Testing for Syphilis in New York City
Testing of syphilis is done by screening an individual with blood tests. The most common blood test available for this purpose is called VDRL (venereal disease research laboratory) and RPR (rapid plasma regain) test and these tests are called non-Treponemal tests. The problem with these screening tools is that they give false positive and false negative results. To confirm them, advanced tests are performed that are called Treponemal tests such as TPHA (Treponema pallidum particle agglutination) and FTA-Abs (fluorescent Treponemal antibody absorption) test. The Treponemal antibody test shows positive results after 2-5 weeks of initial infection.
There are some direct tests also available to make an early diagnosis. This is done by taking the fluid out of the chancre lesion and observing it under direct dark ground microscopy, but it is not preferable due to technical complications. Two other direct tests available are nucleic acid amplification and direct fluorescent antibody testing.
Of note, these tests can only screen an individual for the presence or absence of syphilis infection and cannot give much information about the stage of the disease progression.
What is Syphilis?
Syphilis is a sexually transmitted disease and it is caused by a species of bacteria, Treponema pallidum. There are several viewpoints about the start of syphilis, but the consensus is it spread from the Americas to Europe through returning Columbian crewmembers in the pre-Columbian era, but the other view is that it existed in Europe already, and it went unnoticed. The 19th-century myth of poison women (femme fatale) is also derived from syphilis devastation in Europe.
There are four types of syphilis named as primary, secondary, latent, and tertiary. The transmission of syphilis infection is mainly through sexual contact. All types of unprotected sex including vaginal, anal, and oral can cause bacterial transmission. It can also be transmitted by kissing near a pre-existing syphilis lesion. An estimated 30-60% of individuals who are exposed to primary to secondary syphilis develop the disease. Men having sex with other men are also one of the high-risk groups with the occurrence of syphilis raising up to 60% of the total new cases diagnosed only in the United States. Syphilis can also be transmitted to children born to infected pregnant women, and this is usually called congenital syphilis. Developing countries contribute more than 90% of the total cases of syphilis reported around the world.
What are the Signs and Symptoms of Syphilis?
Syphilis is also commonly called “The Great Imitator” due to its different presentations; it can be of four different types depending on its stage. It can be primary, secondary, latent, or tertiary. One other type is congenital as discussed above due to infected pregnant women infecting their newborn babies.
Primary syphilis presents itself as a skin lesion known as “chancre” that develops at the point of contact. The chancre is a painless, firm, and non-itchy skin ulcer that evolves from a macule or papule that eventually matures into an ulcer. There is usually a single lesion, but occasionally there can be multiple lesions also noticed. This lesion is commonly located on the penis in men and inside the vagina of women. It is usually noticed on the anus or in the rectum of men who have sex with other men. The primary lesion heals without any treatment eventually, but bacteria are still present in the body.
Secondary syphilis develops anywhere between 4 and 10 weeks after the primary infection. It most commonly affects the skin, mucous membranes, and lymph nodes and presents itself as a pink or red, non-itchy rash on the chest, belly, arms, and legs. Sometimes these rashes also develop pus in them. These lesions may change into a wart-like whitish lesions. What is noteworthy is that all these lesions are infectious and contain bacteria that can spread the syphilis infection to others. Other symptoms include flu-like symptoms like fever, sore throat, headache, loss of appetite, weight loss, body ache, and joint pain.
Syphilis may get into a latent phase around one year after secondary syphilis and become symptom-free, but blood tests even in this phase will show traces of infection present.
Tertiary syphilis develops after 3-15 years of the primary infection. Tertiary syphilis also has three types. One is called gummatous syphilis with the development of soft, ball-like tumors of inflammation involving usually the skin, liver, and bones. The second is called neurosyphilis which develops due to the syphilis infection reaching the brain and central nervous system. It causes meningitis and other symptoms like imbalance, seizures, memory loss, weakness diminished reflexes, diminished sensations over the skin, gait disturbance, loss of coordination, and intense joint pains. The third type of tertiary syphilis is called cardiovascular syphilis which affects the heart and blood vessels causing inflammation at the structural level.
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What is the Treatment of Syphilis?
Treatment for early infection of syphilis is uncomplicated and effective. A single dose of penicillin G intramuscularly is given followed by a single oral dose of azithromycin which is considered to be a Gold Standard. Other antibiotics can be used if an individual is allergic to penicillin, but choices of drugs are limited due to the development of resistance against many antibiotics like clindamycin and rifampicin, but still, doxycycline, tetracycline, and ceftriaxone are some of the antibiotics that can be used as an alternative to penicillin G.
Treatment at a later stage has a limited effect. It can only halt the progression of the disease, but it cannot correct the damage that has already been done. Treatment for late infection like neurosyphilis is done with large doses of penicillin intravenously because of the limited ability of penicillin G to penetrate the central nervous system. In the case of penicillin allergy, prolonged treatment with ceftriaxone, doxycycline, or tetracycline in large doses can be used.
Treponema pallidum is a spirochete bacterium, which is a Gram-negative spiral-shaped bacterium. It is highly mobile. There are some other types of subclasses of Treponema, but only the subclass pallidum causes syphilis and humans are the only reservoirs for T. pallidum.