James Morgan MS
Introduction:
Syphilis, caused by the spirochete Treponema pallidum, has a long history of human involvement, with recorded outbreaks dating back to the 1400s. (1) The majority of syphilis cases are sexually acquired, but any contact with spirochetes may lead to infection (2). Because syphilis has been recorded for so long, including the pre-antibiotic era, the disease course with and without treatment is well understood. Additionally, the infamous Tuskegee trial followed 431 black men with untreated syphilis, even though there was a known cure.(3)
Treponemal infection elicits both an adaptive and humoral immune response. The duration and progression of infection depend on the immune response mounted. (4) Stronger delayed-type hypersensitivity (DTH) reactions are associated with a better outcome, with total eradication of spirochetes in some cases; however, the majority of untreated cases proceed to prolonged latency. Individuals that respond initially with antibody production or a cytotoxic CD8 response are more likely to progress to secondary and tertiary disease. In primary syphilis, a delayed-type hypersensitivity reaction (DTH) is responsible for a painless well-circumscribed chancre. An initial cytotoxic t-cell response is associated with prolonged infection and progression to tertiary disease.
Discussion and Conclusion:
Although syphilis is highly infective and has poor outcomes if left untreated, the disease is easily treated with inexpensive and widely available medications. However, despite the treatment being so simple, barriers to care, including lack of insurance, lower socioeconomic status, and lack of health education, prevent pregnant mothers from being treated and syphilis from being eradicated. By ensuring each pregnant woman is screened for syphilis and treated if positive, many of the complications of syphilis can be avoided, thus providing better health and quality of life to both the mother and child.