Biology

Sexually transmitted diseases (sometimes referred to as sexually transmitted infections, STIs) are a group of infections that are transmitted mainly by sexual contact. The American Centre for Disease Control and prevention (CDC) estimates that over 15 million cases of sexually transmitted infections are reported annually (Center for Disease Control and Prevention).

Not less than twenty five (25) diseases fall in this category of sexually transmitted infections, the most common being HIVAIDS, accounting for the highest rates of morbidity and mortality. Other STDs in the United States are syphilis, gonorrhea, Chlamydia, genital herpes, human papilloma virus, hepatitis B, bacterial vaginosis and trichomonias (Workowski, and Levine). Several epidemiological studies show that adolescents and young adults are at the greatest risk of contracting an STD.
This paper will focus its discussion on syphilis with emphasis on clinical manifestation and management.

Signs and symptoms
Syphilis is caused by Treponema pallidum, a bacterium that is transmitted through contact with syphilis sores or wounds found mainly on the vagina, anus, external genitals or rectum (MedlinePlus). This means that untreated syphilis in expectant women can result in congenital syphilis thereby posing the risk of death to the unborn child (Workowski, and Berman). First signs and symptoms of syphilis infection are preceded by an incubation period of between 9 to 90 days after which stage-specific symptoms become manifested (Center for Disease Control and Prevention).

Primary stage syphilis symptoms are characterized by the development of a sore on the part that has been exposed to the infection, most commonly the genitals, rectum or mouth. Sometimes swelling of the groin may occur (MedlinePlus). These primary symptoms do not usually result in an illness and the sore might even heal after a few weeks without necessary seeking for medical attention (MedlinePlus). This phenomenon is however detrimental since the disease actually continues to spread in the body.

Secondary stage symptoms of syphilis occur several weeks after the primary episodes of sore formation and healing (Workowski, and Levine). The infected individual may start to exhibit symptoms of illness like periodic headaches, general body pains, loss of appetite and sometimes may develop fever. Loss of hair, swelling of the lymph nodes and sores in the nose, mouth, throat and genitals become more pronounced (Workowski, and Levine). When treatment is not instituted at this stage, then symptoms disappear in three to nine months post-infection although the body is still infected.

Latent stage syphilis occurs after the secondary syphilis symptoms, and symptoms that are characteristics of this stage have been shown to last from several weeks to fifty (50) years. Infected individuals at this stage now cease to infect others, although expectant women can still infect the unborn baby (Workowski, and Levine).

Tertiary syphilis is the final stage of syphilis. Nearly one third of untreated individuals will exhibit tertiary syphilis symptoms, which include chronic skin ulcers, fever, liver disease, bone pain and anemia (Workowski, and Levine). It is also at this stage that the disease can affect the central nervous system (neurosyphilis) resulting in altered mental functioning. Similarly, the aorta can also be affected and this results in heart disease.

Diagnosis
Syphilis bacterium can be detected from infectious sores by the use of a microscope and serological tests (Workowski, and Levine). Serological tests employ the principle that antibodies specific to the syphilis bacterium are produced by the body during an infection. These antibodies are the ones that are detected with a blood test.

Two major serological tests for the diagnosis of syphilis are (a) The Rapid Plasma Reagin (RPR) test, which is used for screening and pathognostic purposes and (b) the Flourescent Treponemal Antibody-Absorption Double Staining -FTA-ABS (DS) test used principally for confirmation of past or current infections (Workowski, and Levine). Unlike microscopic examination for the syphilis bacterium, serological tests such as those mentioned above provide only indirect detection of syphilis and may therefore result in false positive results (Workowski, and Levine). This means that caution and care must be taken in clinical interpretation of test results in order to achieve proper diagnosis.
Several disease states and chemical agents have been shown to cause false positive reactions in serological tests of syphilis. Such diseases are febrile illnesses and they include atypical pneumonia, chicken pox, filariasis, hyperproteinemia, infectious hypertitis, malaria, measles, tuberculosis and vaccinia (Workowski, and Levine). Other factors like pregnancy, immunization and aging have also been positively associated with false positive serological tests.

Treatment and Management
Since syphilis is largely a sexually transmitted disease, safe and responsible sex remains the only safest way of management by way of preventing transmission (MedlinePlus). Protection in form of condom use greatly reduces the chances of contracting syphilis. Condom use does not however entirely eliminate the risk of contracting the disease.

Syphilis is a curable disease. Over time, penicillin has established itself as the gold standard antibiotic for treatment of the disease (Workowski, and Levine). A single dose of penicillin cures an infected individual for less than one year, although more doses might be needed for an individual who has been infected for a period of more than one year. Infants who contract the disease form their mothers are also given daily penicillin treatment for ten days (Workowski, and Levine). Concern is however arising due to the high rates of antibiotic strains of the syphilis bacterium and this call for concerted efforts in design and development of newer drugs to fight the disease.

Neurosyphilis
As mentioned earlier, neurosyphilis affects the nervous system (Sparling, and Peeling 67). This infection can either be asymptomatic or symptomatic. Much complexity and controversy surrounds diagnosis of this type of syphilis and so far no consensus about the best method of diagnosis has been reached. However, penicillin regimens have been shown to be effective in management of neurosyphilis (Sparling, and Peeling 71). The American Centre for Disease Control and Prevention (CDC) recommends the short acting IV benzyl penicillin levels in the Cerebral Spinal Fluid (CSF) (Center for Disease Control and Prevetion). Several derivatives of penicillin are used in treatment of the disease. Such combinational therapies include Procain benzyl penicillin (PBP) plus probenecin, a first line treatment in the United Kingdom.

Unlike CDC, United Kingdom and most European countries recommend the use of steroids in treating patients with neurosyphilis exhibiting psychotic symptoms or cerebral gummata (Center for Disease Control and Prevention). The reason for the preferred used of steroids is that they (steroids) are believed to prevent the Jarisch- Herxheimer reaction, an immune- mediated reaction that occurs as a result of release of bacterial toxin in the body.

Conclusion
Syphilis is an easily treatable disease when detected early but can be detrimental if symptoms are ignored. Management of some forms of syphilis like neurosyphilis is somewhat complex although combinational therapies in use have been shown to be effective in treatment. Safe sex, however, remains the most successful way used in syphilis management.