Syphilis: do not let your guard down

Far from disappearing, syphilis is now considered a real public health emergency.

Despite the efforts made by health institutions to inform about the risks and promote the prevention of contagion, for some years now sexually transmitted diseases have been spreading consistently among people of all walks of life, level of education and age, to the point of being considered by the World Health Organization (WHO) a real emergency for public health , even in countries with good standards of sanitation and living.

These are not only highly feared diseases, such as HIV infections (for which, moreover, an average higher alert is maintained) or by relatively easy-to-counteract microorganisms such as those at the origin of trichomoniasis, but also bacterial infections that are complex to manage and associated with a serious health risk in the immediate and years to come, such as gonorrhea and syphilis.

What has amazed Western doctors in the last decade has been above all the epidemiological surge of syphilis, a sexually transmitted disease with which more and more people are having to deal, due to unprotected risky sexual intercourse.

To be affected by the new wave of syphilis, in Europe as in the United States, are mainly young men and women sexually active, often not adequately informed and tend to pay little attention to the risk of contagion.

It is therefore necessary to remedy it through greater information and education on “safe sex” to protect not only individual well-being, but also reproductive health, since a sexually transmitted disease such as syphilis can reduce female fertility and, during pregnancy, can be transmitted to the child, who will therefore already be ill at birth (congenital syphilis).

What is syphilis

Syphilis is caused by a bacterium called Treponema pallidum, which is transmitted by direct contact with lesions caused by the disease on the genital mucous membranes or on abraded or damaged skin.

The most frequent occasion of contagion is unprotected sexual intercourse (although, in reality, the condom can only partially protect against the transmission of the bacterium).

Other possible routes of transmission are represented by transfusions of infected blood and the passage of the bacterium from the sick mother to the fetus via the placenta.

Syphilis must be recognized and treated at an early stage (primary syphilis) with a therapy based on antibiotic drugs, because only in this way it is possible to completely eliminate the bacterium from the body and avoid the long-term sequelae associated with the secondary phase and the latent and tertiary phases of the disease, in which Treponema pallidum It can also infect the nervous system and heart, causing severe symptoms and serious risks to overall health, up to death.

The following table shows the symptoms that characterize the different stages of syphilis, described in more detail in the next paragraphs.

The initial symptoms of syphilis

Unless you are aware that you have had risky sexual intercourse with an affected partner capable of transmitting the disease and therefore pay specific attention to its initial manifestations, realizing that you have been infected with syphilis is quite difficult.

The earliest sign of onset consists in the appearance, after a few weeks of risky sexual intercourse, of a lesion at the level of the genital mucous membranes (syphiloma), at the point where the bacterium entered the body.

However, this initial lesion (reddened, wet and ulcerated, but not painful), may be small or placed in a place that is not easily visible and does not cause disorders that would lead to medical attention.

If not immediately treated, the disease evolves into secondary syphilis, causing decidedly more extensive manifestations, which take the form of a diffuse skin rash, with the appearance of lesions at the level of the mucous membranes and epidermis of various parts of the body. Also typical of this stage are fever, swollen lymph nodes, sore throat, patchy alopecia, headache, weight loss, muscle pain and fatigue.

The manifestations of secondary syphilis in the skin and mucous membranes can have very variable appearance and size and be mistaken with those of other infectious diseases (in particular, of the exanthematous type): to guide the clinical diagnosis is above all the characteristic localization of the lesions at the level of the palms of the hands and soles of the feet.

The lesions of secondary syphilis can disappear on their own, even without treatment, but this does not mean that the disease is cured, on the contrary. At this point, in fact, patients develop the so-called “latent syphilis”, which does not portend anything good.

Latent and tertiary syphilis

Latent syphilis is a completely symptom-free phase, in which the disease, in general, is no longer transmitted to a possible sexual partner (but, in some cases, it can still be transferred from mother to fetus during pregnancy) and can only be diagnosed through the execution of targeted laboratory tests, able to highlight the presence in the blood of antibodies against Treponema pallidum or to evaluate other parameters indirectly related to the infection (even many years later).

Typically, at least one Treponema-test and one non-Treponema-test are required for diagnostic confirmation to reduce the risk of false positives.

These and other laboratory tests are usually also performed in cases of primary and secondary syphilis, after the medical examination and collection of the patient’s medical history, to obtain confirmation of the diagnosis and set up the appropriate antibiotic therapy.

In these first two phases, Treponema pallidum can also be easily recognized by observing under a microscope fragments taken from the lesions present on the skin or mucous membranes, thanks to its peculiar shape of a spirally wound tube.

All patients diagnosed with syphilis should also be tested for HIV infection because the presence of Treponema pallidum greatly increases the transmission of this virus.

During the latent phase of syphilis, various types of damage can begin to occur to the internal organs (central and peripheral nervous system, eyes, heart, blood vessels, liver, bones and joints), which can take up to a few decades to manifest themselves in an evident way. Neurological disorders are generally those that appear earlier, sometimes already during the phase of secondary syphilis (neural syphilis).

When latent syphilis further evolves into tertiary syphilis, patients may be affected by serious neurological and motor deficits, with loss of the ability to control movement (up to paralysis), mental confusion, gradual development of blindness and dementia. The picture can become so severe as to lead to death (for example, by paralysis of the respiratory muscles).

Therapy

If treatment is started at an early stage, i.e. from the appearance of the first syphiloma, counteracting Treponema pallidum is quite simple. In most cases, a single dose of penicillin, at an appropriate dosage and administered by injection, is sufficient.

In the presence of penicillin allergy, the doctor may propose alternative antibiotic drugs to non-pregnant men and women. During pregnancy, however, penicillin is the only possible therapy, so allergic women will have to undergo a preliminary desensitization treatment that will allow them to tolerate this precious antibiotic.

An important aspect to underline is that, if syphilis is contracted or present during pregnancy, in addition to immediate treatment of the mother, it will also be necessary to administer antibiotics to the baby immediately after birth to protect it from significant damage.

Partners of men and women diagnosed with syphilis should be promptly informed of the risk of infection, subjected to the necessary diagnostic tests (including HIV) and treated with penicillin as a precautionary measure.

Data from numerous studies and decades of clinical experience have shown that the treatment of syphilis with penicillin (or other antibiotics prescribed by the doctor) is effective, safe and well tolerated and ensures the elimination of Treponema pallidum from the body.

To ensure that this has occurred, all patients should undergo follow-up blood tests after antibiotic therapy to verify that there has been an adequate response to the drugs administered.

During therapy and until blood tests have certified complete elimination of Treponema pallidum from the body, patients should avoid sexual intercourse of any kind.

In addition, it should be remembered that having contracted syphilis does not protect against a new infection if you come into contact with an infected partner: therefore, attention to this sexually transmitted disease must be maintained on every occasion and throughout life.

If primary syphilis is not treated immediately, counteracting Treponema pallidum becomes more difficult, requires repeated administration of antibiotic drugs and, above all, any organ damage that has already established cannot be eliminated.

How to avoid syphilis

Avoiding unprotected sex (i.e. without a condom), especially with casual or newly known partners, is the best method to reduce the risk of contracting syphilis, as well as all other sexually transmitted diseases.

However, as already reported, this precaution may not be sufficient, since infected lesions can be located in different points of the body and contact with intact mucous membranes is sufficient for contagion.

In this regard, it should be considered that Treponema pallidum can be transmitted from person to person even with oral intercourse.

In everyday life, the identification of infected partners at risk of infection is only possible in the presence of visible lesions in the genital mucous membranes or skin. However, the bacterium can also be transmitted in the months before the onset of symptoms.

For this reason, the guidelines of the U.S. Centers for Diseases Prevention and Control (CDC) recommend providing antibiotic therapy also for partners with whom the patient has had intercourse in the three months prior to the onset of symptoms of primary syphilis; in the six months prior to the onset of symptoms of secondary syphilis; in the 12 months prior to the onset of symptoms of latent syphilis.

In Italy, to protect newborns from congenital syphilis, treatment is provided during pregnancy of the mother infected with Treponema pallidum and that of the child immediately after birth; In addition, all women in early pregnancy undergo routine screening tests for Treponema pallidum.