Syphilis

“The Great Pretender”

By: Bruce Martin
Taxonomy
Domain: Bacteria
Phylum: Spirochaetes
Order: Spirochetales
Family: Spirochaetaceae
Genus: Treponema
Species: pallidum
 Characteristics
 Helical, tightly coiled, mobile
 5-20 um in length, 0.1-0.4 um in diameter
 Pathogenic treponemes associated with 4
diseases
 Venereal syphilis (pallidum)
 Yaws (perfenue)
 Endemic (endemicum)
 Pinta (carateum)

 Obligate parasites of humans

 Method of infection
 Viable bacteria from a chancre enters through a
fissure or mucus membrane
 Bacteria multiply locally and causes a painless
chancre
 Spreads via blood stream or lymphatic system
 Can infect almost any organ or tissue
 Continuous in vitro culture has yet to be
achieved
 Symptoms
*some have no symptoms for years

 3 stages
 Primary
 Secondary

 Late or latent

 Congenital (passed from a mother to her unborn

child)
 Primary stage
 Appearance of a single sore or chancre (about
21 days after infection)
 Chancre lasts 3-6 weeks and heals w/o
treatment
 If untreated, disease progresses to next stage
 Secondary Stage
 Occurs as chancre is healing or a few weeks after
 Skin rash develops on one or more areas of body
 Rash can appear like rashes from other diseases (usually
doesn’t cause itching)
 Other symptoms: fever, swollen lymph glands, sore
throat, patchy hair loss, headaches, weight loss, muscle
aches, fatigue
 Without treatment disease progresses to late stage.
 Late stage (hidden stage)
 Person continues to have syphilis even though
there are no symptoms.
 Disease can damage eyes, brain, nervous system,
heart, blood vessels, liver, bones, joints
 Signs include: difficulty coordinating muscle
movements, paralysis, numbness, gradual
blindness, dementia, even death
 Congenital syphilis and hiv
 Congenital
 Can infect fetus during pregnancy
 Can cause still born birth depending on how long mother is
infected and when
 Infected babies can be born without immediate signs or
symptoms
 Infected babies can become developmentally delayed have
seizures and even die.
 HIV
 Genital sores make it easier to transmit and acquire HIV
 Diagnosis
 Material from a chancre can be examined with a
dark field microscope
 Blood test can be performed to check for
presence of syphilis antibodies
 A low level of antibodies will stay in the blood
for years even after treatment
 “Direct Fluorescent Antibody Test”
 Treatment
 Easy to cure in early stages
 Injection of penicillin < 1year
 Additional doses >1year
 If allergic other antibiotics can be used
 No home remedies or over the counters
 Antibiotics will kill the bacteria but cannot
repair damage done
 Spread
 Ways you can get syphilis
 Direct contact with a syphilis sore via vaginal, oral or
anal sex
 Sores occur on the genitals, anus, vagina, or rectum

 Sores can also occur on lips and mouth

 Ways you cannot get syphilis

 Toilet seats, door knobs, swimming pools, hot tubes,
bathtubs, shared clothing, or eating utensils
 Prevention
 Ways you can prevent syphilis
 Like any std: abstinence or mutually monogamous
relationship
 Ways you cannot prevent syphilis
 Latex condoms (reduce transmission, but do not
prevent)
 Washing genitals, urinating, or douching after sex

 *Even a cured person can be re-infected

 Epidemiology
 Worldwide
 WHO estimates 12 million new cases per year
 90% of those cases in developing countries
 In Russia and Eastern Europe, its contributing to hiv
infections
 North America and Western Europe rates have shifted to
MSM, and illicit drug users
 In Africa more females are infected than males
 USA
 During the 90’s rates steadily decreased
 2001-2002 syphilis rates began to increase
 Increase primarily in males, suggesting MSM
 Latest research and preventative
measures
 Prevention
 1999 National plan to eliminate syphilis
 Expanded surveillance and outbreak response activities
 Rapid screening
 Expanded laboratory services
 Strengthen community involvement
 Enhance health promotion
 Their target audience
 National, state, and local legislators
 State and local Health Officers
 Policy “influencers” at national, state, and local levels
 Latest research and preventative
measures
 Faster testing
 One study compared Syphilis Fast latex agglutination
test to Treponema pallidum particle agglutination
test
 98.8% agreement between the two

 Syphilis Fast only takes 8 minutes vs 1-2 hrs

 Ideal for point of care situations, std clinics, and

prenatal care clinics
 Resources
 Centers for Disease Control and Prevention STD Prevention 27 Nov. 2004
<http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm

 Hook III, Edward W. and Peeling, Rosanna W. “Syphilis Control – A Continuing Challenge.” The New
England Journal of Medicine 351(2004): 122-124 29 Nov 2004
<http://content.nejm.org/cgi/content/full/351/2/122?ijkey=Hc7QnNAa2ExyU&Keytype=ref&siteid=nejm

 The Prokaryotes Ed. Martin Dworkin. 17 Mar. 2004. 2 Dec. 2004.

<http://141.150.157.117:8080/prokPub/index.htm

 Centers for Disease Control and Prevention Syphilis Elimination Communication Plan 5 Dec. 2004
<http://www.cdc.gov/stopsyphilis/CommPlan.htm

 World Health Organization Global Prevelance and Incidence of Selected Curable Sexually Transmitted
Infections Overview and Estimates 10 Dec. 2004
<http://www.who.int/hiv/pub/sti/en/who_hiv_aids_2001.02.pdf

 Fears, Martha B. and Pope, Victoria “Syphilis Fast Latex Agglutination Test, a Rapid Confirmatory Test”
Clinical and Diagnostic Laboratory Immunology 8.4(2001) 841-842 10 Dec. 2004
<http://cdli.asm.org/cgi/content/abstract/8/4/841?maxtoshow=&HITS=10&hits=10&RESULTFORMAT
=&titleabstract=syphilis&searchid=1102524542545_3690&stored_search=&FIRSTINDEX=0&search_url=ht
tp%3A%2F%2Fjournals.asm.org%2Fcgi%2Fsearch