What is syphilis?

Definition and history of syphilis

Syphilis is a sexually transmitted infection (STI) caused by the spirochete bacterium Treponema pallidum. This disease has been known to humanity for centuries, and its history dates back to the 15th century, when it was first documented in Europe. Syphilis spread in epidemic waves, especially following European and American contacts, and has been a significant public health challenge throughout various historical periods. The diverse symptoms of syphilis, which depend on the stage of the disease, can create difficulties in diagnosis and treatment. Today, thanks to antibacterial therapy, syphilis is treatable, but it still requires timely diagnosis and treatment to prevent complications and halt its spread.

Epidemiological perspective on syphilis

Although syphilis has been known for centuries, its prevalence today continues to cause concern, especially in developing countries where access to healthcare and preventive services may be limited. This infection is found worldwide, and its prevalence can vary significantly depending on regional and demographic conditions. In recent years, an increase in syphilis cases has been observed, linked to reduced awareness of prevention and risk. According to World Health Organization data, syphilis remains a global public health problem. In the European Union, periodic syphilis outbreaks are observed, associated with changes in sexual behavior and non-compliance with preventive measures. In the USA, an increase in syphilis cases has been observed over the past decade, indicating the need for strengthened prevention programs and educational campaigns. In Latvia, a slight increase in syphilis cases has been observed, suggesting the need for enhanced public education and early diagnosis.

Prevalence and causes of syphilis

Mechanism of infection and risk factors

Syphilis is primarily transmitted through direct contact with infectious ulcers during sexual intercourse, but it can also be transmitted from mother to child during pregnancy, causing congenital syphilis. The bacterium Treponema pallidum enters the body through micro-injuries in the skin or mucous membranes. Several risk factors increase the likelihood of syphilis transmission, including multiple sexual partners, unprotected sexual intercourse, and the presence of other sexually transmitted infections, which can increase susceptibility to syphilis. Additionally, social and economic factors, such as access to healthcare and education, also affect the spread of infection.

Epidemiological data

Epidemiological data indicates that syphilis is a widely prevalent infection in various regions of the world. For example, in Africa and Southeast Asia, syphilis prevalence remains high, which is associated with limited access to healthcare and preventive measures. In Europe and North America, syphilis outbreaks are observed, linked to changes in sexual behavior among specific populations. These outbreaks highlight the need for ongoing public education, prevention programs, and access to diagnostic and treatment services. In Latvia, according to data from the Centre for Disease Prevention and Control, a slight increase in syphilis cases has been observed, suggesting the need for enhanced public education and early diagnosis.

Symptoms and stages of syphilis

Primary and secondary stages

Syphilis develops in several stages, each characterized by distinct symptoms. The primary stage usually begins with one or more sores, called chancres, that appear at the site of infection, such as the genitals, rectum, or oral mucosa. This chancre is usually painless and may go unnoticed, especially if it is located in a hidden area. If not detected and treated, syphilis progresses to the secondary stage, which manifests with various symptoms, such as the appearance of patchy rashes on the body that are often painless and may appear even on the palms and soles. This stage may also include flu-like symptoms, such as fever, fatigue, headaches, and enlarged lymph nodes.

Latent and tertiary stages

After the secondary stage, syphilis can enter a latent period in which symptoms disappear but the infection continues in the body. Latent syphilis can last for several years and is divided into early and late latent phases. In the early latent stage, the individual may still be infectious, while in the late latent stage, the risk of transmission significantly decreases. If syphilis is not treated, it can progress to the tertiary stage, which can occur several years after the initial infection. Tertiary syphilis can cause serious and life-threatening complications, affecting the heart, blood vessels, brain, and nervous system. Complications include neurological disorders, cardiovascular diseases, and other systemic problems.

Diagnostics

Laboratory examination methods

Syphilis diagnosis is based on laboratory tests that include both direct and indirect methods. Direct diagnostic methods include dark-field microscopy, which allows visualization of Treponema pallidum bacteria from ulcer discharge; however, this method has limited availability and is rarely used. Indirect methods, which are more commonly used, include serological tests that detect antibodies against the syphilis-causing agent. These tests are divided into non-specific and specific tests. Non-specific tests, such as RPR (rapid plasma reagin) and VDRL (Venereal Disease Research Laboratory), are screening tests that detect reagin antibodies and are suitable for assessing infection activity. Positive screening tests must be confirmed with specific tests such as FTA-ABS (fluorescent treponemal antibody absorption) or TPPA (Treponema pallidum particle agglutination), which detect specific antibodies against Treponema pallidum. The concordance of both tests is essential for accurate diagnosis and effective treatment planning.

Latest diagnostic technologies

Recently, new diagnostic methods have been developed that improve early detection and accuracy of syphilis diagnosis. Polymerase chain reaction (PCR) is one such method that allows direct detection of Treponema pallidum DNA from clinical specimens, providing high sensitivity and specificity, especially in the early stage. This method is valuable, particularly in cases where serological tests are inconclusive or when differential diagnosis with other infections is required.

Treatment and prevention

Prevention measures and education

Prevention is essential in limiting the spread of syphilis. Education about sexually transmitted infections and promoting safe sexual practices are key elements of prevention strategy that reduce the risk of infection. Proper condom use significantly reduces the risk of infection transmission, although it does not completely eliminate it, as syphilis can also be transmitted through contact with infected areas not covered by the condom. Regular diagnostic testing in high-risk populations and early treatment of infected individuals are essential for reducing infection transmission. Furthermore, screening of pregnant women and, if necessary, timely treatment are critically important to prevent congenital syphilis. The availability of healthcare services and public awareness about syphilis are important factors in maintaining public health.

Vaccination and new prevention strategies

Currently, there is no vaccine available against syphilis; however, research in this area continues, and there is hope for the development of new preventive technologies. Immunoprophylaxis could become an important additional tool in limiting the spread of syphilis in the future. In addition to educational campaigns, the latest prevention strategies may also include the use of interactive public health platforms and mobile apps to promote awareness and responsible sexual behavior.

Complications of syphilis

Impact on health and potential consequences

Untreated syphilis can cause serious health complications affecting multiple organ systems. In the tertiary stage of syphilis, the infection can lead to the formation of gummas — destructive lesions in soft tissues and bones that can result in serious structural damage to the body. Cardiovascular syphilis can affect the aorta, causing aortitis, aneurysms, or heart valve damage, which can be life-threatening. Neurosyphilis, which can develop at any stage of syphilis, affects the central nervous system, causing neurological symptoms such as meningitis, tabes dorsalis, or dementia. Congenital syphilis, when the infection is transmitted from mother to child, can cause fetal death, premature birth, or severe neonatal damage affecting the child's subsequent development. The possibility of these complications underscores the need for early diagnosis and effective treatment.

Long-term impact on society

The prevalence of syphilis can significantly impact public health and the economy. Untreated infections can create long-term health problems that increase healthcare costs and reduce work capacity. Public education and prevention programs can help reduce this burden by ensuring early diagnosis and effective treatment.

Conclusions