What are the Treatment Options for Syphilis?

What is syphilis?

Syphilis is a very dangerous disease if not diagnosed early and treated with proper medication. Worse, it may even lead to death. Syphilis is caused by the bacterium Treponema pallidum and has four stages in its pathogenesis. It is one of those diseases which does not have typical symptoms. Sometimes symptoms are even absent and, therefore, this disease can remain undiagnosed until it progresses to the last stage which is quite difficult to treat. Sometimes syphilis is called ‘the great imitator’ due to the similarity of its symptoms to other common diseases.

Pathogenesis of syphilis (4 Stages)

Primary stage: There are single or multiple painless and round chancre (ulcerations) in this stage. These chancres are often difficult to locate or are located in awkward locations (e.g. vagina or anus). The major problem here is that they heal on their own within a few weeks. Also at this stage, transmission of bacteria can take place by vaginal or anal sex.

Secondary stage: In this stage, there are multiple skin lesions often hideous in appearance. There are many round shaped ulcerations in the mouth, vagina, and rectum. These secondary rashes can appear when the primary rashes are healing, or after they have healed completely. The main feature of this stage is appearance of red or reddish-brown, rough, and round spots in palms and soles of both extremities. Sometimes rashes are not evident to be noticed and in some cases, they are big and raised (condyloma lata), often occurring in moist places of the body.

Latent stage: In this stage, the bacteria goes into dormancy and there are no symptoms. This stage continues for a few years, and a person feels no difference while being in this stage of syphilis.

Tertiary stage: This stage can appear after 10-20 years of acquiring infection. This bacterium often damages brain, nerves, heart, blood vessels, liver, bones and joints. The characteristics of this stage are dementia, deafness, gradual blindness, and paralysis.

Diagnosis

The most common method of diagnosis is taking exudate from lesion and examining it under dark field microscopy to detect T. pallidum. A PCR test can also be done in the earliest stages of syphilis especially when the testing is done on risk groups. The PCR (Polymerase Chain Reaction) is the DNA amplification test which detects the DNA of T. pallidum at very early stage.

When the test for syphilis has to be done as a presumption, two test have to be done: a nontreponemal test and a treponemal test. People with positive nontreponemal test should always go for treponemal test before reaching any conclusion. One should never rely on one type of serological reaction because some tests may give positive reaction in some medical conditions which are unrelated to syphilis.

Treatment

There are no over-the-counter (OTC) drugs or home remedies that can cure syphilis, but it is easy to cure if detected and diagnosed correctly in the early stages. There is no surgical treatment method for syphilis.

The most effective treatment method for syphilis is the use of medication (antibiotics). Penicillin is mostly preferred in all stages of syphilis but dosage, preparation, and the course of treatment depends on the type of rashes and stage of syphilis. Penicillin inhibits the last step of cell wall synthesis; therefore, it is most effective when the bacteria is actively dividing such as during the primary and secondary stages. In the latent period, a longer duration of medication is required since the bacterium is in a dormant stage (it is either dividing very slowly or not dividing at all). It is vital for the doctor to select the appropriate penicillin dosage because T. pallidum could be hiding in other sites such as the central nervous system and aqueous humor - the watery fluid present in the eye.

Practitioners and patients should be aware of the fact that combinations of benzathine penicillin, procaine penicillin, and oral penicillin are not appropriate for the treatment. The similar sounding names cause confusion and often see doctors and pharmacists recommending the wrong combination therapy for treating syphilis.

During pregnancy, penicillin is the only antibiotic which is effective to treat all stages of syphilis. Therefore, if the pregnant woman has an allergy to penicillin, the woman should be de-sensitized and then given penicillin.

Patients should be told about the most common adverse effect that is Jarisch-Hexheimer reaction that develops in the first 24 hours. It is an acute febrile reaction frequently accompanied by headache, acute muscle pain, fever, and other symptoms manifested by the patient. This occurs most frequently among persons who have early syphilis, presumably because the infection load is higher during these stages. Antipyretics should be used to control the symptoms, but they have not been able to prevent this reaction. There is a possibility that the Jarisch-Herxheimer reaction could induce early labour or cause fetal distress in pregnant women, but this should not stop or delay the needed treatment.

During the treatment, the patient will be advised to avoid sexual contact until all the lesions on the body are healed and the doctor says it’s safe to resume sex. If the patient is sexually active, the partner should be treated as well. One should not resume sexual activity until both of the treatments are complete. All kinds of sexual activity or close sexual contact with another person should be avoided until at least two weeks after the treatment finishes. This includes vaginal, anal, and oral sex, as well as close skin contact.

If the patient has any sexual contact during treatment, they could become infected again or could pass the infection on to someone else. All current and previous sexual partners should be tested and treated for syphilis too because leaving the infection untreated can lead to serious problems. How far back one needs to go depends on how long the patient has had syphilis before it was diagnosed and treated. After treatment, the patient will require follow-up blood tests at regular intervals for at least one year.

Syphilis is a disease that is becoming more common by the passing hour, and proper care and conversations surrounding this deadly disease is very important.