Syphilis

Definition:

• Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.

Epidemiology:

• Affects both men and women, with a higher prevalence in men who have sex with men.
• Can be transmitted via sexual contact, from mother to fetus (congenital syphilis), and, rarely, through blood transfusion.

Stages of Syphilis:

1. Primary Syphilis:
   • Characterized by a painless ulcer (chancre) at the site of infection.
   • Occurs 3 weeks after exposure.
2. Secondary Syphilis:
   • Systemic spread of the bacterium.
   • Symptoms include rash (often affects palms and soles), mucous membrane lesions, fever, lymphadenopathy.
3. Latent Syphilis:
   • Asymptomatic phase.
   • Early latent syphilis is within the first year of infection; late latent is beyond one year.
4. Tertiary Syphilis:
   • Occurs years to decades after the initial infection.
   • Can affect multiple organ systems, including neurosyphilis, cardiovascular syphilis, and gummatous syphilis.

Congenital Syphilis:

• Transmission from mother to fetus.
• Can result in miscarriage, stillbirth, or severe neonatal infection.

Diagnosis:

• Non-treponemal serological tests (VDRL, RPR) for screening.
• Treponemal tests (FTA-ABS, TPPA) for confirmation.
• Darkfield microscopy can detect the bacterium in primary and secondary syphilis.

Management:

• Primary, secondary, and early latent syphilis: Single dose of intramuscular benzathine penicillin G.
• Late latent and tertiary syphilis: Three weekly doses of intramuscular benzathine penicillin G.
• Neurosyphilis: Intravenous penicillin G for 10-14 days.
• Alternative antibiotics for penicillin-allergic patients include doxycycline and azithromycin.

Prevention:

• Safe sex practices, including condom use.
• Screening and treatment of sexual partners.
• Prenatal screening to prevent congenital syphilis.