Syphilis (VDRL)

13 September 2016

Syphilis, an STD that returns to the forefront

With its contamination peak in the 19th century and having almost disappeared in the 20th century (the cases recorded in Montreal were almost zero between the 1990s and the 2000s). Syphilis, also called “the disease of Naples” or more commonly the pox, is a sexually transmitted infection (STI) affecting all the sexually active people, an infection caused by a bacterium, the Treponema pallidum or Treponema pallidum.

Unfortunately, it has become famous for having infected some famous authors such as Guy de Maupassant, Charles Baudelaire and Alphonse Daudet. We can see that it is on the rise particularly in Quebec (about 500 cases per year) in recent years having affected the male population with homosexual activity more than others. It is mainly due to an increase in risky practices. Since the beginning of 2016 the increasing cases have raised concerns to the medical community, especially in Quebec, where there has been a drug shortage for the treatment of syphilis. Therefore, vigilance is required.

This microbe is mainly transmitted by:

  • oral sex (cunnilingus, anilingus and fellatio), vaginal and anal sex with a person carrying the bacterium
  • blood contact with infected material (needle sharing particularly in drug use)
  • contact with the symptomatic syphilitic sores of the infected person (i.e. a characteristic canker of this type of infection, i.e. a lesion in the penis, vagina or anus), which explains the fact that syphilis can be transmitted from mother to child before birth but especially during childbirth. (Congenital syphilis)
  • by kiss with exchange of saliva
  • by the use of sex toys that have been used and have been contaminated by an infected person

Symptoms of syphilis

The incubation period is estimated between 10 and 90 days between the starting point of contamination following a risky practice, for example and the onset of the first symptoms. It is a progressive infection which is why it is often complicated to confirm a diagnosis.

In addition, it is a malicious disease because in some patients, the symptoms are completely absent. The risk of transmitting syphilis to your partner, without knowing you have it, is very high, hence the need to be regularly screened, especially for people with multiple sexual partners or those who want to give up using condoms.

Three stages in the evolution of the symptoms can be distinguished:

Primary Stage

The first symptom (not always present in all patients) that appears in general during this incubation period is this characteristic painless sore called syphilitic chancre which takes the form of ulceration of 1 cm in diameter on the initially infected mucosa (mouth, penis, testicles, vagina, anus, vulva) lesion that is highly contagious. This lesion is also associated with the swelling of the lymph nodes in the groin.

The disappearance of the chancre after 3-8 weeks without leaving any trace or its location in areas that are less visible by the patient (e.g. rectum) explains why many patients remain carriers of the bacterium without knowing it. The healing of the lesion is not in fact a sign of the disappearance of this STI, but quite the contrary.

Secondary Stage

This is the stage which makes diagnosis difficult especially if the primary stage went unnoticed. In fact, between 6 weeks to 6 months after the beginning of the infection, syphilis evolves due to the absence of its treatment; infection then becoming widespread.

Several symptoms can be listed:

  • Severe fatigue with pain in joints
  • Rash (papular syphilis) that can occur on all the areas of the body (palms, back … mucosa in the genital organs, tongue …) and which can be easily confused with a roseola, psoriasis, acne or chickenpox.
  • Fever
  • Characteristic inflammation of the lymph nodes
  • Hair loss
  • A more serious attack with loss in hearing and vision with characteristic headaches associated with ringing in the ears; it is called neurosyphilis
    Without treatment, all these symptoms disappear. This is called latent syphilis (which can last for many decades). This STI is therefore still in the shadows and still very contagious.
The tertiary stage (or late syphilis), serious complications

Without diagnosis and treatment of the first two stages, the infection continues to spread over a very long period. Syphilis can cause very serious complications 30 years after the patient has been infected. Damage then occurs in all the organs of the body including vital organs which may sometimes result in the death of the patient.
Here are some serious complications:

  • Brain damage through vision and hearing issues, meningitis, memory loss, epileptic seizures …
  • Serious liver lesions (hepatitis)
  • Heart failure (stroke risk …)
  • Bone lesions
  • Risk of infection transmission from mother to child

Protect yourself against syphilis

Prevention remains essential because in fact there is no vaccine against syphilis.

A responsible attitude is paramount:

  • Use a condom during intercourse. It remains the most effective way to prevent the infection transmission between partners.
    Protect yourself even during oral sex (vaginal, anal) namely during fellatio but also during cunnilingus (oral intercourse man / woman) and anilingus using a dental dam (small square pieces of latex )
  • Get tested regularly if you change sexual partners often
  • Any injections for drug use should be done with sterile equipment without needle exchange.
  • All lesions on your partner or on yourself should automatically alert you (no contact with those sores; seek medical advice as soon as possible with sexual abstinence while these symptoms are diagnosed)

Getting tested for syphilis, it is as simple as a blood test!

Given the complexity of the diagnosis inherent to this infection, (we have seen it with its different infectious stages) the blood test remains the only way to reliably detect syphilis to be performed 3 months after having taken the risk in order for the blood test to be 100% reliable (although a first test can be performed 3 weeks after having taken the risk). In some cases, a canker sampling may be necessary.

Please note that:

* The blood test is still required in pregnant women during the first trimester of pregnancy but also for anyone wishing to donate blood.
* The blood test is highly recommended if you have taken a risk recently (sex without a condom …), if you have multiple partners (blood test to be performed regularly), if you have homosexual sex, if you have HIV or other STIs, or if you are an intravenous drug user.

The blood test is simple and reliable (VDRL method or TPHA method). In laboratory, the amount of antibodies characteristic of the presence of the Treponema bacteria in the patient’s body will be determined. The results will be known within 7 days.

A self-blood screening strip test using a drop of blood can now be done at home and it is available for sale. The patient will know the result after a quarter of an hour. The laboratory test remains the only test that can indicate 100% if the patient has been infected or not.

Syphilis has been a compulsory reportable disease in Canada since 1924 with the infected person being then obliged to reveal the identity of all his/her sexual partners, going back to a period of up to more than a year before the appearance of the first symptoms, to contact them, to detect and to treat them preventively.

Remember that it is good to perform a complete test of all the existing STIs (full test) when you have doubts after engaging in risky activity. Should you have any questions, please ask for advice!

Treatments against syphilis

Are you infected with syphilis? Do not panic, diagnosed in due time, it is an infection that heals very well. There is an antibiotics treatment (most notably the Benzathine and Bicillin MD), based on penicillin, by intramuscular injection, an adequate treatment for addressing each stage of the infection’s evolution. (A single injection in the primary stage or more injections if the infection has reached its tertiary stage)
The doctor may prescribe doxycycline (oral) for patients allergic to penicillin.

Monitoring is required with regular post-treatment blood tests to ensure that the patient is fully healed and that the treatment has been effective.
Please note that a suitable treatment will be implemented if the patient is HIV positive.

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