Testing for Syphilis
According to a 2015 report by the Center for Disease Control, around 15 of every 200,000, or .0075% of individuals in the United States reports contracting syphilis, a rare but potentially devastating sexually transmitted disease. Left untreated, syphilis can have unalterable and fatal repercussions, but with the proper care and management, is completely treatable. Syphilis is a bacterial genital ulcerative disease that develops in stages, which are characterized by their symptomatic manifestations, or by their latency. Syphilis is almost always symptomatic, but symptoms may take months or even years to appear, so it is possible to acquire or transmit the disease without knowledge.
Timing is extremely important in understanding the effects of syphilis, as each stage has its own associated symptoms, appearance, severity, and treatment. It is crucial to recognize syphilis early on, as it becomes more and more dangerous as time passes, and deadly once it reaches the tertiary (post latent, third symptomatic) phase. It is also heavily linked with the facilitation of HIV transmission and acquisition. So, how do you find out if you have syphilis?
Syphilis is a contagious bacterial disease caused by the Treponema Pallidum bacterium, which is transferred via direct, typically sexual, contact with the lesions or bodily fluids of an infected individual. Syphilis is a phasal disease, as it progresses through specific, sequential stages, with very little variation from person to person. So, how long does syphilis last? If diagnosed and treated in the primary or secondary stages, syphilis can be eliminated from the body within days. If untreated, the disease can last for several decades, usually ending in fatality. The first stage has the least severe symptoms, while the final stages, if left untreated, can be destructive.
These stages can progress quickly or take decades to manifest, but how do you know if you have it? First, we take a look at the symptoms of the syphilitic stages.
What are the Symptoms and Stages of Syphilis?
The first symptoms of syphilis can occur from as soon as 10 days to as long as 3 months after acquisition. The average onset of syphilis symptoms is 21 days. So, what should you look for?
The first, or primary stage of Syphilis is mild and can go by unnoticed, even when symptomatic. The first sign of syphilis is the appearance of one or multiple chancre sores at the primary site of infection. Chancre sores are typically firm, round, and painless. Chancres start as pustules, spots with hard sloping edges with a fluid filled center, capable of bursting when pressure is applied. Since syphilis is a sexually transmitted infection, chancres can occur on, in, and around the genitals, on the anus, in the rectum, or on the upper and inner thighs. Syphilis can also be contracted in the mouth or throat, with oral chancres typically located on the pharynx. The chancre pustule then scabs over to become an ulcer, which takes about 3 to 6 weeks to heal fully, regardless of treatment or lack thereof.
The secondary stage of syphilis is markedly more severe and may overlap with the healing process of the primary stage. The first sign of secondary syphilis is a reddish-brown rash upon several areas of the body. The most characteristic area of syphilitic rash is on the palms and the bottom of feet, but rashes like this and other skin inflammation may occur elsewhere on the body. These body rashes often resemble those of other diseases and conditions, such as contact dermatitis, acne, chicken pox, etc. This characteristic has lead to syphilis’s acquisition of the moniker, “The Great Pretender.” Syphilitic rashes are not usually itchy or painful, and can be so faint that they might not even be noticeable. Along the mucous membranes and warm, moist areas of the body, such as the mouth, throat, genitals, and anus, and underarms, large white or grey lesions appear. These are known as Condyloma Lata, which contain vast amounts of infectious Treponema Pallidum spirochetes, making them highly contagious. These occur in about 33% of syphilitic individuals.
Other possible symptoms of secondary stage syphilis include:
- Hair loss
- Myalgia (muscle pain)
- Sore throat
- Swollen lymph nodes
- Weight loss
Just as in the primary stage, secondary symptoms will go away on their own accord with or without treatment. However, if untreated, the infection will progress to the next stage.
Around 30% of those infected with syphilis are currently living in the latent, or dormant period of syphilis. In the latent stage, there are no symptoms. The bacteria reside in the spleen and lymph nodes, inactive for 3 to 30 years. If untreated during the latent stage, the disease will develop into the tertiary stage.
The tertiary stage of syphilis may take years or even decades to arrive, but around 30-40% of all seropositive individuals will progress to it, since the undiagnosed primary and secondary syphilis followed by a long, asymptomatic period can lead to a false sense of security. Though at this stage in the infection the bacteria are typically no longer contagious, their effects on the body can be devastating. The bacteria living inside have at this point congregated and multiplied in one or more organ systems of the body. Common infections include those of the central nervous system, the cardiovascular system, the bones, and the skin.
- Cardiovascular Syphilis
- Gummatous Syphilis
Diagnostic tests are conducted with an array of methods. Syphilis shows up in blood tests and through direct observational methods. These blood tests can also be used to analyze cerebrospinal fluid or other bodily fluids to test for antibodies, and are known as serologic tests.
- Non-Treponemal Serologic Tests
- Treponamel Serologic Tests
- Direct Testing
Treponemal and non-treponemal tests should both be given in order to confirm the presence of T. pallidum spirochetes in the patient with 100% accuracy.
Since there are no commercially available direct T. pallidum tests, diagnosis requires laboratory testing. In fact, diagnosis requires at least one treponemal and one non-treponamel test in order for a conclusion to be drawn. Though there are treponamel tests available in the EU, none have been FDA approved in the US.
Non-Treponamel Serologic Testing
Non-treponamel tests have a higher likelihood of registering a false-positive, especially in combination with immunodeficiency, pregnancy, hypodermic drug use, and old age, and as such must be confirmed by a treponamel test. Non-treponamel tests are also useful in assessing the bacterial activity in the body, and its response to treatment, by measuring the antibodies’ titers, or their concentration within a serologic sample. Though VDRL and RPR tests are both valid diagnostic methods, their results cannot be compared to monitor progress or infection, as they are likely to show different titers in their samples. As such, the patient should stick with the same non-treponamel testing method throughout observation.
After treatment, titers usually decline in syphilis patients. However, in some patients, the antibodies remain active for a very long time, which is known as a “serofast” reaction. 15-25% of patients treated during the primary stage report nonreactive serologic samples after a period of 2 to 3 years. The main benefit of non-treponamel serologic tests is their ability to monitor infection, which treponamel tests are unable to do.
Treponamel Serologic Testing
Reverse screening with ELISA or chemiluminescence immunoassays are able to identify those with a likelihood of infection, those who have been previously treated for syphilis, or those incompletely treated for syphilis. Those with positive treponemal results require a non-treponemal test for confirmation.
If the non-treponemal test returns negative, the lab should perform a different treponemal test in order to confirm or negate the original test result. If the result returns positive, the patient requires no more testing, and should begin treatment as their physician advises. Unless tests show early infection, patients should be treated for late-latent syphilis. If the second treponemal test returns negative, there is a very low likelihood of infection, and the patient may discontinue observation.
For those showing signs of neurosyphilis, such as nerve dysfunction, sensory impairment, meningitis, stroke, or altered personality, diagnosis requires serologic testing of the cerebrospinal fluid or CSF as well as clinical analysis of expressive symptoms. In early syphilis, CSF serologic tests are often abnormal.
CSF-VDRL tests are highly specific, but can be insensitive. In contrast, CCSF FTA-abs tests are not as specific, but are highly sensitive. It is advised that when testing for neurosyphilis, the patient be administered both tests or similar tests in order to cross-compare results and arrive at a diagnostic conclusion.
Testing Positive and Receiving Syphilis Treatment.
Testing is over, and you have received your results. If you find yourself face to face with a positive syphilis test result, take a deep breath. You are going to be okay. It’s common to feel scared, a little embarrassed, and perhaps ashamed, but there are several ways to get help, and you have modern medicine on your side.
Since it is a bacterial infection, syphilis is curable, with the obvious course of treatment being antibiotic medication. Which antibiotic the patient receives is dependent largely on what stage they reside in and which symptoms they are experiencing. But, does syphilis go away after treatment?
The answer to that question is murky. If caught and treated early on in the infection, the bacteria are destroyed and its effects can be reversed. However, if the infection reaches the tertiary stage, the bacteria can be eliminated, but some of the effects will likely be permanent.
- Early Infections
- Late Infections
For more information on syphilis treatment, click here.
To learn what to do if you think you have syphilis, click here.