Transcript Syphilis “The Great Pretender”

Syphilis
“The Great Pretender”
By: Bruce Martin
Taxonomy
Domain: Bacteria
Phylum: Spirochaetes
Order: Spirochetales
Family: Spirochaetaceae
Genus: Treponema
Species: pallidum
Characteristics
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Helical, tightly coiled, mobile
5-20 um in length, 0.1-0.4 um in diameter
Pathogenic treponemes associated with 4
diseases
Venereal syphilis (pallidum)
 Yaws (perfenue)
 Endemic (endemicum)
 Pinta (carateum)
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Obligate parasites of humans
Method of infection
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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
Symptoms
*some have no symptoms for years
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3 stages
Primary
 Secondary
 Late or latent
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Congenital (passed from a mother to her unborn
child)
Primary stage
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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
Secondary Stage
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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.
Late stage (hidden stage)
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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
Congenital syphilis and hiv
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Congenital
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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
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Genital sores make it easier to transmit and acquire HIV
Diagnosis
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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”
Treatment
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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
Spread
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Ways you can 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
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Ways you cannot get syphilis
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Toilet seats, door knobs, swimming pools, hot tubes,
bathtubs, shared clothing, or eating utensils
Prevention
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Ways you can prevent syphilis
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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
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*Even a cured person can be re-infected
Epidemiology
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Worldwide
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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
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During the 90’s rates steadily decreased
2001-2002 syphilis rates began to increase
Increase primarily in males, suggesting MSM
Latest research and preventative
measures
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Prevention
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1999 National plan to eliminate syphilis
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Expanded surveillance and outbreak response activities
Rapid screening
Expanded laboratory services
Strengthen community involvement
Enhance health promotion
Their target audience
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National, state, and local legislators
State and local Health Officers
Policy “influencers” at national, state, and local levels
Latest research and preventative
measures
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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
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Resources
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Centers for Disease Control and Prevention STD Prevention 27 Nov. 2004
<http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm
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Hook III, Edward W. and Peeling, Rosanna W. “Syphilis Control – A Continuing Challenge.” The New
England Journal of Medicine 351(2004): 122-124 29 Nov 2004
<http://content.nejm.org/cgi/content/full/351/2/122?ijkey=Hc7QnNAa2ExyU&Keytype=ref&siteid=nejm
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The Prokaryotes Ed. Martin Dworkin. 17 Mar. 2004. 2 Dec. 2004.
<http://141.150.157.117:8080/prokPub/index.htm
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Centers for Disease Control and Prevention Syphilis Elimination Communication Plan 5 Dec. 2004
<http://www.cdc.gov/stopsyphilis/CommPlan.htm
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World Health Organization Global Prevelance and Incidence of Selected Curable Sexually Transmitted
Infections Overview and Estimates 10 Dec. 2004
<http://www.who.int/hiv/pub/sti/en/who_hiv_aids_2001.02.pdf
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Fears, Martha B. and Pope, Victoria “Syphilis Fast Latex Agglutination Test, a Rapid Confirmatory Test”
Clinical and Diagnostic Laboratory Immunology 8.4(2001) 841-842 10 Dec. 2004
<http://cdli.asm.org/cgi/content/abstract/8/4/841?maxtoshow=&HITS=10&hits=10&RESULTFORMAT
=&titleabstract=syphilis&searchid=1102524542545_3690&stored_search=&FIRSTINDEX=0&search_url=ht
tp%3A%2F%2Fjournals.asm.org%2Fcgi%2Fsearch