Don’t Go There

 Don’t Go There

Peter Galvin, MD

Unfortunately, sexually transmitted infections (STIs) are on the rise. These infections, formerly known as sexually transmitted diseases or venereal diseases, are transmitted by unprotected sexual contact and can be oral, anal, or vaginal, yet the risk of catching them during sexual activity can be substantially reduced by using something as simple as a condom. There are different types of STIs including bacterial diseases (syphilis, gonorrhea, and chlamydia), viral diseases (herpes, HIV/AIDS, genital warts [caused by human papilloma virus, or HPV], and hepatitis B), and parasitic diseases. There are vaccines for some viral diseases like hepatitis B, HPV, and herpes, but vaccination is not 100% protective. In many cases, early infection may be asymptomatic. Also, a pregnant woman may pass some of these diseases to her newborn child, for example, congenital syphilis. Let’s look at syphilis.

In the U.S., the rate of syphilis infection has increased over the past two decades, with 41,655 new cases reported in 2020. Half of these cases were in men who have sex with men, but the rates in women also increased, as did the rate of congenital syphilis. Syphilis can present at different stages. Primary syphilis usually appears as a painless ulcer (called a chancre) on the genitals or mouth. Chancres usually heal on their own in three to six weeks, so they may go unnoticed and untreated. Without treatment, about 25% of people will develop secondary syphilis, which involves spread of the bacteria (Treponema pallidum) to the bloodstream. Symptoms of secondary syphilis usually appear four to 10 weeks after the primary infection and include a whole-body red rash (includes the palms and soles) and flu-like symptoms. Without treatment, secondary syphilis is followed by latent syphilis, a period during which patients have no symptoms, although the infection is still in the body. Tertiary syphilis can occur years to decades after the initial infection and may cause enlargement of the aorta (aneurysm), resulting in cardiac valve dysfunction and heart failure, as well as bone fractures and painful skin ulcers. Neurosyphilis can occur at any stage and may cause meningitis, stroke, hearing loss, blindness, paralysis, and dementia if untreated. Congenital syphilis can cause stillbirth or infant death. Children with it may develop skin rash, teeth, bone, and facial abnormalities, visual impairment, deafness, and intellectual disability.

Early detection and treatment of syphilis is vital. Blood tests for syphilis include the rapid plasma reagin (RPR) test and the venereal disease research laboratory (VDRL) test. Another test is a polymerase chain reaction to detect T. pallidum in the blood. Those who got married more than 30 to 35 years ago may recall that back then NYC required a negative VDRL in order to get a marriage license. Sexual partners of those with a syphilis infection should be tested, and annual testing is recommended for those at high risk, including those with HIV and men who have sex with men. Pregnant women should be screened on their first prenatal visit and, sometimes, again at 28 weeks of gestation. Treatment of choice for early, uncomplicated syphilis is one dose of intramuscular or intravenous penicillin. For those allergic to penicillin, alternate antibiotics or penicillin desensitization can be given.

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