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Introduction
Despite numerous attempts to protect society against sexually transmitted diseases by educating, counseling, and offering specially developed devices like condoms, millions of people admit that they have already faced or are currently having some problems. This type of disease is usually passed from one person to another during intimate physical contact. Syphilis is one of the sexually transmitted infections that may lead to serious health problems. Its prevalence, incidence, mechanism of action, causes, and symptoms will be discussed in this paper to explore the main aspects of treatment, education, and prevention of syphilis among different people, including pregnant women.
Prevalence and Incidence
A person who has vaginal, oral, or anal sex with another person infected with syphilis can get this disease. If this sexually transmitted disease remains untreated for some time, it may lead to serious health problems and change the quality of life considerably. According to the Centers for Disease Control and Prevention (2017), the rate of reported syphilis has dramatically raised during the last decade: about 8.7 cases per 100,000 population. The peculiar feature of the chosen disease is its possibility to be spread from an infected woman to her baby during pregnancy. Treponema pallidum is the main cause of syphilis that is observed in about 1.5 million women annually (Wahab, Ali, Mohammad, Monoto, & Rahman, 2015). In addition to 36% of women with syphilis, the disease is also observed among 15% of men, and this rate is still growing in different countries (Centers for Disease Control and Prevention, 2017). Syphilis must not be ignored.
Transmission, Symptoms, and Clinical Presentation
Transmission of syphilis using unprotected sexual partnership is not the only possibility to be infected. Stoltey and Cohen (2015) focus on such ways of transmission like the one via blood products or organ donation. Though much work has already been done to avoid serious complications and the development of the disease, a blood transfusion can be a threat and a potential cause of this disease. Also, human bites that may be of a sexual and non-sexual character, as well as mouth-to-mouth feeding are reported as the possible transmitters of syphilis (Stoltey & Cohen, 2015). As a rule, the lack of human immunity results in the possibility of re-infection
Syphilis is a disease that may have different stages. Patients may have prior syphilis that is characterized by the presence of a chancre that can only be exposed in several weeks due to its painlessness (Park et al., 2018). In many cases, syphilis lesions heal in one or two months even if therapy is not used. Therefore, many patients infected with syphilis continue living their normal sexual lives without even knowing that they have already been infected. The second stage is diagnosed when multiple mucocutaneous lesions like a rash or patch are found. Syphilis may also be early latent (when no symptoms are observed, but reactive treponemal tests prove the disease) and late latent syphilis (when no evident signs are observed, but the damage of the brain, nerves, and blood vessels occur because of the bacteria in the body) (Park et al., 2018). It is recommended to address a doctor and take the required tests as soon as any unknown rash appears in the groin area.
Pregnant women can infect their unborn children with syphilis. This condition is known as congenital syphilis when the infection occurs through the placenta. Newborns do not usually have any symptoms. Sometimes, rashes or palms of hands or feet take place that without on-time diagnosis and proper treatment can result in deafness or saddle nose (Tampa, Sarbu, Matei, Benea, & Georgescu, 2014). Facial and dental abnormalities may be reported with time. Therefore, a physical examination of mothers and blood tests to check the presence/absence of syphilis is a significant step during pregnancy.
Treatment Modalities
Treatment that can be offered to patients with syphilis depends on a variety of aspects. First, the mechanism of action of the chosen drugs should be studied. Then, all side effects have to be identified. Finally, interactions between drugs and food should be evaluated to be sure the chosen modality does not harm patients. In this paper, penicillin-based treatment is recommended. In case a patient is allergic to this medication, its desensitization with the help of penicillin G can be offered. Ceftriaxone and azithromycin therapy during two weeks may become an effective alternative to a penicillin (Clement, Okeke, & Hicks, 2014). However, in most cases with pregnant women, alternatives to penicillin should be avoided because of possible fetal toxicity.
As well as many other antibiotics of the b-lactam group, penicillin inhibits bacterial cell growth and kills the dangerous bacterium. Penicillin-binding proteins are responsible for the synthesis of peptidoglycans. As a result of this type of synthesis, a protective envelope is created around the bacterium. Enzymes can weaken the work of bacteria cells, prevent their replication, and cause their death (Clement et al., 2014). Ceftriaxone is from the same family of antibiotics, meaning that its mechanism of action is identical. Azithromycin has a similar mechanism of action, inhibiting bacterial protein synthesis through nitrogen present in the cells.
These medications are characterized by a list of similar side effects that can be observed among the patients of both genders, including pregnant women. For example, frequent cases of diarrhea, vomiting, and stomach pain should be mentioned (Tampa et al., 2014). Anemia and seizures may be observed. Still, these effects may be a result of a fast-spreading disease. In addition to the threat of an allergy being developed, the side effects of the offered drugs include bleeding, fever, and itching. However, each case is unique. Therefore, thorough observations and reports are recommended.
At this moment, drug interactions are under discussion. For example, bacteriostatic antibacterials may antagonize the work of penicillin. The combination of ibuprofen, paracetamol, or Tylenol with penicillin is also possible. The same recommendations are given to ceftriaxone and azithromycin. Food intake should occur before the drug is used. Alcohol or the change of the medication must be avoided without communication with a therapist. Blood tests and the analysis of cerebral spinal fluid are obligatory as the main laboratory testing tools for patients with syphilis. The stage of the disease, as well as the chosen therapy and outcomes, do not matter in the decision. Enzyme immunoassay tests show if any antibodies are in the blood.
Prevention and Education
Patients have to be educated about the necessity to choose safe sex and limit the number of sex partners. Monogamy in the relationships is the best practice to avoid syphilis. Education should include information about various preventive tools like condoms that must be given. It is also recommended to test the blood regularly and ask the partner to do the same to make sure there is no infection. Finally, patients should be aware of the risks of overdose, the threats of having sex with a person of the same gender, and the possibility of HIV.
Conclusion
In general, syphilis may be easily prevented in case people learn its causes, understand its prevalence, and take the necessary steps to avoid its threats. Though it has different forms of development, its treatment is usually the same for both men and women. Only in case of an allergy, it is recommended to replace penicillin with another appropriate drug such as ceftriaxone or azithromycin.
References
Centers for Disease Control and Prevention. (2017). 2016 sexually transmitted diseases surveillance: Syphilis. Web.
Clement, M. E., Okeke, N. L., & Hicks, C. B. (2014). Treatment of syphilis: A systematic review. JAMA, 312(18), 1905-1917.
Park, I. U., Fakile, Y. F., Chow, J. M., Gustafson, K. J., Jost, H., Schapiro, J. M.,& Bolan, G. (2018). Performance of treponemal tests for the diagnosis of syphilis. Clinical Infectious Diseases. Web.
Stoltey, J. E., & Cohen, S. E. (2015). Syphilis transmission: A review of the current evidence. Sexual Health, 12(2), 103-109.
Tampa, M., Sarbu, I., Matei, C., Benea, V., & Georgescu, S. R. (2014). Brief history of syphilis. Journal of Medicine and Life, 7(1), 4-10.
Wahab, A. A., Ali, U. K., Mohammad, M., Monoto, E. M., & Rahman, M. M. (2015). Syphilis in pregnancy. Pakistan Journal of Medical Sciences, 31(1), 217-219.
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