STD Clinic: Syphilis 101

Posted by on Dec 12, 2016 in Uncategorized | No Comments

Syphilis

by Grant Huttar

Syphilis is a sexually transmitted disease that has been known by many names, the Great Pox, the Disease of Naples, or the Great Imitator. This last name is due largely to the fact that many of its symptoms closely mimic a variety of other diseases making it easy to misdiagnose. Syphilis is also a highly contagious disease, having unprotected vaginal, anal, or oral sex or physical contact with an individual with an active syphilis lesion can lead to the development of a painless lesion or lesions at or near the point of contact. These lesions (also known as chancres) are typically not irritating and can be easily confused with an ingrown hair or other small blemish. They typically last for three to six weeks and will fade even without treatment, though for the moment it has no visible signs on the surface of the skin, treatment is still required. Symptoms may subside for between weeks and months depending on immune competence of the individual, but typically the disease will reemerge as a rash on any part of the body with highest incidence on the palms of the hands and soles of the feet. During this flair up the bacteria are spreading through the blood and lymph, so coupled with the rash, other symptoms may include fever, sore throat, fatigue, joint pain and malaise. Once again even if untreated the symptoms may subside and remain so for months to years, which is known as the latent stage of the disease. Again, seeking treatment is the only way to be rid of the disease.

At any point the disease has the potential to enter the nervous system which is then dubbed neurosyphilis. This may lead to loss of fine motor control, which maybe confused with Parkinson’s disease, can cause altered mental states and dementia. If the disease were to enter your eyes, it can lead to deteriorated vision or even blindness and is referred to as ocular syphilis.

As has been mentioned, diagnosis by the symptoms alone often leads to a misdiagnosis so a more definitive method is needed. Originally visual analysis under darkfield microscopy was utilized to ascertain the presence of the spirochete bacterium Treponema pallidum but often more time consumptive and would often be able to miss positive cases. Other blood or CSF tests were developed such as venereal disease research laboratory (VDRL) tests and rapid plasma regain (RPR) tests respectively to add a more rapid and sensitive tool in the healthcare workers aid. These specific tests where known as nontreponemal antibody tests because they test for antibodies that weren’t produced by the bacteria, but the bodies response to infections. These could lead to false positive due to cross reactivity with lupus, tuberculosis so another more expensive but more conclusive test is run to verify the results. This is a treponemal antibody test that directly looks for the bodies antibodies to the T. pallidum bacteria called fluorescent treponemal antibody (FTA) test (FTA-ABS).

Once a diagnosis has been established treatment is the next step. An injection of Penicillin is most commonly used for treatment in all stages of the disease, but any damage sustained from the ocular and neurosyphilis is irreversible. The exact treatment amount and duration of therapy needs to be perkily tailored to each individual patient. Temporary worsening of symptoms is common, but most see marked improvement as the Penicillin begins taking effect. However, individuals with syphilis may experience a febrile illness during penicillin treatments due to the death of the syphilis bacteria. This is called the Jarisch–Herxheimer reaction.

If you think you may have been exposed to syphilis, it is important to see a provider right away. Doing just blood work from an online testing agency is not enough. You need a physical examination. We need to know how long ago the exposure was. Many of the blood tests do not show up right away and the physical examination is critical. Treatment can also be given for presumed infection. When on google just search urgent care near me or medical walk in clinic near me. Urgent Cares are typically open 7 days a week and have extended hours. Many Urgent Care centers may not have the ability to inject penicillin it is still important to get in soon so that the appropriate referrals can be given.

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