Syphilis is a bacterial infection and common sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. Oral sex, vaginal sex, anal sex with an infected person, from pregnant mothers to infants are common causes of the spreading of this contagious disease.
Darkfield Micrograph image shows the worm-like spiral body structure of Treponema pallidum bacteria causing Syphilis.
Depending on the exposure to infection period and the severity, Syphilis can be broadly categorized into four stages:
1. Primary Stage or Early Stage
In this initial stage, usually between 3-4 weeks after exposure with the infection, early symptoms that appear are painless chancre (sore) lesions at the inoculation site. Common sites include hands, tongue, inner cheek and lips, penis, labia, and anus. In some cases, these visible symptoms may disappear in 2-3 weeks even without treatment. There have been many instances of asymptomatic cases.
2. Secondary Stage
This stage usually appears after 4-8 weeks of the primary stage where flu, large and prominent lesions, rashes, pink/brown macules on body parts, mucous patches, symptomatic early neurosyphilis, and aseptic meningitis are commonly noticed. In some cases, internal organ manifestation is also seen which includes acute hepatitis and nephrotic syndrome.
1. Latent Stage
The latent syphilis stage is considered as an asymptomatic condition and it is observed after the primary and secondary syphilis stages have been passed.
Latent stage can be further subdivided into two subcategories:
a. Early Latent Stage
The timing of this stage is near about one year from the exposure day. This can be confirmed by the patient’s past medical history and through the medical tests.
b. Late Latent Stage
Patients in this stage are detected positive for serology.
2. Late or Tertiary Stage
In this fourth stage, serious symptoms are visible after 1-10 years of exposure to syphilis. Late neurosyphilis (brain and spinal cord disorders) including tabes dorsalis, gait impairments, and dementia are critical symptoms along with Gumma or ulcerating granulomas on skin, bones and internal organs, cardiovascular effects like aortic aneurysm and coronary arteritis.
RAPID SYPHILIS TEST
Rapid syphilis test helps in screening and diagnosis of contagious and serious syphilis disease.
Two types of rapid syphilis tests are available:
1) Nontreponemal tests and
2) Treponemal tests
Nontreponemal tests (e.g., VDRL and RPR) are screening blood tests conducted at the initial level and they are easy, affordable, and commonly used.
Treponemal tests (e.g., FTA-ABS, TP-PA, various EIAs, chemiluminescence immunoassays, immunoblots, and rapid treponemal assays) are confirmatory tests done after Nontreponemal tests show syphilis positive results.
This confirmation sequence of syphilis testing (nontreponemal test, then the treponemal test) is termed as the “classical” testing algorithm.
If a screening treponemal test shows positive results, a nontreponemal test must be done to confirm the diagnosis. This sequence of testing (treponemal, then nontreponemal, test) is considered the “reverse” sequence testing algorithm.
Widely accepted rapid syphilis tests are:
● Rapid Plasma Reagin (RPR) Test
● Venereal Disease Research Laboratory (VDRL) Test
● Fluorescent Treponemal Antibody Absorption (FTA-ABS) Test
● Agglutination Assay (TPPA)
● Darkfield Microscopy Visualization Test
Rapid plasma reagin (RPR) test is a syphilis blood test that detects antibodies to the syphilis bacteria. Antibodies are proteins made by the immune system to fight foreign substances, such as bacteria.
Venereal disease research laboratory (VDRL) test checks for syphilis antibodies. A VDRL test is done on blood or spinal fluid.
In Darkfield Microscopy method Treponema pallidum bacterium is visualized under the microscope.
RPR and VDRL tests are screening tests. After the screening test shows positive results then further tests are done to double-check the diagnosis of syphilis. These follow up tests are conducted to detect syphilis antibodies and/or actual syphilis bacteria.
The direct fluorescent antibody test for T pallidum is easier to perform than dark-field microscopy. It detects antigen and, thus, does not require the presence of motile treponemes. It is the widely acknowledged syphilis diagnosis test when lesions are visible.
How is a syphilis test done?
A syphilis test is generally done by taking blood samples. Only a few minutes are required to perform rapid syphilis tests. A swab can be taken if there is a sore or ulcer present in visible areas.
In cases of advanced/late stages, a syphilis test is done on cerebrospinal fluid (CSF) taken from the spinal cord through lumbar puncture procedure or spinal tap. This test might require one full day time including the suggested bed rest immediately after the procedure.
There are many syphilis test kits available in the market which are helpful in performing rapid syphilis tests at home. However, it is always advisable to consult a professionally qualified doctor or clinic for proper syphilis tests and treatment.
WHEN TO HAVE SYPHILIS TEST?
Risk of having syphilis increases when someone has:
● Multiple sex partners
● A partner who further has multiple sex partners
● Exposure to unprotected sex
● Exposure to HIV/AIDS infection
● Other sexually transmitted diseases (STD) like GONORRHEA
● During pregnancy
It is advisable for pregnant women to get a syphilis test done during the early stages of pregnancy and before delivery as it may cause serious and deadly complications. This transmission of syphilis disease or infection from mother to infant during pregnancy is termed as Congenital Syphilis.
Early-stage syphilis is treated by various doses of antibiotics like penicillin. A complete cure is possible for early-stage syphilis infections.
For Late-stage syphilis treatment, antibiotics are used to stop the disease from getting worse however, complete cure and full recovery remain doubtful.
As per CDC Factsheet, a combination of penicillin preparation is vital for proper treatment and cure of syphilis. Combinations of some penicillin preparations (e.g., Bicillin C-R, a combination of benzathine penicillin and procaine penicillin) are not appropriate replacements for benzathine penicillin.
Sexual contact must be avoided by persons who have symptoms and/or are undergoing syphilis test or syphilis treatment.
After syphilis treatment, chances of its reoccurrence are minimal. Hidden chancres in the vagina, rectum or mouth can lead to syphilis infection again to self and to the sex partner, both. One must adhere to the guidelines and precautions as suggested by the practicing doctor.
How to prevent Syphilis?
Usage of good quality and medically approved latex condoms help in reducing the risk of syphilis in case of exposure.
The best way to avoid syphilis infection is to maintain distance and not to have sexual contact with a suffering person and to follow monogamy i.e. having sexual relationships with only one partner only throughout life.
Timely conducted syphilis tests from an authorized syphilis test clinic can help in stopping transmission of syphilis infection from one person to another.
Disclaimer: This article has been written with the utmost care and as per the latest information available on various authorized forums as on date.