Syphilis is an infectious disease that affects both sexes and is caused by the bacteria Treponema pallidum. In Brazil, estimates from the World Health Organization of Syphilis account for 937,000 cases per year, including cases of congenital syphilis (transmission of the disease to the fetus throughout the placenta).
As highlighted by Patrícia de Rossi, gynecologist and obstetrician at Conjunto Hospitalar do Mandaqui, in São Paulo, most of the new cases (75%) are in men who have sex with other men. "But people who have casual partners, do not use condoms or are infected with HIV are also at high risk for getting the infection," he says.
The gynecologist explains that the most common form of contagion is through sexual intercourse with an infected partner, even if asymptomatic. Transmission occurs through direct contact with lesions, which may be on the penis, vagina, vulva (outside of the female genitals), anus or rectum, and, more rarely, in the mouth. No transmission by contact with objects such as towels, door handles, toilets, bathtubs or swimming pools. It is estimated 30% risk of acquiring syphilis through sexual intercourse with a carrier of the disease ?, highlights.
Syphilis Symptoms
It is worth noting that syphilis is a disease with several clinical presentations, including a wide variety of signs and symptoms, at various stages of infection.
Patricia explains that the disease develops in three sequential phases with periods of latency (without symptoms). Check it out below:
Read also: Know the importance of gynecological check up
Symptoms of primary syphilis
• In primary syphilis, a lesion appears at the site of infection. The wound, usually unique and called hard cancer, begins as a small? Ball? that turns into an ulcer (deeper wound), painless, hardened and can release a highly contagious clear liquid. The most common sites are penis, vulva, anus and rectum. The lesion appears 10 to 90 days after contact, most commonly 3 weeks, and may cause an enlarged groin (tongue) in the groin. The wound heals on its own in 1 to 3 months, leaving no scars. If left untreated, will syphilis go to the next stage ?, says Patricia.
Bianca Grassi de Miranda, an infectologist at the Samaritano Hospital in São Paulo, points out that primary syphilis causes an ulcer (wound) in the region of bacterial inoculation, which is usually in the genital tract, but can happen in the mouth, for example. "It is painless and disappears spontaneously after a few weeks," he recalls.
"Typical lesions such as hard cancer, condyloma lata and mucosal lesions are highly infectious, with 1 in 3 exposed individuals becoming infected," the infectologist adds.
Symptoms of secondary syphilis
Patricia explains that secondary syphilis begins 4 to 10 weeks after the onset of cancer. The bacterium spreads throughout the body causing general symptoms such as:
- Malaise;
- Fever;
- Loss of appetite;
- Nausea;
- Headache;
- Tiredness;
- Loss of hair;
- Red, non-itchy lesions and sores on the palms and soles and other parts of the body.
"It is common for symptoms to be confused with other diseases, making diagnosis difficult," says the gynecologist.
Bianca points out that after weeks or a few months after primary infection, about a quarter of untreated patients may progress to secondary syphilis. • Patients do not always remember the primary lesion. There are several symptoms that can appear in secondary syphilis, including muscle pain, hair loss and eyebrows, intestinal, liver, kidney and even central nervous system (CNS), he says.
Latent Phase Symptoms
Patricia explains that latent syphilis is the next phase of infection, where the bacteria remains in the body but there are no symptoms. Most people are diagnosed at this stage and do not recall having symptoms of earlier stages. The diagnosis is by syphilis-specific blood tests (VDRL and FTA-Abs) ?, he says.
Bianca points out that the latent phase is precisely characterized by the absence of symptoms, with positive serological (blood) tests. "It can be divided into recent latent (less than one year of infection) or late latent (more than one year of infection)," he adds.
Tertiary Syphilis Symptoms
Infectologist Bianca explains that tertiary syphilis is the later stage of the disease, and there are usually clinical manifestations after three years.It is the most serious phase where the most serious problems occur. In this period, the disease is not contagious. Could there be heart, neurological or vascular problems?
Patricia points out that after several years or decades without symptoms, about 30% of those infected develop tertiary syphilis. The bacteria can affect various organs of the body to varying degrees of severity. For example, skin sores, bone and joint pain, inflammation of the heart and blood vessels, meningitis, and paralysis may appear. Can eyes and liver be affected, as well as the brain, causing dementia ?, he adds.
Bianca points out that whenever there are genital lesions, both men and women should seek medical help. "In addition, whenever the individual feels ill, without apparent improvement, should be subject to medical evaluation, as various health problems can be similar to syphilis," he says.
How is the diagnosis of the disease made?
Bianca explains that the diagnosis is made by clinical examination when there are signs and symptoms, and by blood tests? the so-called treponemal and non-treponemal tests. They serve for diagnosis even when there are no symptoms and for control after treatment. They should therefore be performed periodically on people with active sex lives. Is it mandatory prenatally and at birth to diagnose congenital syphilis ?, he says.
The infectious disease specialist adds that the exam can be done in the public health system, through rapid test, with a? Sting? on the finger.
Patricia points out that the diagnosis is based on blood syphilis antibody tests, even in people who have no symptoms. • A screening test called VDRL is usually done which, if positive, is confirmed by a more specific one (FTA-Abs). These exams are simple and can be taken free of charge and anonymously at Specialized Assistance Services (SAEs) throughout Brazil. If lesions are present, a sample may be sent for laboratory analysis. When a central nervous system infection is suspected, is it necessary to take a cerebrospinal fluid (CSF) sample to perform the tests ?, he says.
Causes of Syphilis
The disease is caused by a type of bacteria, Treponema pallidum. Bianca points out that the classic form of transmission is direct contact with active lesions mainly through sexual intercourse (vaginal, oral, anal).
There is also congenital syphilis, in which the mother passes the disease to the fetus through the placenta or at birth.
Rarely, transmission occurs through direct contact with the mouth injury (ie, by kissing).
It is noteworthy that there is no transmission by contact with objects such as towels, door handles, toilets, bathtubs or swimming pools.
Is it possible to be prevented?
Yes, and this is very important. As the professionals point out, the best means for this are:
- Condom use in sexual intercourse (which also applies to those who have a single partner, because the person may be infected and not know);
- Serological tests for identification of latent infection (for people of any age);
- Immediate treatment of any suggestive injury;
- Prenatal laboratory tests for diagnosis of syphilis should be mandatory in the first and third trimesters of pregnancy, in addition to the time of delivery, according to the World Health Organization.
Remember that prevention is always the best way to take care of your health as a whole.
Syphilis Treatments
Patricia explains that syphilis treatment? before the tertiary phase? It is made with injections of benzathine penicillin (the famous Benzetacil). • In the first year of the disease (primary and secondary stages), a single dose of 2,400,000 penicillin units is sufficient, but if the duration of the disease is longer than one year or unknown, two further doses are given at intervals of one. week between them.?
During treatment, the person should not have sex. "It is necessary that the sexual partners are communicated, tested and treated if they are sick, because they can transmit the disease back," says the gynecologist.
• In cases of penicillin allergy, other antibiotics or desensitization may be used. During pregnancy, only penicillin is effective in treating the baby ?, explains Patricia.
In the tertiary phase, the treatment is to correct the lesions, which are usually irreversible, according to the gynecologist.
After treatment, periodic blood tests are done to find a cure. Only the value of VDRL is used, since FTA-Abs remains positive in more than 95% of treated cases (this is called a serological scar fact) ?, adds Patricia.
5 doubts about syphilis cleared
Below are answers to some common questions related to the disease.
1. The number of cases of syphilis (both in adults, pregnant women and children) has grown in recent years. Because?
Bianca explains that, in the first place, there was an increase in the number of notifications, due to improved ways of collecting information and mandatory reporting of cases to health authorities. "However, greater sexual release coupled with poor adherence to condom use contributes to the spread of the disease in various age groups," he says.
Also according to the infectologist, failures in prenatal care cause a higher incidence of congenital syphilis.
To improve this picture, according to the infectologist, strategies for early diagnosis and timely treatment should be better structured.
2. Why is syphilis even more dangerous for pregnant women?
Bianca explains that syphilis, when it reaches the fetus, can cause fetal death, fetal infection and malformations. "In congenital syphilis there can be a number of malformations, ranging from placental problems, intrauterine growth restriction, to cardiac, central nervous system, bone, etc.," he says.
"Up to 80% of newborns of mothers with untreated syphilis during pregnancy can have problems," adds the infectologist.
3. How does the mother transmit syphilis to the fetus?
When the pregnant woman becomes infected (acquires the disease), T. pallidum crosses the placenta and infects the fetus, according to Bianca. "This can occur at any gestational age, being more severe in the early stages of pregnancy, but more frequent as the gestational age increases," says the infectologist.
4. Can anyone have syphilis?
Yes. Bianca points out that men and women of any age can acquire syphilis, including children, through the vertical transmission of infected mothers. "However, international epidemiological data point to a higher incidence in cases of men who have sex with same-sex partners," he says.
5. Can syphilis be transmitted by kissing?
Yes, but this is rare. Patricia recalls that transmission occurs through direct contact with lesions, usually found in the penis, vagina, vulva (outside of the female genitals), anus or rectum.
Congenital syphilis: what are the risks?
Bianca explains that congenital syphilis is the infection of the fetus / newborn transmitted during pregnancy or childbirth to the fetus. There are several clinical manifestations in the newborn, besides abortion and death of the baby, as the infectologist points out:
- Severe malformations of the central nervous system may occur;
- Bone malformations;
- Malformations of teeth;
- Blindness;
- Deafness;
- Body wounds after birth;
- Pneumonia.
Gynecologist Patricia points out that in 40% of cases of congenital syphilis, babies die before birth, and another 40% are seriously affected even after birth. • They may be born small or early, suffer seizures, blindness, deafness and die early. So blood tests for syphilis during pregnancy are required for mother and baby to be treated?
The diagnosis, according to Bianca, is by blood test, which should be performed prenatally, in the first trimester of pregnancy, last trimester and in childbirth. "In cases where there is no record of prenatal care should be performed before delivery," he says.
Treatment is based on antibiotics for the child, mother and partner. "The baby with syphilis needs a series of tests and specialized medical follow-up until early childhood," adds the infectologist.
Consequences of untreated syphilis
Untreated infection can progress to tertiary syphilis, with several serious clinical manifestations. "If the infected pregnant woman does not treat, can pass to your baby," explains Bianca.
? Moreover, the disease is highly contagious, so if the individual is not treated, it can spread the disease widely. Can people with HIV have more severe syphilis ?, adds the infectologist.
Now you know that you don't play with this kind of disease! Both women and men should protect themselves against syphilis, and the best way to do this is by betting on safe sex with condoms.
In the specific case of pregnant women, attention should be redoubled, so prenatal examinations are essential.
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