Summary

Syphilis is a bacterial infection usually transmitted by sexual contact caused by the bacteria Treponema pallidum. This infection may not show symptoms initially but can lead to serious health problems if left untreated, including complications in the heart and brain.

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Introduction

According to one of the most popular hypotheses, syphilis was first recorded in Europe in the late 15th century, following the Columbian exchange. Its origin, however, remains disputed, with theories suggesting that it might have existed in various forms around the world.^[1]

The disease is typically contracted through direct contact with a syphilis sore during sexual activities, but it can also be passed from mother to fetus during pregnancy, known as congenital syphilis. The infection is categorized into stages: primary, secondary, latent, and tertiary, each with different symptoms. 

During the primary stage, a person may develop a single sore (or multiple sores) where the bacteria enter their body. In the secondary stage, symptoms can include skin rash and mucous membrane lesions. The latent stage may show no symptoms, but the bacteria remain in the body. Tertiary syphilis, the most severe stage, can damage multiple organ systems and can occur decades after the initial infection.^[2]

Syphilis can often be challenging to diagnose because of its ability to present symptoms similar to other diseases - it is also called “the Great Mimicker or Imitator”. However, the disease is detectable through blood tests.^[3]

Though potentially severe and even deadly if left untreated, syphilis is curable with the appropriate antibiotics, particularly in the early stages. Since the bacteria can lie dormant in the body for years, regular sexual health checks are vital for early detection and treatment. Prevention methods include practicing safe sex and regular testing. A person can fully recover from the infection if diagnosed and treated early.^[2,3]

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Possible Test Results 

Blood testing for syphilis generally involves two types of tests: a non-treponemal test for screening followed by a treponemal test for confirmation. The incubation period usually takes between 9-90 days from exposure.^[4]

Non-Treponemal tests detect antibodies produced in response to the cellular damage caused by the syphilis infection rather than to the bacteria itself. These are typically the first tests performed when syphilis is suspected. Two commonly used non-treponemal tests are the Rapid Plasma Reagin (RPR) test and the Venereal Disease Research Laboratory (VDRL) test. However, the test can result in false positives as these antibodies can also be produced in response to other conditions.

If the non-treponemal test is positive, a treponemal test is typically done to confirm the diagnosis of syphilis. Treponemal tests detect antibodies that are specific to the T. pallidum. Examples of treponemal tests include the fluorescent treponemal antibody absorption (FTA-ABS) test and the Treponema pallidum particle agglutination assay (TPPA).^[5,6]  

There are two possible states of your blood test result: positive or negative

• Your syphilis test is positive, indicating a potential infection. Contact your healthcare provider promptly for further evaluation and treatment planning. If your results are positive, contact your current and former sexual partners immediately to prevent further spread of the disease.
• Your syphilis test result is negative, implying no detected infection. Continue protecting yourself through safe sexual practices and regular testing.

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Treatment Options

The preferred treatment for syphilis, at any stage, is antibiotics, specifically Penicillin G, administered via injection. The type of treatment and the dosage depends on the stage of the disease^[4,6-8]:

• Primary, secondary, or early latent syphilis: 

A single intramuscular injection of Benzathine penicillin G is usually sufficient to eliminate the infection.

• Late latent syphilis or latent syphilis: 

Three doses of intramuscular Benzathine penicillin G, each given one week apart, are typically used.

• Neurosyphilis, ocular syphilis, and congenital syphilis: 

These require more intensive treatment, often with intravenous Penicillin G, typically for 10 to 14 days.

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The Science Behind

Below, you can dive into more detailed information about Syphilis. Find out how the molecular mechanisms behind the disease work.

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Molecular Mechanisms

The initial step in the infection process is adhesion, where T. pallidum binds to host cells. The bacteria possess multiple adhesins on its surface, enabling it to attach and penetrate the host tissues. Once attached, the bacteria can invade tissue barriers such as the epithelial lining, allowing it to disseminate throughout the body.

The bacteria have evolved many tactics to evade the host's immune response. One such tactic is its unusually low number of surface proteins, which reduces the bacteria's visibility to the immune system. T. pallidum can slow its metabolic rate and enter a dormant state. This allows it to endure when it lacks nutrients or when the host's immune system tries to fight it off, leading to latent syphilis that can last for years or even decades.

T. pallidum's components, when recognized by the immune system, can provoke an inflammatory response. This immune reaction leads to the formation of the characteristic syphilis sores and, if the infection remains untreated, can escalate to severe health problems, including neurosyphilis and cardiovascular syphilis.^[3,9,10]‍

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Recommendations

Syphilis is a serious condition that, if left untreated, can lead to severe health complications. 

• Practicing safe sex reduces the risk of getting or spreading syphilis. 
• Regular testing is also crucial, especially for those with multiple sexual partners or in a relationship with someone who has tested positive for syphilis. 

If the test result is positive.

• Seek treatment immediately. The preferred treatment for syphilis is antibiotics, typically Penicillin G.
• Inform all recent sexual partners about the diagnosis so they can be tested and treated if necessary.
• Avoid sexual activity until the treatment is completed and the healthcare provider confirms that the infection has been cured.
• Regular follow-up tests are necessary to ensure the infection has been cleared.
• People diagnosed with syphilis should also be tested for other sexually transmitted infections, including HIV, as the risk factors are similar.

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The information and tests provided on our website are for educational purposes only and are not a substitute for professional medical advice. Always consult with your healthcare provider before making health decisions. Our tests do not diagnose or treat diseases. Individual results may vary and should be discussed with a healthcare provider.