By Dr. Poyap J Rooney – General Practitioner and Pathologist
Korobosea Medical Clinic and Port Moresby General Hospital.
Sex is a wonderful part of life and one that should be celebrated in the healthiest way possible! While sex is a necessary means of human survival, our sexual lives also served as the means of survival of several microorganisms (bugs) that have quite cleverly made themselves a part of our lives. Understanding them is important if we are to avoid their negative impact on us individually and our communities.
Sexually transmitted infections (STIs) are caused by bugs that spread from one person to another during sexual intercourse. Getting infected with one of these “bugs” isn’t a good thing as they can lead to various long term complications that can make our lives miserable.
Traditionally the open discussion of our sexual lives has been a taboo; however people are becoming more open about discussing sex, sexuality, sexual behaviours and both the good and bad things that they are associated with.
Though sensitivity must still be applied when using certain words that may cause offense, it is important to have appropriately sanction places whereby frank and open conversations can be had about sex and STIs. Health care facilities like health centres, hospital clinics, and private GP clinics are perhaps the most appropriate places to carry out these discussions.
It is important that health care workers carrying out counselling, testing and treatment for STIs have the necessary qualifications and experience in STIs and carry out their job in a professional manner. CONFIDENTIALITY AND THE PROTECTION OF CLIENT’S PRIVACY IS AN IMPORTANT CORNERSTONE OF STI TREATMENT.
Whatever the mode of sexual intercourse the main “ingredient” for STIs to transmit from one person to another is an environment that allows the exchange of bodily fluids like, blood, semen AND vaginal fluid (all of which may contain the bugs that cause STIs.
IN THIS ARTICLE I WANT TO TALK ABOUT SYPHILIS.
How can one get infected with syphilis?
The bug T. Pallidum usually spreads from an infected person to an uninfected person when certain bodily fluids containing the bug enter the body of the uninfected person. As an example, if you were uninfected and you had vaginal sexual intercourse (kuap) and /or anal intercourse (kuap-hars) with another infected person and the bodily fluids (eg. Karn-wara or kok-wara) of this infected person enters your body you may get infected with the bug and develop syphilis. Syphilis can also be transmitted through blood donations if donated blood is not checked properly.
How does syphilis affect my body?
Syphilis can show itself and affect your body in a number of ways.
Within 2 to 3 week after the bug enters your body you may (but not always) develop sores on the area of exposure (eg. kok, karn, hol-blo-hars or maus). The main feature of these sores is that they are usually painless and they usually disappear by themselves after 1 or 2 weeks. A lot of people who develop these sores never seek medical attention because the sores are painless and disappear without treatment and they may not even notice that they even have these sores which may appear in a hidden place like inside the anus (hol-blo-hars) or inside the vagina (hol-blo-karn). The photographs below are of painless sores in patients with primary syphilis.
It is during this primary stage of syphilis that the risk of spread from an infected person to an uninfected person is highest.
During the primary syphilis stage your own body’s defense system attacks the bug and in most cases the sores of primary syphilis disappear. However, your body’s defense system in most cases will not totally exterminate the bug from your body and after some period in hiding (about a month) syphilis may show itself as secondary syphilis. This occurs when the bug goes into the blood stream and spreads throughout the body.
In secondary syphilis you may feel a general feeling of UNWELLNESS, fatigue and headache. You may lose a significant amount of weight, you may develop some fever and muscle ache.
In PNG many people blame malaria for these nonspecific symptoms which in actual fact may be due to syphilis or any other infectious disease (illness caused by pathological microorganisms)
You may also develop signs that are more specific to secondary syphilis including generalised rash on your skin, sores inside your mouth, and the lining of your throat and food pipe, anus and if you are female, and your vagina. You may also develop swollen painful lymph nodes throughout your body.
Again during this secondary phase of syphilis your body defense system will put up a fight against the syphilis and in most cases these signs and symptoms will resolve by themselves without any specific medical treatment. The syphilis will then enter the latent (or sleeping phase) where once again it goes into hiding.
After about 4 to 10 years after the primary syphilis, for reasons not too well understood syphilis may once again emerge out of hiding to cause havoc. Tertiary syphilis can affect the bones, spinal, and the soft linings of the mouth, food pipe and the vagina and anus. Tertiary syphilis can also affect your heart causing life threatening problems.
This photograph depicts the destruction of a patient’s left knee joint, which was determined to be a case of neuropathic arthropathy, also known as Charcot’s joint, brought on by a tertiary syphilitic infection.
Photo courtesy of Public Health Image library (CDC). http://www.phil.cdc/phil/details.asp
The brain and the nervous system can also be affected by syphilis and this can occur very early in the course of disease or it may take some years to develop.
Pregnant women can pass syphilis onto their unborn child. This can lead to the death of the baby while it is still in the womb or shortly after it is born. If a child becomes infected and is born alive they may have certain birth defects. In PNG it is usual for for pregnant mothers to be offered this test and if syphilis is found it can be treated.
How do I know if I have syphilis?
Your genital normally should be clean, free of any sores, abnormal discharge, smells or odd sensations. You should be concerned if you develop any of the signs and symptoms that I have explained above and visit a health care worker that you trust, ASAP!! Your health care worker should take proper notes of your complaints, do appropriate physical examinations and take appropriate samples for special diagnostic tests.
There are quick and simple blood tests available that can be done if you and your doctor are concerned about any specific problems.
Is there treatment for syphilis?
YES! Syphilis is easily treated with modern medication and if you have syphilis you should be treated even if you do not have symptoms. However syphilis is best handled by a health care worker with a special interest and experience in treating STIs. Special test need to be done before the start of treatment and some weeks after to make sure the treatment has worked.
TAKE HOME MESSAGE!!!!
If you have a strange sore, discharge and/or a strange feeling in your genital area, especially after having recent (1 to 2 weeks) unprotected sex with someone whom you do not know the STI status of – seek help at a health facility that you trust and get it checked out.
Enjoy sex with one regular partner that has had a full STI testing with you and you both have been cleared. Use a condom in the proper manner if you are unsure of the STI status of your sexual partner or if you know that they are infected and they are undergoing treatment.
Condom use is not a 100% protective however it has been shown to greatly reduce the risk STI transmission.
Some of you may see condoms as a nuisance or annoying however many condoms these days are designed to add a bit more fun into people’s sex lives. Shop around for some “fun” condoms!