Therapy Analysis - Chlamydia, Gonorrhoea & Syphilis
Syphilis
Although previously a disease on the decline, incidences of syphilis, caused by the bacterium Treponema pallidum, have been rapidly rising since 2000. Latest figures show that between 2004-2005, the number of reported cases in the UK rocketed by 23% from 2,278 to 2,807. Many of its symptoms are indistinguishable from those of other diseases and it is thus known as 'the great imitator'. As with the other bacterial STIs discussed, syphilis infection is often asymptomatic and often remains untreated, which can lead to serious and perhaps even fatal damage to the heart, brain, eyes, other internal organs and nervous system.
Syphilis infection occurs in four stages: primary, secondary, latent and tertiary (late). The primary stage is usually marked by the appearance of a single, often painless sore, known as a chancre, at the area of bacterial entry - usually the penis or vagina. If left untreated, the infection moves to the secondary and most contagious stage, characterised by 'flu-like symptoms and more recognisably, the formation of a reddish-pink non-itchy rash, which unlike other kinds of rash may cover the palms of the hands and soles of the feet. If identified at these early stages, the infection can be easily treated with penicillin.
Latest figures show that between 2004-2005, the number of reported cases in the UK rocketed by 23% from 2,278 to 2,807.With the disappearance of secondary stage symptoms, the infection moves into a 'latent' stage, lying dormant in the body and showing no identifiable sign of infection for up to 10 years. Advancement of the infection to the tertiary stage occurs in around one third of untreated patients, where it is at its most dangerous and is characterized by soft, tumour-like growths called 'gummas', which can appear anywhere in the body. Common complaints are Charcot's joints (a degeneration of joint surfaces) and Clutton's joints (accumulation of fluid in the knee joint).
More serious manifestations of tertiary stage syphilis infection are neuro- and cardiovascular syphilis. Cardiovascular complications associated with syphilis include aortic regurgitation, which is caused by a leak in an aortic valve in the heart. This leads to blood flow in the wrong direction, and is a frequent cause of syphilis related death. Perhaps the more well known of latestage syphilis complications is generalised 'paresis of the insane' and is a psychiatric disorder resulting from neurological complications. Considered a psychiatric disorder before and during the 19th century when it was discovered, it now occurs in 15-20% of all tertiary syphilis infections and is both a progressive and lifethreatening condition, resulting from gumma formation in the brain or spinal cord. It can cause a wide variety of neurological deficits, including tremors, paralysis and seizures as a result of damage to brain cells.
The 'sexual revolution' has led to the rapid increase of both chlamydia and gonorrhoea, and with a 40% coinfection rate between the two infections, transmission seems to be highly interlinked. With a lack of gonorrhoeal treatment leading to a 5-fold increase in HIV susceptibility, and the known high co-infection rates of syphilis and HIV, the requirement for awareness, prevention and treatment of bacterial STIs has become higher than ever.
