COMBATING SYPHILIS

Though initiatives have been taken by the government and NGOs to promote sexual education/ awareness, a stigma still prevails in our society regarding this matter. Due to this hush-hush nature, a vast majority of young population get exposed to unknowing dangers related to sexual activity.  
We may have some knowledge of sexually transmitted diseases (STDs), due to health campaigns and mass awareness programmes. But what about those people who are already exposed? Do they really know that they are exposed? Do they know what should be done? I have seen patients coming to me with STD cases after months of exposure, only because they were too shy to discuss this matter.

Syphilis is such a STD that does not show any unique symptom, it can be under-diagnosed as its symptoms are masquerade with other diseases. It is caused by an infection with bacteria known as Treponema pallidiu. Like other STDs syphilis can be spread by any type of sexual contact,  it can also spread from an infected mother to the fetus during be pregnancy or at the time of birth.

The good news is that Syphilis cannot spread by sharing the toilet, clothing or utensils with an infected person, as the bacteria cannot survive for long outside the human body.

Types and Symptoms
Syphilis, if left untreated, can progress through different clinical stages, which have distinguished signs and symptoms. Symptoms typically develop around 3 weeks after the infection, but this is not always the case. It may appear anywhere from 2 weeks to 3 months following infection.

Primary Syphilis
This is the first stage of syphilis and is characterized by the formation of a painless ulcer (chancre). It is usually firm and round in shape and develops at the site of infection (male organ or mouth). Single or multiple chancres may be present and the lymph nodes near them may be enlarged.
This is the most contagious state as the chancre contains the infectious bacteria. Any sort of contact with this ulcer/sore can lead to spread of syphilis. The chancre lasts for 3-6 weeks and goes away on its own.

Secondary Syphilis
If treatment is not sought in the primary stage, secondary syphilis may develop. Skin manifestations are noted in this stage but as the infection has spread throughout the body, generalised symptoms may also develop. Following symptoms are usually found-
Skin rash, usually on the palms of the hands and soles of the feet
Sores called mucous patches in or around the mouth, vagina, or penis
Moist, warty patches (called condylomata lata) in the genitals or skin folds
Fever
Malaise (ill feeling)
Loss of appetite
Muscle aches
Joint pain
Swollen lymph nodes
Vision changes
Hair loss

Tertiary Syphilis
This is the rare and terminal stage of untreated syphilis. Symptoms of secondary syphilis fade away after a certain period even if it is left untreated. But it actually gets worse, the infection remains ( in latent state) in the body and about 10 percent of the cases progress to the third stage syphilis. The following are the effects of tertiary syphilis-
Damage to the brian, nerves, heart, eyes, liver, bones, vessels and joints.
Gradual loss of vision, dementia, paralysis and numbness occurs (Neurosyphilis)

Neonatal or Congenital Syphilis
Pregnant women having untreated syphilis suffer the worst as the fetus may die within the womb or shortly after birth. Babies with this disease may bear serious illness even if they survive the initial death blow. Hence, all pregnant women should be tested for syphilis to prevent Neonatal syphilis.

Get Tested
Blood from recognised organisations are usually safe as they are tested for syphilis, but still if you fall into any of the following categories then PLEASE GET TESTED-
Pregnant
Have been to prision
Have had unprotected sex with someone who might have had syphilis (don't take chances, even if it was protected sex)
Have had unprotected sex with multiple people, or have a partner who has done so
Used unsafe needles for any reasons
Go through a complete course of treatment, if the results are positive. Avoid sexual acitivity during that period and also get tested for HIV as precaution.  You should also notify all your recent sexual partners so that they also get tested.

Treatment and Follow up
Treatment for syphilis consists of antibiotics such as penicillin, doxycycline or tetracycline. Follow up blood test must be done at regular intervals to ensure that infection is gone.

Prevention
Practice safe sex as a prevention- using condoms during any sort of sexual activity is a good option
Avoid sharing needles
Avoid having sex with un-trusted partners.

The writer is Research Physician, Centre for Child and Adolescent Health (CCAH), ICDDR,B