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Resurgence of syphilis in NZ?

Syphilis had been considered a rarity in New Zealand, but over the last few years the ESR Annual Sexually Transmitted Infections Surveillance Report has shown increased rates of syphilis. It has been reported that the number of cases of syphilis presenting to the Auckland Sexual Health Service has quadrupled in the last five years. As recently as February this year, the website www.gaynz.com warned readers of the ‘...outbreak of syphilis...’

The trend is particularly worrisome because syphilis is known to markedly enhance HIV transmission rates.

The main people at risk for acquiring syphilis appear to be either men who have had sex with men, or heterosexuals who have had casual sex while overseas.

Symptoms

The symptoms of syphilis depend on the stage of the disease. Patients are infectious during the primary and secondary phases. A significant proportion of individuals may remain without symptoms.

Primary syphilis (usually lasts only a few weeks):

  • chancres - painless sores on genitals, rectum, or mouth
  • enlarged lymph nodes in the area adjacent to the chancre

Secondary syphilis (untreated may last 3 weeks to 9 months):

  • general symptoms such as fever, fatigue, loss of appetite,
  • skin rash
  • extensive lymph node enlargement
  • Other symptoms can also include sores in the mouth, nose, throat, genitals or in the folds of the skin, and alopecia

Tertiary syphilis (may manifest years after initial infection in about a third of untreated people):

  • Lesions on skin, bones, or liver
  • The nervous system, heart and blood vessels may be affected

Testing for syphilis

Serological tests: Requests for syphilis serology are commonly screened first with an enzyme immunoassay able to detected treponemal antibodies. Any reactive samples go on to have RPR (non-specific antibody) and TPHA or TPPA (specific treponemal antibodies). The RPR is usually raised with recent infection and falls after successful treatment. TPHA or TPPA usually remain lifelong, regardless of treatment.

Reference

  • Azariah S. Is syphilis resurgent in NZ in the 21st century? A case series of infectious syphilis presenting to the Auckland Sexual Health Service. NZ Med J 2005;118:1349.