How is syphilis transmitted? What are the dangers?

Author: Wu Hao, Chief Physician, Beijing You'an Hospital, Capital Medical University

Standing Committee Member of the Infection and Immunity Branch of the Chinese Medical Association

Reviewer: Chen Yong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Syphilis is extremely good at imitating and hiding, often showing itself in the form of different symptoms and diseases, making people ignore its true appearance. At the same time, it is also quietly spreading itself. With its superb acting skills, it is called the "universal imitator."

For example, some people suddenly couldn't read the script during a lecture and suffered aphasia. After repeated examinations, it was found that they had syphilis. Some people suddenly felt lightning-like pain in their lower limbs. After many aspects of the nervous system examinations, it was finally discovered that they had syphilis.

Let us get to know this “universal imitator” - syphilis.

1. What is syphilis? How is it transmitted?

Syphilis is caused by infection with Treponema pallidum and is a sexually transmitted disease that is mainly transmitted through sex and mother-to-child transmission.

Figure 1 Original copyright image, no permission to reprint

Syphilis is divided into three stages: primary syphilis, with symptoms of chancre; secondary syphilis, with syphilitic rash on the skin and mucous membranes; and tertiary syphilis, with possible damage to internal organs.

Figure 2 Original copyright image, no permission to reprint

Many patients do not know that they have engaged in so-called high-risk behaviors and have had sexual intercourse with patients with contagious syphilis, which has led to infection.

Now, before doctors do any invasive operation, such as gastrointestinal endoscopy, they must screen for infectious diseases, including hepatitis B, hepatitis C, syphilis, and AIDS. These four items are routine screening. Often, during the screening process, patients discover that they are infected with syphilis.

If you are infected with syphilis during pregnancy, you may pass it on to your child, and the child may be born with syphilis. This is mother-to-child transmission.

Can syphilis be transmitted through blood? Syphilis is mainly transmitted through sexual intercourse, and it is very rare for it to be transmitted through blood products. Under current blood bank storage conditions, it is difficult for Treponema pallidum to survive for more than 48 hours, so syphilis infection through blood transfusion has not been seen clinically.

2. What are the dangers of syphilis? Can it lead to death?

Syphilis is a sexually transmitted disease that increases the patient's concerns and psychological burden.

If syphilis infection is discovered late, diffuse macules will appear on the skin, which will cause trouble to the patient.

Late-stage syphilis can damage the cardiovascular system. Long-term infection can lead to inflammatory lesions in the small blood vessels that nourish the blood vessels, and the blood vessel walls can become more brittle and loose. For example, ascending aortitis or the tissue at the root of the aorta can become particularly loose, which is called syphilitic heart disease.

Syphilis can also cause damage to bones and nerves, leading to syphilitic bone disease, neurosyphilis, etc. It can also invade cranial nerves, leading to hearing loss or loss, visual impairment, sensory impairment, etc.

Female syphilis patients are prone to miscarriage after pregnancy, or they may be infected with syphilis during pregnancy, leading to miscarriage; after syphilis is transmitted to the child, the child will be born with syphilis, and the entire appearance and internal organ function may be affected, such as the appearance of Harrington's teeth, saber-shaped tibia (tibial lordosis), hepatosplenomegaly and many other functional abnormalities.

So syphilis can manifest itself in a variety of forms.

Syphilis is not an acute fatal disease and will not directly lead to death, but it can cause serious dysfunction of important organs and affect the quality of life. As patients age and have underlying diseases, syphilis will make the situation worse.

If syphilis is not detected, or if it is not treated or controlled after being detected and allowed to develop over a long period of time, it will have a significant impact on health.

So, what tests can detect syphilis?

3. What tests are needed to diagnose syphilis?

The most important test is serological test, such as the rapid plasma reagin test, also called RPR, which is a preliminary screening test for syphilis, or the toluidine red unheated serological test (TRUST). If the preliminary screening is positive, further confirmatory tests will be performed.

Syphilis-specific tests include TPPA (Treponema pallidum particle agglutination test), TPHA (Treponema pallidum hemagglutination test), and FTA-ABS (fluorescent treponemal antibody adsorption test).

Nowadays, as long as syphilis is suspected, the patient will generally be asked to undergo both the initial screening test and the confirmatory test.

Figure 3 Original copyright image, no permission to reprint

To assess the patient's health, other tests are done, such as neurological examinations and cranial nerve function tests to see if the nerves are invaded; electrocardiograms and echocardiograms to see if there are any heart problems; X-rays to see if there are any bone abnormalities; and oral examinations to see if there are any dental abnormalities. Based on the patient's clinical manifestations, a comprehensive examination and assessment is performed accordingly.

After syphilis is diagnosed, active treatment is required. Treponema pallidum is very sensitive to penicillin, so penicillin treatment is the first choice. As long as the patient is not allergic to penicillin, penicillin injection treatment can be used.

Primary and secondary syphilis can be completely cured, and complete cure means that all clinical symptoms disappear. Syphilis patients who have undergone strict treatment will not develop into the third stage. If it has developed into the third stage, treatment can prevent the lesion from progressing and keep it at the current level.