Following infection , syphilis goes silent for a while , say 2-3 months , then some of those infected will go on to show signs of the next stage , Secondary syphilis — fever , swollen glands , and a rash . A rash on the palms of the hands and soles of the feet is characteristic . We are also seeing some patients present with vision or hearing loss , which is due to infection of the nervous system . Not everybody goes through the secondary stage , but they remain infected , and the infection can progress .
If undiagnosed and untreated , syphilis then progresses to the latent phase , where it lies completely silent , without any signs or symptoms and can only be detected by a specific blood test .
About 25 percent of those infected progress to the tertiary phase where it can affect any part of the body � heart , blood vessels , bones , skin , liver , and especially the nervous system which can end up with many manifestations , including dementia . At this stage , damage may have been done , and treatment may be too late .
Whilst there are many signs and symptoms of syphilis , most cases are silent — asymptomatic . They are only diagnosed by taking a blood test , and most cases of syphilis are diagnosed in this way .
There is a specific battery of blood tests that are taken to diagnose the infection . It takes 6-8 weeks for the antibodies to the infection to form in the body , so it is important not to rely on a blood test taken soon after the sexual risk encounter , but to repeat the tests 6-12 weeks later , the same as when screening for HI� infection .
When syphilis was very common in the pre-antibiotic era , it was the practice to do routine tests for syphilis on anyone who presented with a rash or needed admission to a psychiatric hospital . In the US at that time , syphilis was so common that many states made it mandatory to be tested for syphilis prior to marriage .
Q
: Which are the most common routes of transmission ?
A
: There is only one mode of transmission - SE� . Especially anal receptive sex , but any type of penetrative or skin-toskin sex will do . Oral sex is included .
Q
: What are the health risks associated with syphilis ?
A
: You can pass it on to others , you can become unwell , it can give you rashes , bone problems , it can affect your heart and blood vessels , it can cause psychosis , blindness , deafness , and paralysis . It can affect every part of the body . Its manifestations are protean . As Sir William Osler said more than 100 years ago , “ The physician who knows syphilis knows medicine .”
Q
: Who are good candidates for testing ?
A
: Anybody who is having sex , especially with not known partners , and especially with someone who has a high risk background , such as Men who have Sex with Men ( MSM ), or comes from an area where syphilis is common .
Q
: Are antibiotics effective at curing most cases ?
A
: The right antibiotic is extremely effective at clearing and curing the infection . The challenge is the diagnosis . Unless you go for testing , the infection may lie silent and undetected for years , spread to others , and do its worst .
Q
: Are people with other sexually transmitted diseases like HIV at a greater risk of having syphilis ? Why ?
A
: If a person has taken the risk to catch one infection , there is the risk of catching others . Today , with the popularity and high degree of effectiveness of PrEP ( Pre- Exposure Prophylaxis ) for HI� , protection against HI� acquisition is available , and there is the potential to revert to risky sexual practices .
Q
: What can people do to prevent syphilis ?
A
: Quality sex — have sex with someone you know , can trust , and have a relationship with . If that ’ s not possible , use a condom and always get a sexual partner ’ s name and phone number so you can let them know if a problem arises .
In some places , the use of DoxyPEP is being considered . Taking a short course of this antibiotic immediately after a sexual encounter can considerably reduce the risk of catching syphilis and chlamydia , but not gonorrhea . Use of DoxyPEP has resulted in a reduction of 50 percent of syphilis cases in some areas . However , the long-term consequences of the widespread use of the antibiotic remain controversial . DoxyPEP is particularly promoted in areas with inadequate sexual health care infrastructure and resources . However , it would be more appropriate to look after the sexual health resources and needs of the community .
Dr Derek Freedman
Dr Derek Freedman is a sexually transmitted disease consultant who runs a private practise in Dublin , Ireland .
GlobalHealthAsiaPacific . com ISSUE 1 | 2024
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