Definisi

Sifilis adalah penyakit infeksi kronik yang disebabkan oleh bakteri Treponema pallidum, yang biasanya
ditularkan melalui hubungan kontak seksual dengan individu lain yang telah terinfeksi. Sifilis dibagi
menjadi tiga stadium yaitu primer, sekunder, dan tersier. Pada stadium awal ( khususnya primer dan
sekunder) dimana terdapat lesi maka akan sangat menular. Lesi yang muncul dapat sembuh dengan
sendirinya dalam beberapa waktu. Sekitar 30 % kasus pasien sifilis yang tidak mendapatkan pengobatan
akan menyebabkan kerusakan pada jantung, sistem saraf pusat, atau organ lainnya setelah perjalanan beberapa
tahun sejak infeksi awal.

Shockman S, Buescher LS, Stone SP. Syphilis in the United States. Clin Dermatol. 2014;32: 213-218.
Etiologi

The causative agent of syphilis, T. pallidum subspecies pallidum, is closely related to other
pathogenic spirochetes (Chapter 320), including those causing yaws (T. pallidum subspecies
pertenue) and pinta (Treponema carateum). T. pallidum is a thin, helical bacterium approximately
0.15 m wide and 6 to 15 m long. The organism has 6 to 14 spirals and is tapered on either end. It
is too thin to be seen by ordinary Gram stain microscopy but can be visualized in wet mounts by
dark-field microscopy or in fixed specimens by silver stain or fluorescent antibody methods.

Unlike most bacteria, which have protein-rich outer membranes, the T. pallidum outer membrane
appears to be composed of predominantly phospholipids, with few surface-exposed proteins. It has
been hypothesized that because of this structure, syphilis can progress despite the brisk antibody
response to nonsurface-exposed internal antigens, which is the basis for serologic tests for the
diagnosis and management of syphilis. Between the outer membrane and the peptidoglycan cell
wall are six axial fibrils; three are attached at each end, and they overlap in the center of the
organism. They are structurally and biochemically similar to flagella and are in part responsible for
the organisms motility.

It is possible to culture T. pallidum, but sustained in vitro cultivation is not yet possible, and yields
are very low. Culture is of limited use in research and of no use in clinical practice. All isolates
studied have been susceptible to penicillin and are antigenically similar. The only known natural
hosts for T. pallidum are humans and certain monkeys and higher apes.

EPIDEMIOLOGY

With the exception of congenital syphilis, syphilis is acquired almost exclusively by intimate contact
with the infectious lesions of primary or secondary syphilis (e.g., chancres, mucous patches,
condylomata lata). Disease is usually acquired through sexual intercourse, including anogenital and
orogenital intercourse. Health care workers are sometimes infected during the unsuspecting
examination of patients with infectious lesions. Infection by contact with fomites is extremely
uncommon. Before the advent of modern blood banking techniques, syphilis was occasionally
transmitted through the transfusion of blood from persons with T. pallidum bacteremia, and
occasional parenteral transmission still occurs as a result of the sharing of contaminated needles.

Syphilis is most common in large cities and in young, sexually active individuals. The highest rate is
found in men between the ages of 20 and 29 years. In 2012, 67% of the 3142 U.S. counties reported
no cases of primary or secondary syphilis, and just 28 locales accounted for about 50% of all
reported infections.3 The disease is most prevalent in the Southeast and California.

Syphilis spares no class, race, or group but is more prevalent among persons living on the margins of
society. U.S. syphilis rates are about six-fold greater in African Americans than in non-Hispanic
whites. In 2012, more than 75% of reported early syphilis occurred in men who acknowledged sex
with other men. Increased numbers of different partners and perhaps indiscriminate choice of
partners increase the risk of acquiring sexually transmitted disease (Chapter 285). A traditional
cornerstone of syphilis control has been the epidemiologic investigation and treatment of sexual
contacts of patients with primary or secondary lesions and patients with early latent disease.
Patients with primary and secondary syphilis name, on average, nearly three different sexual
contacts within the previous 90 days. As syphilis has become associated with drug use and
anonymous sex, epidemiologic investigations have become less efficacious.

The incidence of syphilis has generally declined worldwide for more than 100 years, with the
exception of periods of war or social upheaval. With the introduction of penicillin, there was a rapid
decline in primary and secondary syphilis, to approximately 4 cases per 100,000 people in 1957. This
decline was followed by reductions in federal expenditures for syphilis control, which resulted in
resurgence of infectious primary and secondary syphilis in the United States; peaks of more than 12
cases per 100,000 people were attained several times from 1965 through the mid-1990s. Because
many cases of syphilis are not reported, the true incidence may be much higher.

During the past 40 years, syphilis epidemics have occurred serially in at least three U.S. population
subgroups. In the 1970s and 1980s, men who had sex with other men accounted for a
disproportionate number of the total cases of infectious syphilis. Similar trends occurred in other
countries. Then, after a period of decline, U.S. syphilis rates nearly doubled from 1986 to 1990, with
50,578 cases reported in 1990 in an epidemic disproportionately affecting multiracial heterosexual
men and women and occurring contemporaneously with an epidemic of crack cocaine use. After
1990, syphilis rates again declined; in 2001, there were 6103 cases of primary and secondary syphilis
reported, one of the lowest numbers since 1959. The epidemic of the late 1980s probably
contributed to the spread of human immunodeficiency virus (HIV) infection (see Syphilis-HIV
Interactions) and to dramatic increases in the rate of congenital syphilis. Since 2001, syphilis rates
have again begun to increase in men, and now especially men infected with HIV.

In 2013, the rate of reported primary and secondary syphilis in the United States was 5.3 cases per
100,000 population, more than double the lowest-ever rate of 2.1 in 2000. During 2005 to 2013,
primary and secondary syphilis rates increased among men of all ages, races, and ethnicities across
all regions. Recent years have shown an accelerated increase occurring among men who have sex
with men. Among women, rates increased during 2005 to 2008 and decreased during 2009 to 2013.4

Patients with clinically evident late syphilis, particularly those with cardiovascular or gummatous
syphilis, are becoming less common, perhaps as a result of the effectiveness of penicillin therapy for
early syphilis. However, surveys indicate that there are still significant numbers of patients with
untreated neurologic syphilis, especially in older age groups.