Syphilis: bacteriology, pathology, treatment, and prevention

by Jasmine Richards, GCSOM, MBS 2019
Mentor: Kimberly Miller, PharmD.

When you think of syphilis you may think of sores, prostitutes, and other sexually transmitted diseases. But do you think of Henry VIII, many-times-divorced King of England, Al Capone, the infamous American gangster, Florence Foster Jenkins, the talentless opera singer, Oscar Wilde, the famous Irish Poet, Vincent Van Gogh, the one-eared Dutch painter, or Napoleon Bonaparte, the twice- escaped French general?

No?

Syphilis is s a pandemic that has and does affect millions across the world regardless of sexual orientaion, age, or socioeconomic status. It is a sexually transmitted infection that is caused by the bacterium Treponema Palladium (T. Pallidum). Other related diseases such as betel and yaws (also know as non-sexually transmitted syphilis) that are caused by bacteria that are related to T.pallidum. T.pallidum is a gram negative spirochete bacteria. This is a type of bacteria that has a spiral shape that similar to a corkscrew, and two membranes with a thin layer of peptidoglycan layer between those layers.

 Even though it is classified as a gram negative bacteria, a characteristic unique to T. pallidum proves that this bacterium does not one hundred percent fits in this category is that it doesn’t have as many proteins in its outer cell membrane as other gram negative bacteria. This makes it difficult to treat because the same drugs that work for other gram negative bacteria will not be as effective in destroying syphilis. This also makes it difficult for the host’s immune system to find the bacteria within the body which gives T.pallidum enough time to reproduce and spread outside the site of infection into other organ systems of the host.

Syphilis occurs in four distinct stages, primary, secondary, tertiary, and latency. The primary stage begins at the sign of the first sore also known as a chancre. There may be multiple chancres but they may be hard to find due to its location being in the cervix or rectum. These chancres last three to six weeks and will heal with or without treatment. The secondary stage is characterized by a rash and mucuous membrane lesions all over the body and other symptoms include fever, swollen lymph glands, sore throat, aches, and fatigue. The latent stage is asymptomatic and can last for year. Finally the tertiary stage is rare, can be fatal, and can affect multiple organ systems.

Syphilis is a hard disease to diagnose because it can mimic other diseases like lupus, leprosy, measles, rubella, and many others, so current screening methods are complicated and sometimes requires multiple tests to confirm an accurate diagnosis. Tests are used depending on the presence of symptoms, age, stage of syphilis, and where the patient is screened.

Syphilis is treated with antibiotics such as penicillin, erythromycin, and tetracycline. Penicillin is usually injected intramuscularly. The others are typically taken orally and used when there is a penicillin allergy; however there may be measures taken to see if the patient can undergo penicillin desensitization. The disease is still extremely susceptible to penicillin and completely dies when the patient takes an accurate dose of penicillin. Although penicillin completely cures syphilis, it may not reverse all of the damage that the disease caused such as neuromuscular deterioration. Syphilis used to be treated with arsenic, mercury, and guaiacum, which is sap from the guaiacum shrubs and trees. These “remedies” did more harm than good for the multitude of people trying to get rid of the sores.

Hidden populations such as sex workers, men who have sex with men, and injectable drug users are high risk for infected. These populations are at high risk due to their legal status in their home country, being socially condemned, lack of access to health care, and a continued high probability of exposure to syphilis. These populations, especially sex workers, are criminalized and stigmatized in many countries around the world due to societal perceptions, so they are at a higher risk due to increased violence and unsafe work conditions such as a lack of condom use and higher prosecution rates. They want and deserve the same rights, protections, judgement-free health care that others citizens receive ,and if sex work was decriminalized and these populations were given fair and equal rights then there should be a great reduction in the transmission of STIs.

Syphilis is a disease that could be easily eradicated because syphilis is still highly sensitive to penicillin. This means that if a person takes their medicine correctly, then syphilis should go away, however the body doesn’t develop “immunity memory” or an effective way to fight off reinfection. Future research for syphilis includes vaccine development, new drugs, and identifying all important genes and proteins. With the use of these new discoveries, syphilis and other sexual transmitted infections are closer to being eliminated from the world population.