Syphilis “The Great Pretender” By: Bruce Martin

Family: Spirochaetaceae Taxonomy Domain: Bacteria Phylum: Spirochaetes Order: Spirochetales Family: Spirochaetaceae Genus: Treponema Species: pallidum

Characteristics Helical, tightly coiled, mobile 5-20 um in length, 0.1-0.4 um in diameter Pathogenic treponemes associated with 4 diseases Venereal syphilis (pallidum) Yaws (perfenue) Endemic (endemicum) Pinta (carateum) Obligate parasites of humans

Method of infection Viable bacteria from a chancre enters through a fissure or mucus membrane Bacteria multiply locally and causes a painless chancre Spreads via blood stream or lymphatic system Can infect almost any organ or tissue Continuous in vitro culture has yet to be achieved

Symptoms *some have no symptoms for years 3 stages Primary Secondary Late or latent Congenital (passed from a mother to her unborn child)

Primary stage Appearance of a single sore or chancre (about 21 days after infection) Chancre lasts 3-6 weeks and heals w/o treatment If untreated, disease progresses to next stage

Secondary Stage Occurs as chancre is healing or a few weeks after Skin rash develops on one or more areas of body Rash can appear like rashes from other diseases (usually doesn’t cause itching) Other symptoms: fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, fatigue Without treatment disease progresses to late stage.

Late stage (hidden stage) Person continues to have syphilis even though there are no symptoms. Disease can damage eyes, brain, nervous system, heart, blood vessels, liver, bones, joints Signs include: difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, even death

Congenital syphilis and hiv Can infect fetus during pregnancy Can cause still born birth depending on how long mother is infected and when Infected babies can be born without immediate signs or symptoms Infected babies can become developmentally delayed have seizures and even die. HIV Genital sores make it easier to transmit and acquire HIV

Diagnosis Material from a chancre can be examined with a dark field microscope Blood test can be performed to check for presence of syphilis antibodies A low level of antibodies will stay in the blood for years even after treatment “Direct Fluorescent Antibody Test”

Treatment Easy to cure in early stages Injection of penicillin < 1year Additional doses >1year If allergic other antibiotics can be used No home remedies or over the counters Antibiotics will kill the bacteria but cannot repair damage done

Spread Ways you can get syphilis Ways you cannot get syphilis Direct contact with a syphilis sore via vaginal, oral or anal sex Sores occur on the genitals, anus, vagina, or rectum Sores can also occur on lips and mouth Ways you cannot get syphilis Toilet seats, door knobs, swimming pools, hot tubes, bathtubs, shared clothing, or eating utensils

Prevention Ways you can prevent syphilis Like any std: abstinence or mutually monogamous relationship Ways you cannot prevent syphilis Latex condoms (reduce transmission, but do not prevent) Washing genitals, urinating, or douching after sex *Even a cured person can be re-infected

Epidemiology Worldwide USA WHO estimates 12 million new cases per year 90% of those cases in developing countries In Russia and Eastern Europe, its contributing to hiv infections North America and Western Europe rates have shifted to MSM, and illicit drug users In Africa more females are infected than males USA During the 90’s rates steadily decreased 2001-2002 syphilis rates began to increase Increase primarily in males, suggesting MSM

Latest research and preventative measures Prevention 1999 National plan to eliminate syphilis Expanded surveillance and outbreak response activities Rapid screening Expanded laboratory services Strengthen community involvement Enhance health promotion Their target audience National, state, and local legislators State and local Health Officers Policy “influencers” at national, state, and local levels

Latest research and preventative measures Faster testing One study compared Syphilis Fast latex agglutination test to Treponema pallidum particle agglutination test 98.8% agreement between the two Syphilis Fast only takes 8 minutes vs 1-2 hrs Ideal for point of care situations, std clinics, and prenatal care clinics

Resources Centers for Disease Control and Prevention STD Prevention 27 Nov. 2004 <http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm Hook III, Edward W. and Peeling, Rosanna W. “Syphilis Control – A Continuing Challenge.” The New England Journal of Medicine 351(2004): 122-124 29 Nov 2004 <http://content.nejm.org/cgi/content/full/351/2/122?ijkey=Hc7QnNAa2ExyU&Keytype=ref&siteid=nejm The Prokaryotes Ed. Martin Dworkin. 17 Mar. 2004. 2 Dec. 2004. <http://141.150.157.117:8080/prokPub/index.htm Centers for Disease Control and Prevention Syphilis Elimination Communication Plan 5 Dec. 2004 <http://www.cdc.gov/stopsyphilis/CommPlan.htm World Health Organization Global Prevelance and Incidence of Selected Curable Sexually Transmitted Infections Overview and Estimates 10 Dec. 2004 <http://www.who.int/hiv/pub/sti/en/who_hiv_aids_2001.02.pdf Fears, Martha B. and Pope, Victoria “Syphilis Fast Latex Agglutination Test, a Rapid Confirmatory Test” Clinical and Diagnostic Laboratory Immunology 8.4(2001) 841-842 10 Dec. 2004 <http://cdli.asm.org/cgi/content/abstract/8/4/841?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&titleabstract=syphilis&searchid=1102524542545_3690&stored_search=&FIRSTINDEX=0&search_url=http%3A%2F%2Fjournals.asm.org%2Fcgi%2Fsearch