occur and may involve lips, oral mucosa, tongue, palate, pharynx, vulva, vagina, glans penis or inner prepuce in about one-third of the patients. 

  1. tertiary syphilis may in; volve the central nervous system (CNS) in one of three ways and is seen in 4 to 6.5% of the patients.

Meningovascular syphilis may occur 5 to 10 years after the primary infection and involves the inflammation of pia and the arachnoid. There may be either focal or widespread symptom.

General paresis reflects the damage to the brain and results in personality changes, hyperactive reflexes, change in sensorium including illusion, delusion, and hallucination, change in intellect, decreased recent memory, impaired orientation, judgment and insight and an inability to perform simple calculations, difficulty with speed is seen about 20 years after infection.

Tabes dorsalis is due to the demyelinization of the posterior columns, dorsal roots and dorsal root ganglia of the spinal cord. Sign and symptoms include ataxia, wide-based gait, foot slap, parenthesis, bladder disturbances, importance and loss of position deep pain and temperature sensation. It occurs 25-30 years after the infection.

 

Prevention;

Personnel hygiene, and awareness about such STDs, may help to prevent the infection.

Practicing a safe sex with the partner by using mechanical contraceptives to avoid the chances of the infection if diagnosed to one partner as infected. Time to time consulting with the physician or pharmacist may also help, as the pharmacist knows about the compliances’, medication and the disease control system. An early diagnosis and awareness about the safe intercourse may prevent better. Washing of genitals after the intercourse also helps to reduce the chances of the infection, the soap and water simultaneously dilute the bacteria and also act as an antiseptic too. Similarly, urination can also help to reduce the possibility of infection as it washes out the bacteria from the urethra.

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