Going Into Deep Details: Syphilis
In medical terms, Syphilis is well known as a sexually transmitted infection that is commonly caused by bacterium Treponema Pallidum. This disease usually develops in several phases ranging from the basic stage to the more dangerous one and the fact is that these stages may sometime overall or may not occur in the common order. Generally, when a person gets affected with Syphilis, he/she can face many symptoms related to this for years.
The relaxing news is that Syphilis is treatable disease but you need to identify it at earlier stage. Although, it may take long time for complete removal of infection from body but at least worst effects can be avoided with timely treatment. Anyone who is observing Syphilis symptoms in body is advised to take medical help as soon as possible.
Illustration of symptoms of syphilis affected penis
If Left Untreated Can Chlamydia Turn Into Hiv Or Aids
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The Burden Of Syphilis Infection
Syphilis, a systemic infection caused by the bacterium Treponema pallidum, is the third most frequently reported sexually transmitted infection in the United States behind chlamydia and gonorrhea . Syphilis and other ulcer-producing STIs are risk factors for acquiring or transmitting HIV infection because they directly increase the likelihood that genital secretions will contain an infectious amount of HIV-1 . In addition, syphilis infection might indicate ongoing sexual behaviors that place a person at increased risk of acquiring or transmitting HIV infection .
Since 2001, rates of primary and secondary syphilisthe most infectious stages of the diseasehave increased annually in the United States , especially among HIV-infected men who have sex with men . In 2016, case counts and rates of primary and secondary syphilis were the highest recorded nationally since 1994 at 27,814 and 8.7 cases per 100,000, respectively . Men, who accounted for almost 90% of new primary and secondary syphilis cases in 2016, are disproportionately affected. MSM accounted for 58.1% of all primary and secondary syphilis cases overall, and 47% of MSM with syphilis reportedly had HIV . The rate of reported primary and secondary syphilis cases in women increased by 35.7% to 3,049 cases during 2015-2016, and the rate of congenital syphilis increased by 27.6% to 628 cases.
New York ranks fifth among the 50 states in rates of primary and secondary syphilis, with 2,455 cases reported in 2016 .
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Development Of This Guideline
This guideline was developed by the NYSDOH AI Clinical Guidelines Program, which is a collaborative effort between the NYSDOH AI Office of the Medical Director and the Johns Hopkins University School of Medicine, Division of Infectious Diseases.
Established in 1986, the goal of the Clinical Guidelines Program is to develop and disseminate evidence-based, state-of-the-art clinical practice guidelines to improve the quality of care provided to people with HIV, hepatitis C virus, and STIs and to improve drug user health and LGBT health throughout the State of New York. NYSDOH AI guidelines are developed by committees of clinical experts through a consensus-driven process.
The NYSDOH AI charged the Sexually Transmitted Infections Guidelines Committee with developing evidence-based clinical recommendations for primary care clinicians in New York State who treat patients with syphilis infection. The resulting recommendations are based on an extensive review of the medical literature and reflect consensus among this panel of STI experts. Each recommendation is rated for strength and for quality of the evidence . If recommendations are based on expert opinion, the rationale for the opinion is included.
|AIDS Institute HIV Clinical Guidelines Program Recommendations Rating Scheme|
|Strength of Recommendation|
|3 = Expert opinion|
Centers for Disease Control and Prevention . Syphilis CDC Fact Sheet . 2017 Feb 13.
Hiv And Sexually Transmitted Diseases
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Chancres Definition And Syphilis
You might be curious to know about what does a syphilis chancre look like? The primary stage of Syphilis is named as Chancres and in case if patient keep on ignoring this primary issue then this disease may keep on developing while making major shift from primary to secondary level and finally to the more dangerous latent stage. Avoiding such disease is just like calling long life complications for your life.
Illustration of syphilis. symptoms and causative agent
Std Statistics In The Us
According to the Centers for Disease Control and Prevention , nearly 20 million new STD infections occur every year, accounting for almost $16 billion in healthcare costs. In 2017, the bulk of infections were primarily constrained to three diseases:
- Chlamydia: 1,708,569 infections at a rate of 529 per 100,000
- Gonorrhea: 555,608 infections at a rate of 172 per 100,000
- Syphilis : 30,644 infections at a rate of 9 per 100,000
The rate of STD infections is particularly high among gay and bisexual men who, not surprisingly, account for the highest rate of HIV infections in the U.S.
Gay and bisexual men account for almost all primary and secondary syphilis cases.
To this end, If you are a sexually active gay or bisexual man, you should be tested for syphilis, chlamydia, gonorrhea, and HIV at least once a year. More frequent STD testing, between every three to six months, is recommended for gay or bisexual men at high risk, especially those who have multiple sex partners, use recreational drugs, or practice condomless sex.
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Major Causes Of Syphilis
As we already mentioned, Syphilis is generally developed with sexual activities but in more critical cases, this disease can even get transferred from mother to child at the time of pregnancy. In this case, it is named as Congenital Syphilis. When this infection is transferd from mother to new born child, it may cause low birth weight or chances are to report stillbirth. In case if this disease is avoided and left untreated then little child can develop many harmful symptoms with time like deafness, cataracts or seizures. In worst cases include death of the newborn affected baby. The primary stage of Syphilis is named as chancre syphilis and it shows so many symptoms that affected person can consider to start with basic treatment.
Some common symptoms related to syphilis
Syphilis is commonly divided into several categories: primary , secondary, occasionally and the last one is latent phase. Below are few common symptoms associate with each one of these phases:
Symptoms of primary or chancre syphilis
- The most common trouble in this first stage of syphilis is development of round, firm and painless sores- they are named as chancres syphilis.
- It follows the incubation duration of about 3 weeks that later causes exposure to bacteria.
- Syphilis chancre pictures are often observed to go through self resolution phase for first 3 to 6 weeks but in order to stop progress of this disease, one need to take medical help urgently.
Symptoms of secondary stage
Sores On The Genitals
Most sores on the genitals are sexually transmitted.
Sores on the genitals should be kept clean. Wash them with soap and water. Dry them carefully. Wash any cloth that you dry them with before you use it again.
WARNING! Other infections, especially HIV, can easily pass through these sores on the genitals during sex. The best way to prevent passing infections from one person to another is to not have sex until your or your partners sores have healed.
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Syphilis Treatment Can Be Less Effective In People With Hiv
Having HIV may also make syphilis harder to treat. This may be due to HIVs impact on the immune system.
A assessed syphilis treatment in 510 people with and without HIV, finding treatment was ineffective in 10.94 percent of people. Being HIV-positive was associated with a three-fold increase of ineffective syphilis treatment or syphilis reinfection.
A looked at the medical records of 560 people with both HIV and syphilis. While the type of syphilis treatment used didnt impact the outcome, several other factors associated with ineffective syphilis treatment were found, including:
- low levels of antibodies in a rapid plasma reagin syphilis test
- a previous history of syphilis
- CD4 count lower than 350 cells per milliliter
The process for diagnosing syphilis in people living with HIV uses the same types of tests as for HIV-negative individuals. Lets explore this further.
When Is It Safe To Have Sex
People with syphilis must avoid sexual contact until they have completed all treatment and received blood test results confirming that the disease has resolved.
It may take several months for blood tests to show that syphilis has reduced to an appropriate level. Low enough levels confirm adequate treatment.
A doctor will carry out a physical examination and ask about a persons sexual history before carrying out clinical tests to confirm syphilis.
- Blood tests: These can detect a current or past infection, as antibodies to the syphilis bacteria will be present for many years.
- Bodily fluid: A doctor can evaluate fluid from a chancre during the primary or secondary stage.
- Cerebrospinal fluid: A doctor may collect this fluid through a spinal tap and examine it to monitor the diseases effects on the nervous system.
If a person receives a diagnosis of syphilis, they must notify any sexual partners. Their partners should also undergo testing.
Local services are available to notify sexual partners of their potential exposure to syphilis, enable testing and, if necessary, administer treatment.
Healthcare professionals will also recommend testing for HIV.
Many providers now offer at-home tests for syphilis.
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How Is Syphilis Treated
Syphilis can be cured with antibiotics. However, its important that you get tested and treated early on, as some health problems caused by late-stage syphilis cant be resolved.
The specific antibiotics used to treat syphilis may vary depending on where you are. Ask your healthcare professional any questions you have about your treatment.
Your healthcare worker will be able to tell you when your infection has cleared. They may advise you to avoid having sex until you have finished your treatment, the sores have healed and they say its ok.
Remember, having been treated for syphilis previously does not make you immune. You can still get syphilis again.
What Is The Link Between Syphilis And Hiv
In the United States, approximately half of MSM with primary and secondary syphilis were also living with HIV. In addition, MSM who are HIV-negative and diagnosed with P& S syphilis are more likely to be infected with HIV in the future. Having a sore or break in the skin from an STD such as syphilis may allow HIV to more easily enter your body. You may also be more likely to get HIV because the same behaviors and circumstances that put you at risk for getting other STDs can also put you at greater risk for getting HIV.
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What Are The Signs And Symptoms In Adults
Syphilis has been called The Great Pretender, as its symptoms can look like many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months, or even years:
The appearance of a single chancre marks the primary stage of syphilis symptoms, but there may be multiple sores. The chancre is usually firm, round, and painless. It appears at the location where syphilis entered the body. These painless chancres can occur in locations that make them difficult to notice . The chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated or not. However, if the infected person does not receive adequate treatment, the infection progresses to the secondary stage.
The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. Without treatment, the infected person will continue to have syphilis in their body even though there are no signs or symptoms. Early latent syphilis is latent syphilis where infection occurred within the past 12 months. Late latent syphilis is latent syphilis where infection occurred more than 12 months ago. Latent syphilis can last for years.
Neurosyphilis and Ocular Syphilis
What Are Alternative Diagnostic Testing Approaches
Traditionally a nontreponemal test, such as the RPR, has been used for screening, followed by confirmatory treponemal testing . Recently, many laboratories have reversed the order, screening with the automated TP-EIA and using the more labor-intensive nontreponemal test for confirmation. This reverse sequence screening may engender diagnostic dilemmas, particularly when the screening treponemal test is reactive and the nontreponemal test is nonreactive. In patients without previously treated syphilis, an alternative treponemal test such as the T pallidum particle agglutination assay should be performed to confirm the positive TP-EIA. In the case of this patient, both treponemal and non-treponemal tests were reactive, a finding diagnostic of syphilis.
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Will Treating Someone For Stds Prevent Them From Getting Hiv
No. Its not enough. Screening for STDs can help assess a persons risk for getting HIV. Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.
If someone is HIV-positive and is diagnosed with an STD, they should receive counseling about risk reduction and how to protect their sex partner from getting re-infected with the same STD or getting HIV.
Health care providers with STD consultation requests can contact the STD Clinical Consultation Network . This service is provided by the National Network of STD Clinical Prevention Training Centers and operates five days a week. STDCCN is convenient, simple, and free to health care providers and clinicians. More information is available at www.stdccn.orgexternal icon.
How Can You Protect Yourself From Hiv And Stds
- Avoid or put off having sex. If you do have sex, use a male latex or female condom every time.
- Latex male condoms and female condoms, when used the right way every time, are very effective in preventing HIV and many other STDs. Condoms may prevent the spread of other STDs like HPV or genital herpes, only when the condom covers the infected areas or sores.
- Talk with your partner about HIV and STDs.
- Don’t share drug “works”
- Get STD and HIV counseling and testing.
To find out if you might have an STD, visit your doctor or clinic as soon as you can.
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Application To This Patient
This patient has late latent syphilis and should receive 3 weekly injections of benzathine penicillin G.
Because the patient is asymptomatic with reactive serologies, he has latent syphilis. Latent syphilis can be divided into early-latent syphilis, diagnosed within 1 year of infection, and late-latent syphilis, diagnosed 1 year or more after infection. When the date of original infection is unknown, the patient is considered to have late-latent syphilis.,
Early-latent syphilis is treated with a single intramuscular dose of benzathine penicillin G, while late-latent syphilis requires 3 weekly doses of benzathine penicillin G. Following successful treatment, the RPR declines over time and may become nonreactive. However, the RPR may remain reactive at a low titer , a condition referred to as the serofast state. The serofast state does not apply to this patient because he has no previous syphilis history. He does not have falsely elevated titers his treponemal and nontreponemal tests were both reactive, making the diagnosis of syphilis and obviating the need for repeat testing. Because T pallidum can invade the central nervous system early, neurosyphilis should be considered in any patient with reactive syphilis serologies. Lumbar puncture is usually suggested following treatment failure or in patients with neurologic symptoms. The likelihood of neurosyphilis is greater in patients with higher RPR titers and in HIV-infected patients with lower CD4 cell counts.
Reporting: New York State
Requirements: Prompt reporting of suspected or confirmed syphilis is mandated under the NYS Sanitary Code . In NYS, syphilis cases should be reported immediately to the local health department as follows:
Partner notification: The local health department may contact the patient for epidemiological investigation or to offer assistance with partner notification.
Clinicians can contact local health departments to obtain previously reported nontreponemal and treponemal test results and treatment histories. See STD Clinics in NYS for contact information for clinics in each county.
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