Uncovering the Real Story: Syphilis in a Single Case Study

Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It usually enters the body after unprotected sexual contact through oral, vaginal, or anal routes. It can also spread through homosexual contact, needle prick injuries, blood transfusions, or using infected syringes. Additionally, it can pass to a baby during pregnancy and sometimes through breastfeeding. Syphilis is commonly seen in individuals who have multiple sex partners, sex workers, and injection drug abusers.

Stages of Syphilis

Primary Syphilis:Primary syphilis usually appears as a smooth, hard sore known as a chancre. It appears on the penis, vagina, anus, or oral cavity where the bacteria enter the body. It typically appears 2 to 12 weeks after sexual exposure. The chancre is painless, does not itch, and can last for weeks to months before disappearing. However, its disappearance does not mean the infection is gone. Syphilis is easily treatable at this stage, and both partners need to be treated. If not treated, it can progress to secondary syphilis.

Secondary Syphilis:A few months after the disappearance of the localized sores of primary syphilis, reddish bumpy sores appear. These sores are generalized and can appear on the chest, abdomen, back, hands, palms, and soles. Like primary syphilis, these sores do not itch. During secondary syphilis, individuals may also experience constitutional symptoms such as fever, weight loss, swollen lymph nodes (lymphadenopathy), and hair loss. These generalized sores can last for months to years before going away. Individuals at this stage can also pass the infection to their sexual partners.

Latent Syphilis:If not treated at the secondary stage, the individual moves towards the latent stage. In latent syphilis, the generalized sores go away, and some individuals may experience milder flares of symptoms. Latent syphilis can last for several years. During this stage, the infection can cause organ damage. It is very rare to pass the infection to a sexual partner in this stage.

Late or Tertiary Syphilis:Only around 20% of individuals progress to late syphilis. Individuals in the late stage show systemic symptoms of organ damage, including:

• Cardiovascular System: Valvular heart diseases, cardiomyopathy, and aneurysm.

• Central Nervous System: Seizures, dementia, tremors, and other cognitive problems.

• Musculoskeletal System: Muscular weakness, muscular atrophy, joint damage (especially large weight-bearing joints), and osteoporosis.

• Eyes: Vision loss and blurring of vision.

• Ears: Conductive hearing loss and labyrinthine vertigo.

• Neuropsychiatric Symptoms: Irritability, depression, psychosis, and personality disorders.

Case Presentation

A 36-year-old male, a chronic alcoholic, smoker, and divorced for the last 8 years, presented with a complaint of a sore over the glans penis for 1 week. The sore was not painful and did not itch. He had been taking treatment from a local chemist, but it had not healed.

Examination:He was conscious, alert, and afebrile at the time of examination. His vitals were stable, and his general physical examination was normal. Local examination revealed a non-tender, hard sore over the glans penis, appearing as a chancre.

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History:The patient revealed that he had unprotected intercourse with a sex worker around 1 month ago.

Tests:Blood tests were conducted for diagnosis and differential diagnosis. His viral markers were normal except for a positive VDRL test and a positive test for Treponema pallidum.

Treatment:His chancre disappeared within 10 days of treatment. He was further advised to repeat the HIV test after six months, as it can be false negative during the window period.

Conclusion

STIs are easily treatable in the initial stages, but people often seek medical help late due to fear and shyness. The chances of contracting HIV increase fourfold with STIs. It is best to be loyal to your partner and always use barriers (condoms) during intercourse.