Introduction
The existence of syphilis can be traced back in the ancient days and the era when immigration was the norm from different ethnic groups that catalyzed intermarriage. The disease was also identified among Charles VIII’s soldiers of France after the invasion of Italy and among other soldiers who participated in the World Wars. The impact of syphilis on soldiers during the war era influenced the advancement in the medical field that saw the innovation of Penicillin as a form of treatment (Norris, Fraser and Weinstock 1998) . Despite the history of the disease and its causative agent, the genesis of the illness is still debatable today due to various factors and elements from the ancient days. Syphilis is a sexually transmitted disease; which can lead to the severe implications in the body of the victim if treatment is not administered as early as possible.
Causative Agent of Syphilis
As a sexually transmitted disease, the causative agent of syphilis is a spirochete bacterium called Treponema pallidum. Like most bacteria, Treponema pallidum cannot be seen by the naked eyes but by the use of an obliquely lighted microscope. According to the World Health Organization (2004) in collaboration with renowned medical researchers and experts, syphilis can also be transmitted through non-sexual ways especially in environments that are of poor hygiene standards hence is referred to as endemic syphilis. For instance, a second party can be infected with the disease in cases where the causative bacterium is passed through blood transfusion. An infected mother is also in a position to pass the infection to her unborn child either through the placenta or during delivery, and hence medical practitioners refer this kind of syphilis as congenital. The children who get infected with congenital syphilis in most case develop various abnormalities and fatal conditions that may lead to death. In consideration of the possible ways of transmission, the Treponema pallidum bacterium thrives well in the human genitals of infected individuals. The core reason for the survival of the bacterium in the genitalia environment is mostly because of the ideal temperatures and pH maintained in these areas (World Health Organization, 2004). The supportive temperature that suits the survival of the bacterium is 30 to 37 degrees Celsius and a neutral environment of 7.2 to 7.4 pH.
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According to Jenna Reynolds (n.d), the four subspecies of Treponema pallidum cause different ailments that include bejel, pinta, yaws, and syphilis which is the factual venereal disease. In reference to the principal of diagnosis, spirochete Treponema pallidum is gram negative due to the thin nature of the bacterium and the difficulty in classifying of the stain. Its composition is made up of 5% carbohydrates, 20% lipids, and 70% proteins (World Health Organization, 2004). According to experts, the lipid composition in the Treponema pallidum bacterium is very high compared to other bacteria. The size of the bacterium cells ranges from six to fifteen micrometer whereas the width is 0.1 to 0.2 micrometer. As mentioned earlier, the bacterium requires an oblique lighted microscope to have a clear view or any other methods of silver impregnation (World Health Organization, 2004). Furthermore, the bacterium relies on oxygen for survival hence it is a microaerophile and therefore multiplies by the transverse fission; thus, the exposure to sunlight, air, and antiseptics result to its death.
Diagnosis
To deliver the right treatment in case of observation of the signs and symptoms, diagnosis of syphilis is conducted through various tests the most being the tests of blood samples that are used in identifying the existence of the causative bacterium. Some of the standard tests used in diagnosing syphilis include serology which is comprised of treponemal & nontreponemal antibody tests and direct detection of bacteria. Under serology, the blood sample and cerebrospinal fluids are used in detecting the existence of antibodies. The nontreponemal tests refer to the tests that are focused on antibodies that are not directed to the causative bacterium of syphilis. The nontreponemal antibodies are mostly produced during the infection with syphilis or other non-related conditions. The tests in detection of nontreponemal antibodies are sensitive, but not specific hence may result in false results. Rapid Plasma Research (RPR) is one of the tests for nontreponemal antibodies that are used in measuring the level of antibodies available in the body of the patient (Norris, Fraser and Weinstock 1998). Another nontreponemal antibody test besides RPR is Venereal Disease Research Laboratory (VDRL) which is conducted on CSF for purposes of identifying neurosyphilis. As for the case of treponemal antibody tests, blood samples are explicitly tested to determine the Treponema pallidum causative bacterial of syphilis. Hence, other conditions are unlikely to be detected positive. Unlike the nontreponemal antibody detection, patients who are tested and found positive with the treponemal antibodies are at a higher risk of possessing the antibodies in their blood system for their entire life. On the contrary, a proper treatment of the identified antibodies can disappear within three years (Norris, Fraser and Weinstock 1998). Therefore, for precise results of detecting syphilis in an individual requires the use of both nontreponemal and treponemal antibody tests.
Under the direct detection of bacteria, the significant tests include the dark-field microscopy and molecular testing. While they are not commonly performed, the dark-field microscopy is mostly used during the early stages of the illness after the identification of syphilis sores (Norris, Fraser and Weinstock 1998). The process involves scraping the sore widely referred to as chancre and placing the scraped contents in a slide then examining it with a dark-field microscope. On the other hand, the molecular testing involves to as the detection of genetic composition in the sample scraped from the syphilis sores, CSF or blood.
Mortality and Morbidity Rate of Syphilis
The mortality and morbidity rate of syphilis had varied during the years because of various factors. Initially, many infected individuals were observed to end up with a severe disability because of lack of proper treatment (Su et al. 2016). With the advancement in medical treatment and innovation of effective drugs, the high numbers of deaths and disabilities caused by syphilis dropped with a slight percentage for some years. The catalyst factors ensured that the disease had a constant rate of deaths and morbidity for several years which also increase with time throughout the following years. According to the reports given by the Center for Disease Control and Prevention done between 2005 and 2013, the rate of deaths caused by syphilis was observed to be on the increase. For instance, the data recorded for the 2013 report indicated that the rate of primary and secondary syphilis was 5.3% of every 100 000 individuals in the United States (Patton, John Su, & Weinstock, 2014). The lowest rate of deaths observed in the country compared to the other years was in 2000 which had a rate of 2.1% of the population. Pregnant women with syphilis and lacked proper treatment profoundly contributed to the deaths of children and those who developed conditions that were fatal increased immensely (Patton, John Su, & Weinstock, 2014). The high numbers of infection with syphilis are attributed to the increase in the rate of homosexuality and liberty in having several sexual partners. The disparity of the occurrences of the disease was also identified in the age, race, and ethnicity. It is evident that the efforts applied during the 90s that contributed to the decrease in the rate of syphilis are currently facing immense challenges since the cases of the illness have been increasing slowly and steadily.
Symptoms
The signs and symptoms of syphilis vary with the stage in which the illness is at. On the other hand, numerous patients develop different symptoms that in most cases will not follow a defined order since they may overlap over stages. As observed earlier, the initial sign indicating a possible infection of syphilis is the chancre or the sore that is painless and hard. In most cases, the chancre develops or appears in the area where the bacteria entered the body. Syphilis is an illness that can exist in the body for years without its victims having any symptoms. The development of a chancre is mostly identified as a sign of primary syphilis which occurs around the third week of exposure (Patton, John Su, & Weinstock, 2014). The inability of the victim to recognize the infection in their bodies is because the chancre may hide underneath the rectum or vagina without feeling any pain and sometimes disappears in a period of three to six weeks.
Secondary syphilis occurs after the disappearance of the first appeared chancre. The development of a rash commences which later covers the rest of the other parts of the body. The rash lacks itchiness and is commonly followed by sores that are wart-like around the mouth and the genitals. The secondary symptoms tend to disappear and reappear even for one year. In addition to the rash, the infected individual can also develop hair loss, fever, muscle aches, swollen lymph nodes and sore throats. In case the patient does not seek medical attention at this stage, the disease develops into latent syphilis which is the stage at which no symptoms of the illness is observed. On the other hand, the symptoms of the disease may not reoccur, and hence it ends progressing into the tertiary stage also referred to as the third stage. Quick treatment of the disease is advised since; the infected individual may end up developing the late phase or tertiary syphilis which contributes to fatal conditions and complications that include, brain, heart, nerve, bones, joints, blood vessels and liver damage. In the case of newborn babies with congenital syphilis, they lack apparent evidence of the disease apart from some of the rashes that develop on the palms and soles of the feet (WHO, 2014). Due to the inability to identify the infection in the children at an early stage unless the mother is aware of their condition, the children end up with severe complications like deafness, saddle noses, deformed teeth and brain damage among others. As mentioned earlier, the diseases that can develop due the syphilis causative agent include yaws, pinta, and bejel. All of these conditions affect the skin of the individual who is affected and at the end, if not treated may develop into the venereal disease which is syphilis.
Preventative Measures and Precautions of Syphilis
The factors that determine the prevention measures of syphilis are the modes of transmission and the stages of the symptoms. Physicians affirm that the disease is treatable during the first stages but does not hinder the individual from contracting the same or any other sexual infection again. Therefore, to protect oneself from either contracting the illness, a reoccurrence of the same or infecting others, these are some of the steps to consider. One must think of practicing safer sex which includes having limited sexual partners and using protective measures like condoms. Physicians reckon that it is easier for an individual to know the changes of their sexual activities if they have one partner (Su et al., 2016. Moreover, it is advisable for individuals to stay away from activities that might expose them to unprotected sex like excessive use of alcohol and abuse of other drugs. It is crucial for individuals to consider taking tests periodically since the symptoms of syphilis are not noticeable especially during the first stages. Moreover, spouses are also expected to openly discuss their sex life for reasons of ensuring that they are both safe and keep away from possible infection. In cases where an individual was ones infected, they are expected to know the symptoms and have extensive knowledge of the disease for purposes of avoiding a relapse.
Treatment
Syphilis is a curable condition notably when it is detected at an early stage where the impact has not severely interfered with the body of the patient. Therefore, the primary and secondary syphilis can be treated through the use of penicillin injections (WHO, 2014). Other antibiotics used for people who are allergic to penicillin include doxycycline, ceftriaxone, and azithromycin. People with neurosyphilis are given doses of penicillin on a daily basis.
Conclusion
Syphilis has been in existence for the longest time and a reason for deaths in the world. Since its identification, so many steps have been taken to ensure that it is curbed. On the other hand, the most used method in preventing the illness includes awareness. Avoidance of sexual contact with infected persons is advised. While it is difficult to identify who is infected and who is not, use of protection condoms is encouraged to ensure that infection is either limited or prevented entirely. On the other hand, frequent tests provide that early detection is enhanced because late identification of the diseases causes complications that are irreversible.
References
Norris, Steven J., Claire M. Fraser, and George M. Weinstock. 1998. "Illuminating the Agent of Syphilis: Thetreponema Pallidum Genome Project (Minireview)". Electrophoresis 19 (4): 551-553. doi:10.1002/elps.1150190415.
Patton, M., John Su, R. N., & Weinstock, H. (2014, May 9). Morbidity and Mortality Weekly Report (MMWR) . Retrieved November 20, 2017, from Center for Disease Control and Prevention: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a4.htm
Reynolds, J. (n.d.). Syphilis; Etiological agent- Treponema Pallidum. Retrieved November 20, 2017, from Austin Community College: http://www.austincc.edu/microbio/2421b/tp.htm
Su, John R., Lesley C. Brooks, Darlene W. Davis, Elizabeth A. Torrone, Hillard S. Weinstock, and Mary L. Kamb. 2016. "Congenital Syphilis: Trends In Mortality And Morbidity In The United States, 1999 Through 2013". American Journal Of Obstetrics And Gynecology 214 (3): 381.e1-381.e9. doi:10.1016/j.ajog.2015.10.007.
WHO. (2004). Disease Watch Focus: Syphilis . Retrieved November 20, 2017, from World Health Organization: For Research on diseases of Poverty: http://www.who.int/tdr/publications/disease_watch/syphilis/en/
