Syphilis Syphilis is a chronic, systemic sexually transmitted disease caused by infection with the bacterium Treponema pallidum (TP), primarily spread through sexual contact, mother-to-child transmission, and blood transmission. The disease is highly dangerous, as its effects can affect nearly all tissues and organs in the body. During pregnancy, syphilis can lead to premature birth, stillbirth, miscarriage, and congenital syphilis in newborns.

A chronic, systemic sexually transmitted disease caused by Treponema pallidum

Mainly transmitted through sexual contact, mother-to-child transmission, and blood transmission

Preferred treatment with penicillin-class drugs, with partial curability

Safe behaviors and enhanced premarital and prenatal examinations for prevention

Syphilis is a chronic, systemic sexually transmitted disease caused by infection with Treponema pallidum (TP), mainly transmitted through sexual contact, mother-to-child transmission, and blood transmission. This disease is extremely harmful, with lesions affecting almost all tissues and organs of the body. Syphilis during pregnancy can also cause premature birth, miscarriage, stillbirth, and congenital syphilis in newborns.

Untreated patients are highly infectious within 1-2 years of infection. As the disease progresses, the infectivity decreases, and patients infected for more than 4 years are basically non-infectious.

Sexual contact transmission

Unprotected sexual contact with a syphilis patient, such as vaginal intercourse, anal intercourse, or oral sex, or sharing sex toys with an infected person, inevitably causes minor skin and mucosal damage, allowing syphilis to invade the body. Approximately 95% of patients are infected through sexual contact.

Mother-to-child transmission

After 4 months of pregnancy, Treponema pallidum can be transmitted from the pregnant woman to the fetus through the placenta and umbilical vein, and during childbirth, the newborn can be infected due to abrasions on the head or shoulders during passage through the birth canal.

Blood transmission

Treponema pallidum has strong cold resistance, and the blood of syphilis patients remains infectious within 3 days of refrigeration. Transfusion of such blood can cause syphilis infection. This type of transmission is rare because blood products are currently strictly screened, and the survival time of syphilis in the external environment is limited.

Some people may be infected by sharing needles for drug injection or sharing razors with syphilis patients.

Other situations

In most cases, Treponema pallidum is difficult to survive outside the human body, and boiling, drying, sunlight, soapy water, and common disinfectants can quickly kill it. Only a few people can be infected through kissing, handshaking, breastfeeding, or contact with clothing, utensils, etc., containing Treponema pallidum.

The surface polysaccharide enzyme of Treponema pallidum may be related to its pathogenicity. The human body's skin, aorta, eyes, placenta, umbilical cord, and other tissues are rich in polysaccharides, so Treponema pallidum has a high affinity for these tissues and can adhere to them. The polysaccharide enzyme breaks down the polysaccharides in the tissues, causing vascular collapse, local blood supply obstruction, and subsequent vascular inflammation, tissue necrosis, ulcers, and other lesions.

Due to the low antigen concentration and weak immunogenicity of Treponema pallidum, immunity to syphilis is still incomplete. Even if the titer of Treponema pallidum antibodies in the blood is high, TP can still reproduce and spread. The pathogen that is not cleared fluctuates in quantity with the decline and growth of the body's immunity, clinically presenting as self-healing, latent, or progressive syphilis.

Early acquired syphilis refers to the primary and secondary stages of acquired syphilis, with a duration of less than 2 years. Patients mainly present with chancre and syphilitic lymphadenitis. Without treatment or with delayed treatment, they may develop skin rashes, bone and joint lesions, eye lesions, neurological manifestations, and multi-organ involvement.

Early congenital syphilis, diagnosed within 2 years of age, presents with similar lesions to severe secondary syphilis in adults. Skin and mucosal lesions may include dry skin, wrinkles, macules, papules, vesicles or bullae, pustules, desquamation, petechiae, mucosal patches, and condyloma lata.

The skin and mucosal lesions of syphilis are sometimes difficult to distinguish from other common skin lesions, and may be differentiated through a medical history, serological tests for syphilis, and histopathology.

Primary syphilis: characterized by a painless ulcer known as a chancre, which needs to be distinguished from genital herpes, chancroid, and other conditions.

Secondary syphilis: characterized by syphilitic rashes, it should be differentiated from roseola, psoriasis, viral rashes, flat warts, tinea cruris, and cutaneous lymphoma, among others.

Tertiary syphilis: characterized by syphilitic gummata, it should be distinguished from cutaneous tuberculosis, leprosy, and skin tumors. Neurosyphilis should be differentiated from other central nervous system diseases or psychiatric disorders. Cardiovascular syphilis should be distinguished from other cardiovascular diseases.

Sexual partners of syphilis patients should also receive treatment simultaneously, and sexual activity should be avoided during the treatment period to prevent reinfection and transmission to others.

Patients with syphilitic cardiovascular disease should be closely monitored for Jarisch-Herxheimer reaction during treatment.

For patients with recurrent syphilis, re-treatment may be necessary after a series of examinations.

Patients undergoing drug treatment should undergo regular blood tests to monitor treatment efficacy.

All syphilis patients should be screened for HIV infection.

Those allergic to penicillin should inform their doctor in advance. Doctors may choose ceftriaxone as an alternative, and sometimes may recommend tetracyclines and macrolides, although their efficacy is inferior to penicillin. Tetracyclines are contraindicated in pregnant women, children, and those with impaired liver or kidney function.

In case of penicillin resistance, if the treatment effect is not satisfactory, the doctor may suggest further tests to determine better alternative drugs.

Patients with syphilitic aortic insufficiency may undergo aortic valve replacement surgery; those with stenosis of the coronary ostium may undergo procedures such as coronary ostial dilatation and endarterectomy, coronary artery bypass grafting, and coronary artery bypass surgery; surgery for aortic aneurysms should be performed at the discretion of a cardiovascular specialist, based on the size, location, and severity of symptoms caused by the aneurysm.

Early syphilis

Patients diagnosed with primary or secondary syphilis, without other systemic diseases, can be cured if they receive timely and appropriate treatment. However, after being cured, they need to strictly follow up and monitor their condition as a small percentage of patients may experience a relapse or reinfection.

Latent syphilis

It can remain asymptomatic for several years or even decades. However, without timely diagnosis or treatment, there is a possibility of progression to tertiary syphilis at any time in a person's life, leading to multi-system or multi-organ tissue damage, resulting in organ dysfunction and even life-threatening situations.

Tertiary syphilis

The prognosis is not optimistic. Tertiary syphilis often affects internal organs, impacting organ function and even life, and is a major cause of death. Treatment cannot reverse the formed physical organ damage. Although 90% of neurosyphilis patients can have a certain clinical effect with appropriate treatment, the possibility of restoring vision in patients with optic nerve atrophy due to neurosyphilis is very low. The prognosis for cardiovascular syphilis is also poor.

Pregnancy and syphilis

The spirochetes of syphilis can infect the fetus. If left untreated, it can increase the risk of miscarriage, stillbirth, premature birth, neonatal death, and various complications. Early detection and timely treatment can allow pregnant women to deliver uninfected fetuses. Research reports that syphilis spirochetes do not invade placental tissue or fetuses before 4 months of pregnancy, so treatment within 4 months of pregnancy can effectively prevent congenital syphilis in newborns.

Psychological care: Family members should communicate with the patient, learn about syphilis treatment together, provide psychological support, and help the patient maintain a good mental state to cooperate with the treatment.

Medication care: Adhere to early, adequate, and regular treatment, and strictly avoid self-discontinuation or dosage reduction. During medication, closely observe changes in the condition.

Lifestyle

Maintain a positive attitude, face the disease correctly, actively cooperate with the treatment, and strive for early recovery.

Protect the skin lesions and refrain from scratching.

Maintain personal hygiene and isolation to prevent transmission. Personal items should be for individual use only, and used clothing should be disinfected before washing. Regularly disinfect daily necessities.

Keep the external genitalia clean and use disinfectant to clean the ulcers daily.

Diet

Stick to a light diet, avoid alcohol, strong tea, and coffee.

Improve nutrition, enhance immune function, and improve treatment effectiveness.

Syphilis and pregnancy

After curing syphilis, it is possible to conceive and have children, but regular testing of syphilis titers is necessary to assess the stability of the condition and the possibility of recurrence. If the syphilis titers turn negative or remain at low titers, pregnancy and delivery can be considered under the guidance of a professional doctor.

Pregnant women with syphilis should seek medical attention promptly. Early treatment can prevent the transmission of syphilis to the fetus.

Self-testing for syphilis

Self-testing for syphilis can be done using a syphilis treponemal antibody diagnostic kit, which includes test strips, a blood collection needle, a pipette, diluent, alcohol swabs, and an instruction manual. After collecting the blood sample with the needle and pipette, it is then dropped onto the test kit's sample well and observed for the appearance of red lines in the test area (T) and the control area (C) after half an hour.

If only a red line appears in the control area, the test is successful, and the result is negative, indicating that the tested individual is not infected with syphilis treponemes.

If two red lines appear, indicating a positive result, it suggests a high likelihood of being infected with syphilis treponemes, and further confirmation through professional medical testing is necessary.

It is important to note that the accuracy of this self-testing method for syphilis is not very high. Therefore, for individuals engaging in high-risk behaviors, it is best to seek medical testing promptly if there are any abnormal self-test results to confirm the diagnosis.

First, isolate and treat the source of infection. Suspected patients should undergo preventive screening and syphilis serological tests to detect and treat the disease early. Syphilis patients are the main source of infection, and early detection and treatment are fundamental to eliminating the source of infection. During treatment, sexual activity should be avoided.

Second, cut off the transmission route. Syphilis is mainly transmitted through sexual contact, so it is important to maintain good sexual ethics, have a monogamous and stable sexual partner, and practice safe sex using condoms. It is also essential to cultivate good hygiene habits, avoid bathing in unsanitary public baths, and refrain from sharing towels, razors, and utensils with others.

Third, protect the second generation by strengthening premarital and prenatal examinations to prevent the transmission of syphilis to the fetus. Infected pregnant women can transmit syphilis to the fetus through the placenta or infect the newborn through the birth canal. Therefore, the following examinations are recommended:

All pregnant women should undergo syphilis serological screening at their first prenatal check-up after becoming pregnant.

It is preferable to start the first prenatal check-up within 3 months of pregnancy.

Pregnant women in high-risk areas for syphilis or those at high risk of syphilis should be screened again during the last 3 months of pregnancy and before delivery.

Finally, pay attention to the risk factors for bloodborne transmission, strictly avoid sharing syringes, and refrain from unsanitary practices such as tattooing.