A Vaccine for Syphilis

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A Vaccine for Syphilis

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 2

Abstract

Design and application of a vaccine for syphilis is proposed. Syphilis, once a widespread and crippling disease, has decreased in prevalence and significance due to public health education and the use of penicillin, which is extremely effective in curing the disease. This decline has reduced the urgency for a vaccine for syphilis. However, in recent years the incidence of syphilis has been increasing. A persistent reservoir remains in highly impacted groups such as sex workers and men who have sex with men. It is proposed that the critical application of a vaccine for syphilis to these groups could eventually eliminate this disease. Evidence is presented that the most effective immune response to syphilis infection is delayed type hypersensitivity (DTH). In this review a design for a vaccine for syphilis directed to the induction of DTH is described. Syphilis has a long and devastating history. It first appeared in Europe shortly after the return of Columbus’ ships from the new world. Treatises by Francisco Lopez de Villalobos in 1498 [1] and Ray Diaz de Isla in 1539 [2] accurately describe the clinical symptoms and epidemiology as syphilis jumped form the new world to the old world. The disease spread rapidly throughout Europe because of the dispersal of infected soldiers after the conquest of Naples by Charles VIII in 1494. Although some questions have been raised that there might have been a form of syphilis in the old world before this, this idea has largely been discredited [3]. In addition, at that time syphilis was spreading through Europe, sexual behavior was not yet restricted by religious beliefs. In fact, D. H. Lawrence attributed the rise of puritanism and its sexual restrictions in Europe to the arrival of syphilis [4]. In the early 20th century Syphilis was considered one of the three great plagues, along with tuberculosis and cancer [5]. An extensive investigation by The Royal Commission on Venereal Diseases in England and Wales in 1916 concluded that the number of persons with syphilis “cannot fall below 10 per cent of the whole population…”, [6] and more than 20% of patients in U.S. mental hospital in the 1920s had tertiary syphilis [7]. Syphilis occupied a prominent position in the minds of clinicians of the time not only because of the prevalence but also because of the wide range of presentation of signs and symptoms. Sir William Osler, recognized as the preeminent physician of his time, noted that syphilis was the great imitator and that “he who knows syphilis knows medicine” [8]. He noted that syphilis struck terror into the hearts by the rapidity of its spread, the ravages it made, and the apparent helplessness of the physicians to cure it. Although vaccines had been effectively applied to other infectious diseases, no one appeared to have an idea how to make a vaccine for syphilis. Then Interest I should be lc in a vaccine for syphilis declined as the prevalence of the disease decreased. The incidence of syphilis first declined because of extensive public education efforts in the mid-20th century, but was even more affected by the introduction of penicillin. Penicillin is an extremely effective treatment for syphilis and the use of penicillin to treat syphilis resulted in a marked decline in the prevalence of the disease. Between 1940 and 1951 the incidence of syphilis dropped from close to 400 cases per 100,000 to less than 100 per 100,000 in 1950. In 2000 the national number of reported primary and secondary syphilis was 2.1 cases per 100,000 population. However, the rate has increased almost every year since then. In 2016 the rate increased to 8.7, the highest seen since 1993 [9]. Recently an argument for the need of a vaccine for syphilis has been made [10]. It is unlikely that syphilis vaccination would be applied to the general population. However, it could be very applicable to selected populations, for example: sex workers and men who have sex with men. Up to 5% of sex workers in 20 of 45 reporting countries are infected with syphilis [11]. Thus, prevention of syphilis in sex workers by vaccination could by itself greatly reduce spread of infection, particularly in vulnerable populations. In the United States over 50% of diagnosed cases of primary or secondary syphilis are in men who have sex only with men [9]. Thus, this population would also be a prime target for vaccination. In addition, 1 million pregnant women world-wide have active syphilis infection and are at risk for adverse pregnancy outcomes such as stillbirth and neonatal death due to congenital syphilis. Congenital syphilis has increased by 27.6 % between 2015 and 2016 [9]. Selective immunization of women at high risk for syphilis and pregnancy should also be considered. Immunodefense Against Syphilis

Authors and Affiliations

Stewart Sell

Keywords

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EP ID EP592752
DOI 10.26717/BJSTR.2018.07.001486
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