Beware of Latent Syphilis

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Illustration by Sains Kompas

Syphilis is a sexually transmitted infection (STI) caused by the Treponema pallidum which causes abnormalities in the skin and manifests systemically. This infection is transmitted through sexual contact or from mother to baby through the placenta, and can also be transmitted through blood transfusions. People often do not realize if he is infected with syphilis. This is because in medical science, syphilis is known as “The Great Pretender” or a great impersonator. Why is that? Because the symptoms that arise, in addition to syphilis sores can resemble the symptoms of other diseases. Syphilis also usually follows a pattern of progression from the initial phase of infection to the phase that lasts for years. Syphilis has several stages, the primary stage, secondary stage, tertiary stage and syphilis that do not show clinical symptoms called latent syphilis.

Latent Syphilis

Latent syphilis is a stage of syphilis characterized by active serological examination without primary, secondary or tertiary syphilis. Classification of latent syphilis includes, first, early latent syphilis, early latent syphilis that occurs less than one year since the beginning of primary syphilis. Secondly, late latent syphilis which occur one or more years starting from the beginning of primary syphilis emergence. Patients usually come during this phase. Syphilis was only discovered because of screening for sexually transmitted infections (STIs). In the latent phase, syphilis is hidden, where the patient has no symptoms, but the infection is still present in the body. The latent phase can last for years. If it is left untreated, then the next 10-20 years, people with latent syphilis will enter the latent phase of syphilis. It is dangerous because in this phase, it can damage internal organs and cause paralysis, blindness, and dementia (senility). Syphilis in this phase is very dangerous and fatal.

Because latent syphilis has no symptoms, laboratory tests are needed for diagnosis. Therefore, clinical diagnosis must always be supported by appropriate laboratory tests. The results of laboratory tests can be interpreted on the patient’s history and findings on physical examination. Syphilis detection methods can be through blood tests aimed at treponema or non-treponema. The latter includes VDRL or RPR tests. This method is used for quick diagnosis because it is easy to do and inexpensive. The weakness of this test, it is not specific for syphilis and may give false positive results. So, for people with positive non-treponema test results must be confirmed by Treponema test.

The treponema test detects antibodies that are specific for syphilis and can last for a lifetime even if the person has received syphilis treatment. If you do a treponema test and the results are positive, then a non-treponema test still needs to be done to calculate the titer. This is necessary to confirm the diagnosis and determine further management.

Can Latent Syphilis Be Cured?

Because latent syphilis is not sexually transmitted, the goal of treating people at this stage of the disease is to prevent complications and transmission from a pregnant woman to her fetus. Early latent syphilis must be treated in the same way as early active infection syphilis, by getting penicillin-G injection therapy in ten days. The response to this disease is quite good. With latent syphilis, the patient does not show any clinical symptoms of infection, so the treatment evaluation is not on the clinical changes of the patient as a result of successful therapy. Proper evaluation of the results can only be obtained by following the patient throughout his life. About 2% of treated late latent syphilis cases will then develop to cause serious manifestations of advanced syphilis despite adequate treatment.

For those who are at risk should take a syphilis test. They are pregnant women, MSM populations, prisoners, prostitutes or people who have risky sexual behavior such as those with many sexual partners, unsafe sex practitioners, drug and alcohol users, and of course those who have partners with positive syphilis. The most effective way of prevention is to implement safe sex. Abstinence or not having sex is certainly the most effective way. Another way is not to change partners (monogamy) and use condoms. Condoms must also be used appropriately and consistently to be effective in preventing syphilis.

Author: dr. Dwi Murtiastutik,Sp.KK(K)

Details of this case report available at:

https://e-journal.unair.ac.id/BIKK/article/download/10893/pdf

Bernadaya Yogatri Anjuwita Saputri dan Dwi Murtiastutik. A retrospective study: Latent Syphilis. BIKKK 2019; 31(1):46-54

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