SYPHILIS AND INFERTILITY (Part 2)

Last week, we started a topic on Syphilis and infertility. We discussed the risks, signs, symptoms and complications of syphilis. This week, we will conclude with diagnosis, prevention, treatment and its effect on male and female fertility

DIAGNOSIS OF SYPHILIS
Syphilis can be diagnosed by testing of blood and spinal fluids.
Blood screening tests: Blood tests are used to detect the presence of antibodies that the body produces to fight infections. The antibodies to the syphilis-causing bacteria remain in your body for years, so these blood test can be used to determine a current or past infection. Some of these tests includes:

• Venereal Disease Research Laboratory (VDRL) Test: The VDRL test is used to screen the blood for an antibody produced in people with syphilis. This antibody is not produced as a reaction to syphilis alone, so the test result could be positive for reasons other than syphilis.

• Rapid Plasma Reagin (RPR) Test: The RPR test also helps to find syphilis antibodies in the blood.

• Rapid Immunochromatographic Test: This test screens for antibodies that are specific to syphilis alone.

Cerebrospinal Fluid Screening Test: Nervous system complications may require collection of a sample of cerebrospinal fluid through a lumbar puncture for syphilis screening.

TESTS TO CONFIRM SYPHILIS
Tests used to confirm a syphilis infection include:
• Enzyme immunoassay (EIA) test: A positive EIA test should be confirmed with either the VDRL or RPR tests.

• Fluorescent treponemal antibody absorption (FTA-ABS) test: It can be used to find syphilis except during the first 3 to 4 weeks after exposure. The test can be done on a sample of blood or spinal fluid.

• Treponema pallidum particle agglutination assay (TPPA): It is used after another method tests positive for syphilis. This test is not done on spinal fluid.

• Darkfield microscopy: This test uses a special microscope to look for the syphilis germ in a sample of fluid or tissue from an open sore. This test is used mainly to diagnose syphilis in an early stage.

• Micro hemagglutination assay (MHA-TP): The MHA-TP is used to confirm a syphilis infection after another test shows positive results for syphilis.

PREVENTION OF SYPHILIS
There is no vaccine for syphilis. The only way to completely avoid getting syphilis is abstinence. The following can also help reduce the risk of infections:
• Having only one monogamous sexual partner.
• Using condoms during sexual activity
• Avoiding alcohol and recreational drugs (which can compromise your judgment, leading to unsafe sexual practices)

TREATMENT OF SYPHILIS
There are no home remedies or over-the-counter drugs that will cure syphilis, but syphilis is easy to cure in its early stages. Penicillin is one of the most widely used antibiotics and is usually effective in treating primary and secondary syphilis infection. People who are allergic to penicillin will likely be treated with a different antibiotic, such as:
• Doxycycline oral tablets
• Azithromycin oral tablets
• Ceftriaxone
Neurosyphilis can also be treated by taking daily doses of penicillin intravenously. This will often require a brief admission in the hospital. Unfortunately, the damage caused by late syphilis cannot be reversed. The bacteria can be killed, but treatment will most likely focus on easing pain and discomfort.

Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin.

During treatment, sexual activities should be avoided until all sores are completely healed. If you’re sexually active, your partner should be treated as well. Don’t resume sexual activity until you and your partner have completed treatment.

EFFECTS OF SYPHILIS ON FERTILITY
Male infertility
Although, a direct effect of syphilis on male fertility has not been reported, complications of syphilis can affect male fertility. Syphilis can also cause epididymitis (blockage in the epididymis). Prolonged syphilis infection may also lead on the development of Tabes Dorsalis; which is when the disease starts to cause nerve degeneration. One of the consequences of late-stage syphilis in male is Erectile Dysfunction.

Female infertility
Syphilis can cause Pelvic Inflammatory Diseases (PID), which can lead to endometrial damage. This damage causes the endometrium to thicken thereby causing reduced endometrial receptivity (the ability of the uterus to hold an embryo), resulting in infertility.
Syphilis may also lead to devastating effects on pregnancy and the newborn. Spontaneous abortion and still birth occur in 50% of pregnancies, with mortality of infected infants being over 10%.

Before proceeding with any form of fertility treatment, it is imperative that both partners should be tested for syphilis and treated when indicated.

CONCLUSIONS
Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore, typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. After the initial infection, the syphilis bacteria can remain inactive in the body for decades before becoming active again. Early syphilis can be cured, sometimes with a single shot (injection) of penicillin but without treatment, syphilis can severely damage the heart, brain or other organs, and can also threaten fertility. Syphilis can also be passed from mothers to unborn children.

If you think you might have syphilis, It is advisable to follow safe sex practices, such as using a condom in cases where abstinence is a challenge, it is best to avoid sex until you and your partner have been treated.