Can condom use still prevent syphilis?

One day, a man came at the hospital I work at, requesting for a prescription of strong oral antifungal medication, “Dr nina fangasi, naomba dawa kali za fangasi, saizi nipe vidonge”.

He said he had been using antifungal cream for a long time now, which however, could not assuage the situation.

Upon asking for what condition he needed the tabs, with hesitancy, he revealed that he had self-diagnosed a ‘fungal’ infection on his genitals.

This doesn’t come as a surprise to know that the only skin disease most of the people know is a fungal infection, such the case of the man who came reporting that he is suffering from it.

Due to this know-how, I wasn’t fully convinced with his self-diagnosis and instead I tried to seek his permission for a thorough genital examination. Upon the man consenting to it, I found out that the condition was nowhere close to a fungal infection.

His groin/scrotum area had turned reddish and rough. I immediately asked him to go for a urine test and a VDRL (venereal disease research laboratory) test, a test designed to assess whether or not one has syphilis (a sexually transmitted infection). To his surprise, the latter was tested positive.

Why is syphilis diagnosis rare?

Globally, syphilis is described in three stages whereby in the primary stage a patient will have a painless sore at the original site often penis, vagina or vulva. Doctors term this sore a “chancre”.

It doesn’t bleed but when it is rubbed, it leaks a clear fluid which is infectious.

Many people do not bother consulting a doctor since it is not painful and it may heal in 3 to 12 months.

In secondary stage, it begins with a skin rash, usually on palms of your hands and bottom of your feet. Whereas in tertiary stage, it is associated with severe medical problems with many organs being affected such as the heart and brain. Personally, I have not come across a syphilis patient in a tertiary stage.

But I have happened to diagnose syphilis rather incidentally than through first seeing the obvious symptoms and signs like a painless sore around or on genitals prior to investigation. The disease becomes a less diagnosed infection since its rarely suspected.

In Tanzania, women are lucky that during their antenatal clinic (ANC) visits (during pregnancy), they are tested for syphilis as a compulsory examination. The test in the ANC card is usually termed as VDRL/RPR.

A health care provider will fill in the words “reactive” or “non- reactive” depending on the results. This is why you may find that there is limited data which has been done to-date to size up the magnitude of the problem for the Tanzanian population.

With the exception of pregnant women whose data are exactly known and can be tracked down, hence the testing during pregnancy has fueled the early detection of the disease and the prevention of the neonatal complications.

Can you still contract syphilis despite condomising?

Few weeks ago, a woman in her 20’s was tested positive after a VDRL test.

Upon receiving the results, her face looked troubled, her eyes wistful and she wept tears, sobbing and trembling. She questions, “mimi natumia condom na wanaume wote ninao kutana nao, nilikuwa situmii kondomu na mpenzi wangu wa kwanza tu, nae amesafiri tangu mwaka jana, sasa docta napataje kaswende ?” (I do use condom every time I have sex with a man barring the time when I was with the first lover who is now away since last year, then how comes that I contacted syphilis).

One can get syphilis by direct contact with a syphilis sore during during vaginal, anal or oral sex. The problem is that we are accustomed to think that syphilis sore can only be found on genitals, but it must be well construed that sores can be found on or around the penis, vagina, anus, rectum, on the lips or in the mouth. Syphilis can also spread from mother to her unborn baby.

If you are sexually active, such as the woman who was in a long term monogamous relationship with a partner who has been tested for syphilis, use a latex condom, the right way, every time you have sex.

Condoms prevent syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by condom, contact with these sores can still transmit syphilis.

Prevention and early detection

In Tanzania once you are diagnosed with syphilis, most of the doctors will prescribe a popular drug called “Benzathine penicillin injection”, they prefer the use of the name penadur.

People with primary and secondary syphilis are highly infectious, they must avoid sexual contact until they and their sex partners have completed treatment.

A study done in Tanzania in 2011 whose main objective was to size up the prevalence of HIV and syphilis infections among pregnant women attending ANC in Tanzania, revealed that the overall syphilis prevalence was 2.5 per cent.

The risk of syphilis infection was significantly higher among women attending semi-urban and rural clinics and those having 3-4, and 5 previous pregnancies, whilst HIV/syphilis co-infection occurred in 109 of 38,928 (0.3 per cent).

I strongly urge the government to introduce VDRL test along with HIV test as easily accessible tests.

We are already doing better for HIV screening, then it should also be an included routine test for syphilis. The fight against sexually transmitted infections (STIs) including syphilis and the prevention of their subsequent clinical upshots will remain a tawdry affair, unless we go beyond the ANC corridors.

The author is a medical doctor, public health activist and a researcher based in Dar es Salaam.