A presentation on

Teponema : Epidemiology, Pathogenesis, Prevention, Control,

Diagnosis and Treatment

COURSE NO.: BGE-5205

COURSE TITLE: MEDICAL & DIAGNOSTIC MICROBIOLOGY

Presented to, Presented By,

Dr. Ahsan Habib Anisha Tashruba Riya,
Professor ID: MS-220707
Biotechnology and Genetic Engineering Biotechnology and Genetic Engineering
Discipline, Discipline,
Khulna University. Khulna University.
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The genus Treponema contains both pathogenic and nonpathogenic species. Human
pathogens cause four treponematoses and Nonpathogenic treponemes may be part of
the normal flora of the intestinal tract, the oral cavity, or the genital tract.:

Pathogenic Treponema

• Treponema pallidum subsp pallidum causes
venereal syphilis; (Reproductive tract
disease) 
• T pallidum subsp pertenue causes
Fig: Treponema pallidum yaws; (skin-bone infection)
Non-pathogenic Treponema • T pallidum subsp endemicum causes
endemic syphilis/ Bejel; (Skin disease in hot-
T. denticola
dry area) and 
T. macrodenticum • T carateum causes pinta.(Skin disease in
T. orale tropical area)
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Syphilis Yaws Bejel Pinta
Fig: Comparison of epidemiology, Geographical distribution, age group, transmission, and characteristics of 3
Syphilis, yaws, Bejel, Pinta
Fig: Development stages of Syphilis disease over time 4
Epidemiology Syphilis
outbreak in
o Treponematosis originated in Africa
Naples, Italy. in the form of yaws . It passed
1495 through Asia to North America,
spinning off a mutation (in the form
of bejel) on the way . Bejel also
passed through Asia into North
America . However, it was in North
America that another mutation took
place, creating syphilis (2000-1800
year ago)

o The first well-recorded European

outbreak of syphilis occurred in
1495 among French troops
besieging Naples, Italy.
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Epidemiology

Fig: Syphilis and other STD cases per 100000 patient in each continent 6
Epidemiology
Primary and Secondary Syphilis — Rates of Reported
Cases by Age Group and Sex, United States, 2020

Fig: Comparison of syphilis rate among different sex and age group from USA and Bangladesh

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Epidemiology

Table: Current condition of Syphilis patients in Bangladesh (2020)

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Pathogenesis

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Pathogenesis

• The surface antigens in T. pallidum outer membrane facilitates local

replication of the pathogen and dissemination which eventually
triggers immune recognition in host body.
• Pathogen cells are uptaken up by dendritic cells, which then present
treponemal antigens to naive B cells and T cells.
• During early response to T.pallidum, human macrophages (MΦs) are
able to bind unopsonized spirochetes but the cells phagocytose very
limited numbers and many Treponema pallidum are able to escape.
• The phagocytic process is inefficient and results in minimal
inflammatory cytokine production.

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Pathogenesis

• After antigen presentation by phagocytes, lymphocytes such as CD4+

T cells, CD8+ T cells, and NK cells produce IFNγ (Interferon) locally.
• T cell activation can aid in B cell maturation and Tp specific antibody
production.
• MΦs increase expression of Fcγ receptors (FcγRs) and allow for
enhanced phagocytosis of opsonized treponemes and ultimately
resulting in interaction with TLRs, such as TLR2 and TLR8.
• The activated MΦs produce elevated levels of inflammatory cytokines
(TNF, IL-12, and IL-15) and chemokines.

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Prevention and Control
There is no vaccine for syphilis. To help prevent the spread of syphilis, follow these
suggestions:

• Abstain from having sex or be monogamous.

• Use a latex condom. Condoms can reduce your risk of contracting syphilis, but only if
the condom covers the syphilis sores.
• Avoid recreational drugs. Misuse of alcohol or other drugs can inhibit your judgment
and lead to unsafe sexual practices
• Sexual health promotion and education programs aim to increase awareness of increase
awareness of syphilis.
• Trace contacts of syphilitic patients; these contacts are then treated prophylactically
before onset of clinical manifestations.

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Diagnosis
DIRECT TESTS
 The rabbit infectivity test or RIT is the only standardized method
for the isolation of T. pallidum. This technique has the highest
sensitivity to detect treponemes.
 Dark field microscopy is a less sensitive method. It has sensitivity of
78-86%. This technique confirms the presence of spirochetes in skin
and mucosal lesions such as those found in the oral cavity in children
under 6 months of age.

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Diagnosis
SEROLOGICAL TESTS
 Non-treponemal tests:
One of the most commonly used non-treponemal tests for the
presumptive diagnosis of syphilis is the Venereal Disease Research
Laboratory (V.D.R.L), which is a flocculation reaction. On the other
hand, the agglutination test R.P.R can be used with serum and plasma
using antigen bound to carbon particles.
They are based on antigens composed of alcoholic solutions with
predetermined amounts of cardiolipins, cholesterol and lecithins. They
measure substances simultaneously, which are produced in tissues
damaged by T. pallidum (e.g. reagins) or by other diseases. They do not
measure specific antibodies against T. pallidum, therefore their
positivity does not ensure syphilitic disease
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Diagnosis
 Treponemal tests: they are used to confirm positive screening tests and detect
specific antibodies against Treponema pallidum. This type of tests includes the
FTA-ABS 200 DS, TPHA.
The main problem with the serological diagnosis of congenital syphilis is to
distinguish the infected asymptomatic infant from the uninfected infant

MOLECULAR TESTS
 Among the genes that have been used for the molecular determination of
gestational and congenital syphilis are the following: 16S rRNA, polA, tpr, arp,
TpN47, tpf-1, bmp, tmpA and tmpB.

 Several variants of PCR have been used in the diagnosis of gestational and
congenital syphilis.
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Treatment
• Early Stage:
Penicillin is prescribed. If allergic to penicillin, doctor may suggest another
antibiotic or recommend penicillin desensitization.

• Primary, secondary or early-stage latent syphilis:

Single injection of penicillin. If syphilis is longer than a year, additional doses
may be needed.

• Pregnant woman and newborn baby:

Penicillin is the only recommended treatment for pregnant women with syphilis.
Women who are allergic to penicillin can undergo a desensitization process that
may allow them to take penicillin.
Newborn child should be tested for congenital syphilis and if infected, receive
antibiotic treatment.
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 Fig: Prescribed antibiotic and dose for syphilis.

The first day of receiving treatment, patient may experience the Jarisch-Herxheimer reaction.
Signs and symptoms include a fever, chills, nausea, achy pain and a headache. This reaction
usually doesn't last more than one day. 18
Reference
1. Bruce M. Rothschild . History of Syphilis
2. Lucian G. Scurtu, Viorel Jinga and Olga Simionescu. Fascinating
Molecular and Immune Escape Mechanisms in the Treatment of STIs
(Syphilis, Gonorrhea, Chlamydia, and Herpes Simplex)
3. Farah A , Rahman MH , Rahman O , Zakir. Socio Demographic Study
of Gonorrhoea and Syphilis in Two Medical College Hospital and
Two Private Chamber in Bangladesh.
4. https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/syp
hilis.aspx#prevention
5. https://www.ncbi.nlm.nih.gov/books/NBK7716/#_A1997_
6. Andrea Tatiana Durán-Rodriguez, Yolanda Cifuentes, Jeannette
Navarrete Ospina and Liliana Muñoz Molina. New perspectives in
the study of the congenital syphilis: A narrative review 19
Reference
7. Kelly L. Hawley , Adriana R. Cruz , Sarah J. Benjamin , Carson J. La
Vake , Jorge L. Cervantes , Morgan LeDoyt , Lady G. Ramirez , Daniza
Mandich , Mary Fiel-Gan , Melissa J. Caimano , Justin D. Radolf and
Juan C. Salazar. IFNγ Enhances CD64-Potentiated Phagocytosis of
Treponema pallidum Opsonized with Human Syphilitic Serum by
Human Macrophages
8. Eugene Rosenberg (Editor-in-Chief) Edward F. DeLong, Stephen Lory,
Erko Stackebrandt and Fabiano Thompson (Eds.) The Prokaryotes
Human Microbiology
9. Rosanna W Peeling and Edward W Hook. The pathogenesis of syphilis:
the Great Mimicker, revisited

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 BE LIKE BIRDS
BE MONOGAMOUS

Thank You
THANK YOU
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