The number of people contracting syphilis is on the rise. If a mother has an active infection of syphilis when she is pregnant, it can cause serious health issues for her baby.
The organism that is responsible for syphilis is a spirochete bacteria called Treponema pallidum. An individual can be infected and not even know it until it is too late. Early effective treatment can cure syphilis.
The primary or incubation stage occurs between three and 90 days after the infection is transmitted. The average time the first symptom appears is three weeks after infection. The symptom is a single, painless chancre or ulcer that develops at the site of initial infection. In some people it is so small it goes unnoticed. It can heal on its own within two to eight weeks. The sore heals but the disease spreads throughout the body as the Treponema pallidum invades. Between two and 16 weeks later, other symptoms develop.
Ninety percent of cases present with rashes on the palms of the hands and soles of the feet. Some people have fever, weight loss, extreme fatigue, mouth sores and other nasty things. This is when most people seek treatment with antibiotics. The latent stage can be over a period of months or years. During this time, signs of the disease are not visible. Tertiary or late syphilis is very rare now because of the successful treatment of syphilis with antibiotics. It can present anywhere from 10 to 25 years after the initial infection.
A rapid plasma reagin (RPR) test is a sensitive, but not specific, blood test that is used as a screening test for syphilis. Results are typically available within 24 hours. If it is negative, no further testing is needed. However, if clinical symptoms of syphilis are evident, further testing is required.
If the RPR is positive, another test is necessary to confirm the presence of syphilis. The fluorescent treponemal antibody absorption (FTA-ABS) is specific to syphilis and demonstrates the presence or absence of antibodies. If the test comes back negative there is no current or past infection of syphilis. If it is positive the patient is or was infected with syphilis. The antibodies are usually present in a person for life, even when cured of the disease.
If the RPR is positive and the FTA-ABS is negative then further testing for other diseases should be done. Lupus, Lyme disease, some types of pneumonia, malaria and Tuberculosis can also produce a positive RPR test.
Part of routine testing with pregnancy is the RPR. The RPR is repeated after delivery. This is to protect the baby from congenital syphilis. Nearly half of all babies exposed to syphilis in the womb die shortly before or after birth. Those who survive are sick with a variety of symptoms. If a mother has had a negative RPR during her pregnancy, but has a positive RPR after delivery, then a FTA-ABS is done. If the FTA-ABS comes back negative the mother needs to be seen to rule out the other diseases that can produce a positive RPR.
Researching for this column has given me a better understanding of the RPR and FTA-ABS tests. I hope that if you have been given the news of a positive test you also have a better understanding.
Thank you to Dr. Tom Farrell, pathologist at Manatee Memorial Hospital, for his guidance, clarification on this subject.
Katie Powers, R.N., is a board-certified lactation consultant and perinatal educator at Manatee Memorial Hospital's Family BirthPlace. Contact her at firstname.lastname@example.org.