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Syphilis

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The natural history of syphilis is very variable. The course of the infection spans many years and may lead to various clinical presentations, which are classified into early (infectious) and late (non-infectious) stages. Early syphilis may be further divided into primary, secondary, and early latent syphilis; late syphilis includes late latent and the various forms of tertiary syphilis. The immune response to syphilis involves production of antibodies to a broad range of antigens, including non-specific antibodies (cardiolipin or lipoidal) antibody and specific treponemal antibodies.
The bacterium Treponema pallidum is a spirochetal bacterium that is the cause of syphilis. T. pallidum is a spirochete it can range from 6 to 20 um in length and 18 to 20 um in diameter it requires low amounts of oxygen which it is able to draw from the atmosphere around it. Spirochetes are usually Gram negative but T. pallidum will not show up on a gram stain because the organism is too thin. It can however be detected using special stains such as the Dieterle stain. Spirochetal bacterium have long helical shaped cells the reason for the helical shape if because of the different arrangement of the axial filaments which is known as endocellular flagella the filaments run the length of the cell causing the spiral shape, these flagella are used to move the spirochete. Spirochetes are usually found in liquid environments such as blood, lymph or water. (Encyclopedia Britannica 2010.) Syphilis can present in four different forms, Primary, Secondary, Latent and Tertiary. These forms of syphilis all present with different symptoms and they all progress from each other. Primary syphilis is the first stage of the infection this is where a sore or Chancre, which can be more than one appears at the site of the infection, it is small and white and usually painless this usually heals in 2 to three weeks. The symptoms of the secondary stage of syphilis are a skin rash and mucus lesions, the rash usually appears first in one or more places on the body usually the palms of the hands and the soles of the feet. The rash can appear as the chancre is healing or two to six weeks after.
Treponemal EIAs are an appropriate alternative to the use of combined Venereal Disease Research Laboratories/rapid plasma reagin and Treponema pallidum haemagglutination assay (TPHA) tests for screening for syphilis. If a treponemal EIA is used for screening an alternative treponemal test, such as TPHA, should be used for confirmatory testing. The fluorescent treponemal antibody-absorbed test is probably best reserved for specimens giving discrepant results. Serology remains the mainstay of laboratory testing for syphilis, except during the very early stage of infection when direct detection of treponemes in material from lesions by dark ground or fluorescent microscopy is necessary. Certain characteristics of syphilis make it amenable to serological screening. It is an important health problem, there is a recognized latent phase, validated serological tests are widely available at relatively low cost, there are serious adverse effects if cases are missed (stillbirths, congenital syphilis, further adult sexual transmission, tertiary syphilis), and effective treatment is available

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