Treponema pallidum (syphilis)
DNA PCR test

How does the infection spread? Entry at cell level

Syphilis is extremely infectious: clinical data show that body fluid containing as few as 10 bacteria can be enough to pass on the disease.

• Ways in: During sexual contact with an actively infected partner, the bacteria enter directly through the mucous membranes, or through tiny, microscopic abrasions in the skin, which are naturally present in the genital and perianal (around the anus) areas because the skin there is thinner.
• Attachment: For infection to take hold, the bacterium has to attach firmly to the host's surface cells and the tissue between them.
• Vertical transmission (mother to child): The infection can also pass to the unborn baby through the placenta (vertically). The risk is highest in the first 1–2 years after the mother is infected (primary, secondary and early latent stages), but the risk remains throughout the first 4 years after exposure.

Why 'the Great Imitator'? The clinical stages of syphilis

The disease produces extremely varied symptoms that often mimic completely different infections or skin conditions, which is why it has rightly earned the name 'the Great Imitator' in medicine. Without treatment, syphilis progresses through four clearly distinct stages:

1. Primary stage

About 3 weeks after infection, one or more lesions called a hard chancre appear at the point of entry (genitals, anus, mouth), along with marked swelling of the lymph nodes in the groin. These ulcers are completely painless, yet the fluid from them contains huge numbers of bacteria. Even without treatment they heal on their own within 3–6 weeks, which gives a false impression of recovery – while the bacterium is in fact spreading into the bloodstream.

2. Secondary stage

It develops weeks after the ulcer has gone. This is the stage at which patients most often see a doctor. It is marked by a blotchy, bumpy (maculopapular) rash across the body – especially on the upper body, the back, the palms and the soles of the feet. At the same time, broad-based, highly infectious wart-like growths (condylomata lata) may appear around the perineum and anus.

3. Latent stage

As the rash and active symptoms fade, the disease enters a hidden phase, in which it can persist in the body with no symptoms at all for years or even decades.

4. Tertiary stage

It develops 10–20 years after the initial infection in people who have not been treated. It causes serious neurological symptoms (neurosyphilis), irreversible damage to internal organs and blood vessels, and deep, ulcerating skin lesions (gummas). Since modern antibiotics became widely available, this stage has become much rarer.

When is the test particularly recommended?

Specialists at Sabjanics Medical Center recommend a targeted Treponema pallidum PCR or the comprehensive multiplex STD PCR panel in the following cases:

• If you have any symptoms that suggest a sexually transmitted disease (a painless ulcer, an unusual rash, discharge, swollen lymph nodes).
• If a current or previous sexual partner has been diagnosed with a sexually transmitted infection.
• If you have a new sexual partner, or more than one sexual partner.
• As part of regular screening for higher-risk groups, such as MSM (men who have sex with men).

Why is DNA PCR testing a breakthrough in diagnosing syphilis?

There are many ways to detect syphilis (e.g. serological blood tests such as VDRL, RPR or the specific TPHA test). Real-Time PCR technology, however, fills a unique and critical gap in diagnosis:

• Immediate detection in the early stage: Standard blood tests measure the body's immune response (antibodies), which can take 4–6 weeks to appear after infection. PCR, by contrast, identifies the bacterium's DNA directly from genital ulcers, so it can confirm syphilis in the very first days, before antibodies appear.
• Pinpoint accuracy: PCR is highly sensitive and specific for samples taken from skin, mucous membrane or tissue lesions (ulcers, rashes). An important clinical fact is that PCR on blood or spinal fluid is not recommended for routine screening, because these fluids contain few free bacteria – whereas the surface of a sore is teeming with them.
• Please note: because the number of bacteria on the surface of a sore can vary, a negative PCR test does not rule out syphilis 100%. If syphilis is suspected, the result must be assessed together with the clinical picture and serological tests.

A short guide to the test

What should you do if your result is positive?

Syphilis can still be treated effectively and cured completely at every stage with proper antibiotic treatment (especially penicillin-based medicines).

• Prompt specialist consultation: If your PCR result is positive, contact the dermatology and venereology specialist at Sabjanics Medical Center without delay, to confirm the diagnosis and start a targeted treatment plan.
• Testing and treating your partner: Because syphilis is highly infectious, it is essential to test and treat your sexual partner(s) at the same time to prevent the 'ping-pong effect' (passing the infection back and forth). You must stop all sexual activity until you are confirmed cured.