CAMAGÜEY.- Although the subject of syphilis is not alien to us, it is appropriate to address it given the importance of unknown details, because when considering it as easy as we sometimes think, false visions and even myths are created around it.

Syphilis is a predominantly sexually transmitted infectious disease (STI) caused by the bacteria Treponema pallidum. This causes the infection by penetrating the skin or mucous membranes, usually the genitals, this is how Dr. Yaima Estela Leyva Varona, specialist in MGI and Dermatology, Master in Infectious Diseases, from the municipality of Sibanicú announced.

-What are its main characteristics?

—Its route of transmission is sexual and it is suggested that it consists of a systemic disease, which runs through two periods that are opposed to each other; the first is called early syphilis and corresponds to the first year of evolution of the disease, a stage in which it is highly contagious, since the symptoms disappear without leaving sequelae and does not compromise the life of the patient.

“However, in the second period, which is called late syphilis, it appears from the first year of the evolution of the disease, it is no longer contagious and the symptoms that do not disappear do leave sequelae, affect health and can compromise the life of the sick.

“A pregnant woman can transmit it through the placenta, and it is also known that it is contracted by direct contact with the lesions, the chancre cannot be manipulated and that is strategic in health personnel, so protection is vital.

“If a pregnant woman has syphilis, mother-to-child transmission can occur, which would be congenital syphilis, and it is usually devastating for the fetus if the maternal infection is not detected in time, so that it can be treated early in its gestation.

"It is considered an eminently vascular disease, with the exception of the syphilitic gum (nodule) that constitutes a manifestation of benign late syphilis and is associated with a hypersensitivity or hyper immune response."

—Even though it seems obvious, is it a disease from the era or from modern times?

—It is as old as humanity, it was already endemic in the years 1472-1473. There are those who assure that it was introduced in Europe by those who traveled with Christopher Columbus and returned from Haiti; however, others assure that it had been installed on that continent before, only that it was not known and was called in various ways.

“From then on a great epidemic developed throughout Europe and at that time it was treated with mercury salts, with high doses, and even intoxication was reached, it is suggested that the symptoms and signs of syphilis were already part of a tertiary syphilis, and that is why that arises from: A night with Venus —Goddess of love— and 20 years with Mercury —for the treatment, although this caused relapses in the patient and continued to be transmitted”.

—Does it have an incubation period?

—Between 10 and 90 days, with an average of 21 days. This is important because when you have a case of syphilis you are required to look for infectious contacts three months before.

—Is there a first symptom?

—The entrance gate of treponema is the skin and mucous membranes, and some authors report that it enters the body through intact skin and mucosa and others that the latter occurs when the skin is previously injured.

“The bacteria enter and through the lymph reaches the lymph nodes, there it multiplies, passes into the bloodstream, and spreads, goes through an incubation stage and then the first manifestation of syphilis appears, which is called syphilitic chancre, it lasts between one and five weeks and begins at the exact place where the bacteria enter and initially appears as a papule until it becomes a chancre, which can be one or more”.

—Does it always appear on the genitals?

—90% and the other 10% extra genitalia; in the case of men in the glans, foreskin, in the body of the penis, in the root of this —condom gap— and they say this because it is infected despite using a condom, in the scrotum, in the urinary meatus, in the anus, in the mouth, in the hands, the navel, and in any part of the body.

"Women may not be aware of it because it can come out through the vagina, the cervix, and they are cases that do not show signs, although they also come to light in the clitoris, external labia, rectum ...".

—It doesn't hurt or itch. That is why sometimes the patient does not go to the doctor and since it is a resolute lesion, it disappears and passes as if he did not suffer from anything.

“It lasts from one to five weeks, disappears spontaneously and remains symptom and signs -free for a time and there is talk of a second incubation period and it returns as a storm in a clear sky and it is when it is known as syphilitic secondary with a series of clinical manifestations that affects the skin, mucous membranes and more spectacular signs. Sometimes the affected person goes to the doctor and not infrequently it is interpreted as other diseases, hence syphilis is called the great simulator.

“Sometimes it can be seen in the form of macules —macular syphilis— and the patient realizes when bathing because they do not hurt or itch, even, it is mistaken even for hives, or in other forms or as reddish papules and affects the palms of the hands and feet, and I repeat, asymptomatic, and they are the most frequent, but it still presents as ulcers and in other ways”.

—You mean it can lead to confusion?

—Yes, without a doubt. Even in the newborn, congenital syphilis manifests itself in the form of blisters.

"When it affects the hair of the scalp, it leaves alopecia especially at the level of the parietal, occipital and temporal regions, it is as if they were the 'cockroaches' identified by the population, and they do not itch or hurt and it can be reversed, it does not leave a scar, as with the fall of the brow tail. The nails are also altered”.

—Are there no other symptoms than visible ones?

—Yes, the person reports joint pain, general malaise, fever, especially in the evening, skin rash, ophthalmological affectations, hoarseness, dysphonia, and in the cardiovascular system the known murmurs and other affections, enlargement of the liver, anorexia, infectious mononucleosis , just to mention a few, with a duration of between two and six weeks and from there a so-called early latency begins and symptoms and signs disappear, in about six months and then we have the second period in which the patient can heal spontaneously, in fact in 33% of them it happens, in another 33% they remain in a latency, that is, free of symptoms and signs and in 34% they develop late syphilis, either neuro-syphilis, which is when it affects the nervous system, cardiovascular or late benign, which are nodules on the skin and sometimes internal organs, and at this stage it is no longer contagious, but the sequelae are irreversible.

"Anytime the disease appears it can be curable, but in the face of these sequelae, unfortunately they remain."

—Can it be passed on to the family?

—Especially the early one. Of course, I mean, in all cases, patients without treatment. It can only be cured with treatment, in any of its stages.

—How could it be detected early?

—Through reactive serology, which is an essential laboratory test for its diagnosis and is ordered at the slightest suspicion of the disease. It is a cheap method and with the appropriate indication and repetition it helps us to determine the clinical evolution of the disease and how it decreases. What is uncertain about this test is that it reveals itself as positive for other ailments such as a simple flu or other chronic conditions, among others, hence the importance of monitoring when in doubt.

“There are also other specific tests, which are performed in pregnant women, and thus the doubt is left out because, unlike serology, they always remain positive. Some treated patients maintain reactive serology throughout their lives ”.

- Is that why serology is done on all pregnant women?

—Of course, it is done in the first, second and third trimesters of pregnancy, which is why Cuba exhibits such good results in this regard.

—If the use of a condom runs the risk of being infected, what would be the best way to prevent it?

—The correct and uniform use of condoms significantly reduces the risk of infection; however, maintaining a stable partner is essential and that both are, so there is no possibility of acquiring it through sexual intercourse.

"It is important that people know about this disease, know their body and go to the doctor before any changes detected."

—Always go to the dermatologist?

—The family doctor is trained to find out what is happening and who conducts the first survey is responsible for looking for the chain of transmission, then refers the patient to a specialist in dermatology.

Before any manifestation, the patient should never self-medicate, or feel sorry to go to a doctor, this can delay the good process against the disease.

Translated by Linet Acuña Quilez