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What is Syphilis?

Syphilis is a sexually transmitted disease caused by a bacterium called Treponema pallidum, which has a spiral shape and is found in blood, secretions, and saliva. In 2021, it was reported that 7.1 million people were infected with syphilis worldwide. The main groups of infected people include those aged 15-24 years, pregnant women, and men who have sex with men (MSM). Syphilis is transmitted through direct contact with an affected area, usually occurring in the genital, anal, and mouth areas, making it mostly transmitted through sexual intercourse. Additionally, mothers infected with syphilis can pass the infection on to their children. Syphilis has three stages of progression. After being infected with syphilis, there is an incubation period of approximately 3 weeks during which the patient may or may not have symptoms. The current drug used to treat syphilis is antibiotics. However, if the patient neglects to receive proper treatment, it can cause serious health problems.

Symptoms of syphilis

The progression of syphilis has many stages. In each stage there will be different symptoms and lesions that appear.

The stages of syphilis include primary syphilis, secondary syphilis, latent syphilis, and tertiary syphilis.

Primary syphilis

Primary syphilis occurs approximately 21 days after a person has been infected with syphilis. The symptom of primary syphilis is a chancre appearing on the penis, female genitals, around the anus, or mouth. There will be only one wound with a hard, raised edge, and the bottom of the wound is clean. When pressed, it will not hurt. Although the patient is not being treated with injections or oral syphilis medications, the wounds of primary syphilis can heal on their own within 3-6 weeks and progress to secondary syphilis stage.

Primary syphilis is classified as the stage in which the infection is easily transmitted to others. This is because the chancre of primary syphilis is a lesion that contains a large amount of syphilis bacteria.

Secondary syphilis

Secondary syphilis is a continuation of primary syphilis. Symptoms usually appear when the chancre disappears. The symptoms of secondary syphilis include a rash. The characteristic syphilis rash is a light red rash appearing on the torso, arms, and legs, along with circular or dark red ovals occurring on the palms and soles of the feet (Roseola Syphilitica). In addition, people infected with secondary syphilis may have a raised rash (Condyloma lata) around the genitals, buttocks, or in the mouth, or may have symptoms of patchy hair loss (moth-eaten alopecia).

Other symptoms that may be found in secondary syphilis include low-grade fever, enlarged and tender lymph nodes, headache, muscle aches, fatigue, and a sore throat. If the disease is not treated, it will progress to latent syphilis.

Secondary syphilis is classified as the stage in which the infection is easily transmitted to others. This is because at this stage, the syphilis virus has spread throughout the body, putting others at risk of accidentally coming into contact with the lesions more often. Lesions that can easily infect others include raised, wet rashes around the female genitals, around the anus, or raised, wet rashes in the mouth.

Latent syphilis

Latent syphilis is a continuation of the disease from secondary syphilis. People infected with syphilis in latent syphilis will not have any symptoms at all, such as a chancre, a red rash, or a wet rash. At this stage, syphilis can lie dormant in the body without showing symptoms for up to 20 years. However, we can detect syphilis infection through laboratory tests such as Anti-TP and RPR test results. Even though syphilis does not display symptoms during this latency period, people infected with syphilis at this stage can still spread the disease to others through sexual intercourse.

Tertiary syphilis

Nowadays, tertiary syphilis is very rare, but it is a very dangerous stage. This is due to the syphilis virus having spread in the body for a long time. Tertiary syphilis is an advanced stage of syphilis infection that begins with symptoms and spreads to various systems in the body, such as the cardiovascular system, vascular system, brain, and nervous system, as well as bones and joints. This stage can cause complications, including joint pain, aortic aneurysm, aortic valve leakage, and other systemic conditions, which can lead to death if left untreated.

In addition to the stages of syphilis mentioned above, syphilis can also cause disease in the brain system. Symptoms of syphilis in the brain system (neurosyphilis) include fever accompanied by a severe headache, muscle weakness or difficulty moving muscles, seizures, or a change in personality. If not treated correctly and appropriately, people infected with syphilis in the brain can also die.

How is syphilis transmitted?

Syphilis is transmitted through direct contact with syphilis sores during vaginal, anal, or oral sex. Syphilis can also be spread from mother to fetus, causing syphilis in newborns (Congenital syphilis), which has severe complications and can be life-threatening to the unborn child. It can also cause physical abnormalities in the child, such as the development of a syphilitic nose, and can be dangerous to the life of the unborn child. If a patient receives blood from a person infected with syphilis, the patient will also become infected with syphilis.

Misconceptions about how syphilis is transmitted.

Syphilis cannot be contracted by contact with materials or equipment used by people infected with syphilis, such as bathtubs, bathrooms, doorknobs, swimming pools, or sharing clothing or eating food from the same container, etc.

Congenital syphilis

Congenital syphilis is caused by a mother who contracts syphilis during pregnancy. Syphilis is spread through the placenta to the child during pregnancy, with only a small portion spreading the infection during delivery. When a baby is born, there are different symptoms, divided into 2 stages: early-onset manifestations found 5 weeks after birth. Common symptoms include paleness, rashes, and clear, shiny blisters on the palms and feet. The late-onset manifestation period will show symptoms 2 years after giving birth. Common symptoms include deafness, blindness, and abnormal teeth. The nose has an abnormal appearance (Syphilis nose), bone abnormalities, etc.

syphilis treatment

Syphilis screening

The diagnosis of syphilis is done by a blood test to detect antibodies to the syphilis bacteria in our body. At present, the United States Centers for Disease Control and Prevention (CDC) has recommended the use of a reverse algorithm, which is more accurate and faster than in the past. It can also diagnose people who have been infected with syphilis for a long time, whereas past tests were unable to detect the infection. The examination is divided into 2 types.

1. Screening for syphilis in people who have never had it before

Using the Anti-TP test to confirm a syphilis infection to determine if there is an infection or not.

  • If the Anti-TP result is negative, it can be confirmed that the person does not have a syphilis infection.
  • If the Anti-TP result is positive, RPR testing will be performed to confirm that the person is actually infected with syphilis.

If the Anti-TP test is positive and the RPR test is negative, a TPPA or TPHA test is required to confirm syphilis infection in the individual. The diagnosis of syphilis infection is based on the results of the TPPA or TPHA test.

2. Screening for syphilis in people who have previously had it

Using the RPR test to confirm a syphilis infection is important. Even if a person has been infected with syphilis before and has received the correct treatment and been cured, the Anti-TP, TPPA, and TPHA results will be positive for life.

3. Screening for syphilis using cerebrospinal fluid testing

If the patient is in tertiary syphilis stage, where the infection has spread to various systems of the body, including the nervous system, patients may be considered for diagnostic testing by cerebrospinal fluid sampling. This involves collecting cerebrospinal fluid to be further examined for syphilis and abnormalities.

How to treat syphilis

Treatment for syphilis is divided according to the stage of disease progression, with an injection of the antibiotic penicillin.

  • Patients with primary, secondary, and early latent syphilis stage are recommended to receive benzathine injections. Benzathine penicillin G 2.4 million units should be administered one time, divided into 1.2 units per hip muscle.
  • Patients with late latent syphilis or syphilis of unknown duration are treated with benzathine penicillin G. The treatment consists of 2.4 million units of benzathine penicillin G injected into the hip muscle, divided into three doses of 1.2 million units each, administered once a week for three weeks.

Oral medication is used to treat syphilis.

In cases where some patients are allergic to penicillin, the doctor will recommend alternative medication. The duration of taking the medicine depends on the stage of the disease progression.

  • Patients with primary, secondary, and latent syphilis stage should take Doxycycline 100 mg after meals, 2 times a day for 14 consecutive days.
  • Patients with tertiary syphilis should take Doxycycline 100 mg after meals, 2 times a day for 28 consecutive days.

Side effects after injections to treat syphilis may include fever, chills, body aches, and rash. These side effects are caused by reactions, specifically the Jarisch-Herxheimer Reaction, which is the body’s immune system reacting to dead syphilis bacteria. Symptoms typically disappear within 24 hours. Patients can take medicine to reduce fever and relieve these symptoms. However, if the symptoms do not subside, seek immediate medical attention as you may be experiencing an allergic reaction to penicillin.

Can syphilis be cured?

Syphilis is a sexually transmitted disease that can be cured, but it can also recur. Currently, the main treatment for syphilis is still antibiotics, which can be administered through injections or oral medications. Therefore, if a patient observes symptoms of syphilis, it is important to get tested quickly and receive proper treatment. With prompt and appropriate treatment, patients can recover from the disease. However, if a patient who has recovered from syphilis comes into contact with the infection again, it can recur and develop into syphilis once more.

How to protect yourself from contracting syphilis?

Because syphilis is transmitted through direct contact with syphilis at the site of the lesion, through the mouth, genitals, and anus, it is often found that patients get the infection through sexual intercourse. Therefore, the best way to prevent it is to:

  • Wear condoms for protection every time you have sex.
  • If your partner has lesions around the mouth, genitals, or anus, refrain from sexual activity.
  • Abstain from having sex with a person with syphilis until the patient has recovered.
  • Get regular screenings for sexually transmitted diseases at least once per year.

Couples should consider participating in a health program before planning marriage or having children.

How often should we be screened for syphilis infection?

If you are still having sex regularly, it is recommended to be screened for syphilis infection every 3-6 months. You should also be screened for syphilis infection if you have suspected symptoms, such as wounds similar to primary syphilis or rashes similar to secondary syphilis.

Syphilis and the risk of contracting HIV

Syphilis and HIV infection are both diseases that are transmitted through sexual contact, but they differ in their causes. Syphilis is caused by bacteria, while HIV is a virus. However, reports have found that patients with syphilis have a higher chance of being infected with HIV because they may have sores in the mouth, genitals, or anus, making them more at risk of contracting HIV than usual.

It can be considered that syphilis is another disease that couples or people with diverse sexual preferences should not overlook. This is because syphilis is a disease that can be contracted by touching wounds in the genital, anal, and mouth areas. It is mainly contracted through sexual intercourse, it is important to be proactive about preventing and treating syphilis. Contact PSK Clinic, a specialist in sexually transmitted diseases, for advice, treatment, and prevention from expert doctors. Good sexual health is important, and PSK Clinic is here to help.

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