Syphilis is a chronic infectious dips-ease caused by Treponema pallidum. From the portal of entry usually the genitals there is a lymphatic invasion and blood-borne spread (trip-anemia), and the infection is generalized from the beginning. Subsequently, the disease becomes localized and dispersed. The early lesions are benign and the late manifestations destructive in character. Several organs of the body may be involved, but late treponema and establishment of-further lesions occur rarely in the acquired dis-ease; this reflects the relative stability of the community that develops during the course of the disease.
The host response includes specific humored and cell-mediated immunity. The immune response can be detected by serologic and other tests. Despite its slow evolution and remarkable immunologic features, syphilis will, if untreated, eventually incapacitate one of three and kill one of ten infected persons.
Treponema Pallidum.T. pallid, discovered by Schaudinn and Hoffman in 1905, is a helical cell about 0.15 pc wide and 6 to 15 long. Around the central protoplasmic core is wound a bundle of three to four axial fibrils that provide the “muscle,” giving T. palladiums a characteristic motility pattern. Treponema. es undergo transverse fission. Multiplication time is 30 to 35 hours. palladium has not been cultivated in vitro. It can remain viable for many hours on special media, or indefinitely if preserved at extremely low temperatures (carbon dioxide ice, liquid nitrogen).
A few treponemes suffice to im-plant infection (Magnuson et al., 1956). Trans-mission is facilitated by moist conditions and congenital temperature and occurs almost exclusively by direct contact with infectious lesions. Injured or inflamed- areas will favor implantation. The author wishes to acknowledge the valuable advice, critical-cases, and suggestions by his colleague Dr. 0. Inspire, Consultant on Treponematoses, World Health Organization, Geneva, concerning this article.
Sexual transmission is the rule. Not infrequently genitor-oral, genitor-rectal or mouth-to-mouth transmission takes place. The chain of infection sometimes involves both heterosexual and homosexual practices. As many as 30 to 40 infected persons have been brought to treatment on the basis of a single index case. “Innocent” transmission by adults or children occasionally occurs. Contact between the infected host, the moist object, and the susceptible must be rapid to achieve in-direct transmission. Inoculation into the skin or a vein has resulted from an accidental needle prick.
An initial lesion does not arise in blood-borne transmission when it occurs in utero of pregnant syphilitic women (prenatal syphilis) or more rarely by blood transfusion from an infected blood donor (syphilis d’emblee). A macerated fetus and the mucocutaneous lesions of early prenatal syphilis are highly contagious. Infected individuals can pass asymptomatically through the early stages of syphilis for unknown reasons, as distinct from a misinterpretation of early trivial symptoms or their being “masked” by treatment of other conditions, e.g., gonorrhea. Physiologic secretions (salivary, vaginal, Seminal) may contain treponemes from contagious lesions. Direct intrauterine infection of the egg or the fetus from semen of a syphilitic male cannot arise. Epidemiology. The health of the public is affected when syphilis spreads within and between countries.
Propagation is facilitated by the properties of the agent, by its mode of transmission, and by behavioral, social, and several environmental factors. In recent years the climate of opinion concerning sexual behavior has become overtly permissive among the young. The pattern of pro-biscuity and of heterosexual and homosexual relations has altered. Industrialization, urbanization, migration, and unprecedented tourism have facilitated human contact and sexual encounters with the concomitant risk of acquiring the venereal disease.
Paradoxically, medical advancements have contributed in the same direction. Thus fear of infection has been removed by easy and effective anti-microbial therapy and fear of pregnancy by oral contraceptives and intrauterine devices. General-ly it has become clear that medical advancements have been to some extent outweighed by the com-plex ecologic forces in a rapidly changing environment. It has been recognized that new ways are