With this video we continue our cognitive journey on syphilis. In the previous lesson we have already described the general aspects of the disease, which I will briefly summarize before continuing. First of all, we have seen that syphilis is a serious infectious disease due to the introduction into the body of a bacterium, called Treponema pallidum. Syphilis is mainly transmitted sexually and by direct contact with infected lesions. In addition, a mother affected by the disease can pass it on to her fetus during pregnancy or at the time of delivery. We have also anticipated that the disease has a very long course, divided into various stages which, in the absence of treatment, gradually become more serious, up to seriously damaging the nervous system. Having made this necessary premise, in the course of the video we will deepen the symptoms of syphilis and the possibilities of diagnosis and treatment.
The course of syphilis is divided into three different phases. It is therefore possible to distinguish between primary, secondary and tertiary syphilis. Let's start with primary syphilis, which corresponds to the initial stage of the infection. After about 3-4 weeks from the infection, right at the point of entry of the Treponema pallidum, a lesion appears, called syphiloma. This initial sign is similar to a nodule with a rounded shape, well circumscribed, of variable size, but, above all, not painful. Soon, the surface of the lump erodes and ulcerates, exposing a bright red bottom, from which a serous exudate, containing the bacteria responsible for syphilis, comes out. In humans, syphiloma appears more frequently at the level of the balano-preputial sulcus, that is, between the glans penis and the foreskin. In women, however, it can arise on the cervix, vulva or vagina. In addition, in both sexes, syphiloma can also appear in the anorectal and inside the oral cavity, therefore on the lips, gums, pharynx or tongue. The site of appearance of the syphiloma corresponds in fact to the point where the infection occurred. About a week after the onset of syphiloma, another typical sign of primary syphilis occurs, represented by "swollen lymph nodes. The symptoms of the first stage of syphilis tend to disappear after 4-6 weeks, even without treatment. In addition, the symptoms of the first stage of syphilis tend to disappear after 4-6 weeks, even without treatment. these symptoms may go unnoticed, especially when the lesions are very small or hidden, but this regression of symptoms and lesions should not be misleading, as the disease and its transmissibility still remain.
The next phase of syphilis, called secondary, begins 3-6 weeks after the onset of syphiloma. This phase is characterized by systemic manifestations due to the proliferation of Treponema and its spread throughout the body via the blood and lymphatics. Also for this reason, secondary syphilis is typically accompanied by flu-like symptoms such as fever, asthenia, headache and general malaise. In addition to these, the most important symptoms of secondary syphilis, however, occur in the skin, mucous membranes and appendages. In particular, a generalized rash appears which can have a very variable appearance, often asymptomatic or associated with mild itching. For example, small diffuse round spots may arise, reminiscent of the typical measles rashes. These manifestations also disappear spontaneously after a few weeks.
The patient, after the regression of the secondary phase, enters a long latency period, which can last for months or even years. During this period, the patient has no symptoms, however the infection and contagiousness remain. At the end of this apparent "calm", Treponema "reactivates" and can cause permanent damage to the heart, brain, bones, skin and other organs. At this point, syphilis has fully entered the tertiary phase, which is fortunately very rare today. In tertiary syphilis the most important manifestations are those affecting the central nervous system, with degenerative changes in the nervous tissue of the brain and spinal cord. In the so-called neurosyphilis, progressive degeneration can cause personality changes up to dementia and inability to control muscle movements up to paralysis. The damage can be severe enough to lead to the patient's death.
At this point, a paranthesis relating to congenital syphilis and the consequences it can cause is necessary. We have seen several times that syphilis can be contracted during pregnancy by the passage of bacteria through the placenta. In this case, the infection does not involve any primary lesion, because the spread of treponemes occurs through the hematogenous route. However, when a baby is infected during the long passage through the birth canal, the process is more similar to that described for acquired syphilis. As for the consequences on the fetus or newborn, it should be emphasized that syphilis can cause malformations and other very serious problems, such as bullous eruptions on the skin, pneumonia, blindness or even miscarriages.
Let's now look at how syphilis can be diagnosed. From what you understand, the disease is not particularly easy to diagnose clinically, as symptoms tend to regress between one phase and another. The suspicion of the disease may be guided by the set of symptoms reported by the patient. However, it is not always easy. realize that you have contracted syphilis, either because of the absence of significant symptoms, or because the lesions are present in hidden locations. In addition, it may happen that some symptoms of syphilis are mistaken for those of other less serious diseases, thus delaying treatment The diagnosis can be confirmed by the search for treponemes in the exudate and by the positivity to specific serological tests. Treponema pallidum is highlighted with microscopic observation in the dark field. In practice, the secretion of a syphiloma is smeared on the slide and looked at fresh. In this way the Treponema can be identified by its typical helix shape, moreover it appears mobile and bright on a dark background. In addition to microscopic analysis, the presence of the bacterium in the blood can be highlighted with a serological test. I'll explain. Starting from the infection, Treponema begins to enter the bloodstream. Serological tests are therefore aimed at detecting the possible presence of antibodies against the bacterium already in the early stages of infection. Through this analysis it will be possible to understand if syphilis has been contracted and at what stage the patient is, so as to begin the most appropriate treatment.
The antibiotic therapy of choice for the treatment of syphilis is based on penicillin. Only in patients allergic to this active ingredient are other drugs used, such as doxycycline and tetracycline. The doctor will rely on the stage of the disease to determine the correct dosage and duration of treatment. It is important to emphasize that therapy is most effective if started in the early stages. In fact, it does not allow to remedy any damage occurred to the various organs in the most advanced stages of the disease. Of course, it is necessary to carry out diagnostic tests and treatment on the patient's sexual partners as well.Not only that: to avoid infecting your partner, abstinence from any type of sexual intercourse is mandatory, at least until the lesions caused by syphilis have completely healed. It must always be kept in mind that wounds and skin ulcers, in fact, can transmit the infection even during oral sex or any other skin contact with infected areas. Finally, it should be remembered that, once cured, one does not become immune to subsequent infections. This means you can get syphilis again.
There is still a very important consideration to be made before concluding. Those with syphilis are at greater risk of being infected with HIV, the virus responsible for AIDS, because skin lesions represent a gateway for the virus. As we have repeated several times, syphilis, like other sexually transmitted diseases, can be transmitted from an infected partner during sexual intercourse. It is therefore clear that a good preventive measure is represented by the correct use of condoms during sexual intercourse of any kind, including the exchange of sex toys.
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