1. Syphilis “The Great Pretender”
By: Bruce Martin

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

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

4. 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

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

6. 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

11. 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.

13. 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

16. 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

17. 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”

20. 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

21. 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

22. 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

23. 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
syphilis rates began to increase
Increase primarily in males, suggesting MSM

26. 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

27. 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

28. Resources
Centers for Disease Control and Prevention STD Prevention 27 Nov <
Hook III, Edward W. and Peeling, Rosanna W. “Syphilis Control – A Continuing Challenge.” The New England Journal of Medicine 351(2004): Nov 2004 <
The Prokaryotes Ed. Martin Dworkin. 17 Mar Dec <
Centers for Disease Control and Prevention Syphilis Elimination Communication Plan 5 Dec <
World Health Organization Global Prevelance and Incidence of Selected Curable Sexually Transmitted Infections Overview and Estimates 10 Dec <
Fears, Martha B. and Pope, Victoria “Syphilis Fast Latex Agglutination Test, a Rapid Confirmatory Test” Clinical and Diagnostic Laboratory Immunology 8.4(2001) Dec <