Syphilis and Etiology

Syphilis in Penis Male
Syphilis Ulcer in Male
Syphilis is an infectious disease which caused by Treponema pallidum. its a chronic and systemic diseases which during the course of the disease can affect all organs of the body. There is a latency period without manifestations of lesions in the body. Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex.
Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact. Although this disease is spread from sores, the vast majority of those sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to his or her sexual partner.

        In 1905, the cause of syphilis was discovered by Schaudinn and Hoffman, namely Treponema pallidum, which includes order Spirochaetales, Spirochaetaceae family, and the genus Treponema. Regular spiral shape, length between 6-15 um, 0.15 um wide, consisting of eight to twenty-four indentations. Its movement along a rotation axis and forward like a corkscrew motion. Breed, the transverse division, during the active stages occur every thirty hours.

        Classification of syphilis is very difficult to do, because Treponema species can not be cultured in vitro. As a basis of differentiation, there are four species, namely Treponema pallidum sub-species pallidum that causes syphilis, Treponema pallidum sub-species pertenue that causes Frambutia, Treponema pallidum sub-species endemicum  that causes bejel and Treponema carateum causes pinta.

      Treponema pallidum enters the body through mucous membranes (such as in the vagina or mouth) or through the skin. Within a few hours, the bacteria will get to nearby lymph nodes and then spreads throughout the body via the bloodstream. Syphilis can also infect the fetus during pregnancy and cause birth defects.

Syphilis Ulcer in Vagina Female
Syphilis Ulcer in Female

Etiology of Syphilis 
A. Morphology and Identification
        Treponema is derived from the Greek word "Trepein" means spinning and "NEMA" means the thread. Treponema a smooth spiral, 5-15 microns long and the diameter of 0009 to 0.5 microns. Each curve of the wave within 1 micron and an average of every germ consists of 8-14 waves. Actively engaged and due to the spiral shape is very subtle, it can only be seen by dark field microscopy or by immunofluorescence techniques. Hard colored with aniline dye, but can reduce silver nitrate to metallic silver which stay attached to the surface of germ cells. By silver impregnation Levaditi , these germs in the tissue can be seen clearly.

        These bacteria reproduce by transverse fission. T. pallidum is pathogenic to humans, has never been successfully bred in a hatchery definitely unusual, seed tissues or in eggs germinate. Reiter strains were successfully grown anaerobically in vitro, perhaps only a saprophyte germs, but morphologically similar to T. pallidum. These strains require growth media containing 11 kinds of amino acids, vitamins, salts, minerals, and serum albumin.

Treponema Pallidum
Treponema pallidum  as seen with Dark-field Microscopy

        In anaerobic state at a temperature of 250C, T. pallidum can stay alive and move on for 4-7 days, if stored in a liquid seed containing albumin, sodium carbonate, pyruvate, cysteine​​, and bovine serum ultrafiltrate. In fresh blood or plasma were stored at 4 ° C, the bacteria still can survive for at least 24 hours. This fact needs to be considered if it will do a blood transfusion. There is a strain of T. pallidum that can be cultured in rabbit testes, this strain is known as the Nichols strain. In the dry state of T. pallidum will quickly die, neither do the 42 ° C temperature.

      This fact is utilized in the treatment of fever (fever therapy) for syphilis. Arsenic, mercury and bismuth can lead to immobilization and death of germs that cause syphilis. These effects can be accelerated by high temperatures, otherwise bacteria can be reactivated if the given compounds containing-SH groups, such as cysteine ​​or BAL. Although in small doses, penicillin remains the treponemicide, only the effect is less rapid, probably because the effect of the development rate is not fast enough germs. As is known, the time division germs approximately 30 hours.

B. Antigen

        There are 3 kinds of antigens, in the form of protein that is not heat resistant, heat-resistant polysaccharide and lipoid antigens similar to the material in cardiolipin. If the review is based from specification, then there are only 2 kinds of antigens, ie antigens contained in several different genera and antigens that are limited to one or a few species.

       Treponema antigens typical among others, can be checked with the Treponema pallidum immobilization test (TPI = T. pallidum immobilization test). TPI test is actually a bactericidal reaction that requires the presence of complement, incubation in an anaerobic atmosphere for 18 hours and the temperature of 35oC. A positive test result if bacteria can not move anymore which means dead. This test is very specific, but it can not distinguish between syphilis with other Treponematosis.

      Protein antigen found on most Treponema, both pathogen species or the sporophyte, a macro-borne RNA molecules. This antigen is used to test the binding of complement proteins using Reiter (Reiter protein RPCF = complement fixation). These antigens or proteins that are very similar to these antigens, which can be found on the Treponema flora living in the human digestive tract, therefore antibodies to it can be found in human serum. Although this antibody levels are generally very low, but it can sometimes give a positive result on the test RPCF.



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