Qwhen we talk about sexually transmitted diseases (STD)one hardly thinks of syphilistoo often ed mistakenly considered a problem of the past. With 6.3 million cases a yearsyphilis represents instead the third infection sexually transmissible for worldwide distribution after chlamydia and gonorrhea.
Prevention and early diagnosis can make the difference: if intercepted in time, in fact, the disease is curable while, without treatment, the infection progresses through a number of stagesup to provoke in the most serious cases very serious consequences.
To turn the spotlight on this pathology, which still constitutes a serious public health problem, is Santagostino Monitoring – Health Observatory. Here’s everything you need to know.
What is syphilis
syphilis, caused by the bacterium Treponema pallidumcan be transmitted through any type of sexual intercourseincluding the oro-genitalie one, through the contact with infected blood or again be transmitted from mother to fetus during pregnancy, causing serious problems for the unborn child if not diagnosed and treated in time. For this in Italy, screening for syphilis in pregnancy is carried out.
How widespread is the disease
According to the annual report ECDC (European Center for Disease Prevention and Control)the syphilis affects 9 times more men than womenwith a peak in the age group between 25 and 34 yearsand in 74% of the cases it is men who have sex with other men (MSM). It is the same ECDC data that unequivocally clarify how syphilis is far from a problem of the past: in the 28 countries involved in the monitoring (Europe and the United States), in fact, i cases have steadily grown between 2010 and 2019except for a plateau in 2017 and 2018.
Syphilis: how it manifests itself
Syphilis is a complex disease that can evolve over a long period of time. In the adult, the pathology crosses indeed three different stages. In the so-called primary syphilisBetween 10 and 90 days from the infectionusually one appears skin lesion (syphiloma) at the initial site of contact, most commonly the genitals, anus, throat or mouth.
«Typically – explains Leva – it is a solid relief of the skin with sharp edges, which ulcerates in a short time e which does not cause any pain. Sometimes several lesions are present at the same time and there may be swelling of nearby lymph nodes. Healing occurs in 3-6 weeks. In some cases, however, syphilis can manifest itself in ways that are different from the typical ones and it can be difficult to recognize it».
Symptoms not always recognizable
«For example – continues the andrologist – a study recently conducted in Melbourne pointed out that it is much more difficult to identify the primary stage of syphilis when the lesions develop in the anal area than when they appear on the penis. This can lead to misdiagnosis and delay in treatment. It is important to be aware of this possibility and to consult a doctor if you have any concerns or suspicious symptoms. Timely diagnosis and early treatment are key to managing syphilis effectively and preventing long-term complications.”
6-8 weeks after the primary infection can instead, reddened lesions appear on the skin or mucous membraneswhich may be accompanied by symptoms such as fever, bone pain, gastrointestinal disturbances, eyebrow alopecia, headache, weight loss and diffuse lymph node swellings. If left untreated, the infection can further continue in the latent, asymptomatic stage.
The most serious consequences
In about 20% of cases not treated, 1 to 20 years after the primary stagecan appear the tertiary syphilis with nodules involving the skin, internal organs (such as bone, liver, cardiovascular system and brain) ei small blood vessels that feed the wall of the aorta. This can cause the wall of the aorta to weaken, leading to the formation of aneurysms.
«It is important to note – underlines Leva – that about 10% of untreated patients may develop these aneurysms, representing a threat to their life. In addition, syphilis can also cause serious neurological and psychiatric manifestations. These manifestations can lead to extremely disabling consequences and include the condition called neurolue. About 8% of untreated patients may develop these serious neurological and psychiatric manifestations. It is vital to understand that syphilis can have serious health implications if not treated properly».
Prevention and early diagnosis
As with other sexually transmitted diseases, so too with syphilis prevention plays a key role. In particular, the use of condoms it remains one of the most effective methods of preventing disease transmission. By using a condom correctly during every sexual act, you can significantly reduce your risk of contracting and spreading syphilis.
«In any case it is fundamental – adds Leva – perform comprehensive screenings regularly for sexually transmitted diseases when you have casual relationships with different partnersalways including syphilis since its multi-mode transmission mode it also allows its transmission with oral intercourse, often unprotected».
The tests
Syphilis it is mainly diagnosed through blood tests. Commonly used diagnostic tests follow one sequence called “non-treponemal tests – treponemal tests” in order to reduce false positives which can occur with non-treponemal tests, caused by viral infections or other conditions.
L’combined use of non-treponemal tests and treponemal tests helps doctors confirm the presence of syphilis and to distinguish between the different stages of the disease. “It is important to consult a doctor or healthcare professional to undergo appropriate tests e get an accurate diagnosiswhich allows for the initiation of timely and adequate treatment» – recommends Leva.
The therapy
Treatment-wise, the most common therapy for syphilis is injections of penicillin. However, in cases of penicillin allergy, it can be used clarithromycin as an alternative. The dosage and duration of treatment depend on the stage and severity of the disease. “The prognosis for syphilis is generally good if treatment is given during the primary or secondary stages before damage occurs in the tertiary stage of the disease,” Leva said.
And the vaccine?
“At the moment – concludes the expert – there is no vaccine available for syphilis. The development of a vaccine was hampered by the difficulty in culturing the Treponema pallidum bacterium in vitrobut some technical challenges have recently been overcome.
Thanks to the advances in diagnostic techniques in recent years, it is now possible to sequence the complete genome of the pathogen from samples taken directly from patients. Understanding the genetic differences between different strains of circulating bacteria is critical to the potential development of an effective syphilis vaccine. The future studies and research efforts targeted could contribute to progress in creating a preventive vaccine against this disease.
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