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Sexually Transmitted Diseases

Syphilis in Singapore – An Overview

Syphilis in Singapore

What Is It, and how Common is Syphilis in Singapore?

Syphilis is a bacterial infection that is usually transmitted through sexual contact. Syphilis is caused by the bacterium known as Treponema pallidum. The infection starts as a painless sore, typically on the genitals, mouth, or rectum. Syphilis spreads from individual to individual through the skin or mucous membrane contact with these sores. According to health authorities (2018 data), there are around 1,500 cases of syphilis in Singapore reported yearly.

Symptoms of Syphilis

Syphilis develops in stages and its symptoms can vary depending on each stage. But the stages of infection may overlap, and symptoms don’t always appear in the same corresponding order. You may be infected with syphilis without noticing any symptoms for years.

Primary syphilis

The primary stage of syphilis occurs about 3 to 4 weeks after a person contracts the bacteria. The first sign begins with a small, round sore called a chancre. This sore appears at the spot where the bacteria entered the body, such as on or inside the mouth, genitals, or rectum. A chancre is painless, but it’s very infectious. People may not even notice when they have one because it may be hidden within the vagina or rectum.

Secondary syphilis

Within a few weeks of the original chancre healing, the patient may experience sore throat and skin rashes normally found on the palms or soles or any part of the body. Other symptoms include headaches, fatigue, fever, swollen lymph glands, hair loss, and muscle aches. Without adequate treatment, secondary syphilis symptoms will probably progress to latent and potentially tertiary phases.

Latent syphilis

After the rashes disappear there will be a period without any symptoms, this is called “hidden stage”. Even if the symptoms go away, the syphilis infection is still present and start damaging the inner organs. This stage could last for decades before progressing to the last stage.

Tertiary syphilis

About 15% to 30% of patients infected with syphilis who don’t get treatment will develop complications known as tertiary syphilis. Tertiary syphilis could occur years after you are initially infected as this could be life-threatening and could cause serious health problems such as blindness, memory loss, deafness, mental illness, destruction of soft tissue, heart diseases, etc.

Congenital syphilis

Babies born to mothers who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although a few experience a rash on the palms of their hands and the soles of their feet.

Later signs and symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses.

However, babies born with syphilis can also be born prematurely, may die in the womb before birth, or can die after birth.

Diagnosis of Syphilis

It is important to make an early diagnosis of syphilis as this infection can be easily treated and early treatment prevents progression to later stages of the infection. The diagnosis of syphilis is done through clinical history and physical examination, supported by laboratory and serological testing.

Dark-field microscopy

This is the gold standard test used to identify the presence of the spirochete Treponema pallidum in one or more samples collected from the chancres or the affected tissues.

Non-treponemal tests

These are screening tests for a syphilitic infection, usually done 4-6 weeks after the primary syphilis infection. The tests most commonly performed include the Venereal Diseases Research Laboratory (VDRL) test and the Rapid Plasma Reagin (RPR) test. Occasionally false positives occur and have to be confirmed by confirmatory tests.

Treponemal tests

These are confirmatory tests, which are done after positive results are seen on the non-treponemal screening tests. These tests all look for specific antibodies to the spirochete and include the Treponemal Antigen-based Enzyme Immunoassay (EIA) for IgG and IgM, the Treponema pallidum hemagglutination assay (TPHA), the Treponema pallidum particle agglutination assay (TPPA), and the Fluorescent Treponemal Antibody-absorbed (FTA-ABS) test.

The sexual partners of infected individuals should also be tested and treated to prevent the spread of syphilis.

Cost of Screening for Syphilis in Singapore

The cost of screening for syphilis in Singapore ranges from around $50 for basic tests to about $200 for screenings that cover a number of different STDs.

Treatment for Syphilis

Syphilis infection in its early stage is typically easy to treat. Primary, secondary and early latent syphilis can be treated with antibiotics. For late-stage syphilis, additional doses may be necessary. Treatment will cure the infection and prevent further damage, but it will not repair damage already done.

Follow-up testing for up to 24 months is recommended to confirm that treatment is successful.

This article is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.