Section: Dermatology

Original Research Article CLINICO-DEMOGRAPHIC TRENDS OF SYPHILIS IN

A TERTIARY HOSPITAL OF NORTHERN ODISHA,
INDIA

Binodini Behera1, Debabrata Nayak2, Nikhil Ranjan Das3, Pradip Kumar

Received : 26/07/2023
Received in revised form : 29/08/2023 Bhue4, Sambit Ranjan Dalei5
Accepted : 09/09/2023
1
Associate Professor, Department of Dermatology, Pandit Raghunath Murmu Medical College &
Hospital, Baripada, Odisha, India.
Keywords: 2
Assistant Professor, Department of Dermatology, Pandit Raghunath Murmu Medical College &
Clinico-demographic Trends, Record
based study, Syphilis, Tertiary
Hospital, Baripada, Odisha, India.
3
Hospital, Northern Odisha. Assistant Professor, Department of Dermatology, SLN MCH, Koraput, Odisha, India.
Assistant Professor, Department of Community Medicine, Government Medical College &
4
Corresponding Author: Hospital, Sundargarh, Odisha, India.
5
Dr. Debabrata Nayak, Assistant Professor, Department of Dermatology, FM MCH, Balasore, Odisha, India.
Email: [email protected]

DOI: 10.47009/jamp.2023.5.5.90 Abstract

Background: Classic sexually transmitted disease, syphilis manifests in wide
Source of Support: Nil,
Conflict of Interest: None declared
variety of presentations in individuals. Due to existence of synergy with HIV,
there has been steady rise in cases of both the diseases all over the world and
Int J Acad Med Pharm also in our country. Several studies have been published regarding its rising
2023; 5 (5); 459-464
trend and other factors contributing the disease. In our outpatient department
(OPD) located in northern part of Odisha we noticed an increasing number of
cases of syphilis in last few years, therefore the current cross-sectional study
was conducted to assess the trends of syphilis in patients who reported to tertiary
care hospital. Materials and Methods: The current study is a record based
cross-sectional study of 113 patients of syphilis from various sources who
reported to the tertiary care hospital. Data were collected from 2018 to 2022 and
were divided year wise to assess the trend. Demographic details, clinical
examination findings and laboratory investigations reports were also collected.
Result: There was overall rising trend of syphilis except in year 2020. All 113
syphilis patients were found to be both RPR & TPHA positive. Male, female &
transgender were 67.2%, 26.5% and 6.1% respectively. Most of the patients
belong to age group 31-40(40.7%), Mean age being 34.6 year. Majority of the
patients were from rural area 61 (54%). HIV positive were found in 11 (9.7%)
number of syphilis patients. Plaque type was the most common form of lesion
found in syphilitic patients. Lymphadenopathy was the most common systemic
findings found in 18 (36.7%) syphilitic patients. Conclusion: There was overall
rising trend of syphilis from year 2018 to 2022. Finding from this current study
will be helpful for monitoring better trend of disease at community level and
future control and prevention strategy.

INTRODUCTION various recent studies from developed and

developing countries have identified rising trend of
Syphilis, a classic sexually transmitted infection is syphilitic cases since beginning of 21st century.[4,5]
caused by spirochetes Treponema pallidum is It not only increases risk of transmission of HIV and
regarded as the ‘Great Imitator’. Globally each year other STDs in community, but also causes
887 new cases of syphilis are diagnosed per million multisystemic complication in affected patient if left
population in age group of 15-49 years and in India untreated. There remains a unique synergy between
the incidence ranges from 5.4% to 8.2%.[1-3] The syphilis and HIV, where syphilis facilitates
disease is commonly transmitted by unprotected acquisition and transmission of HIV virus, HIV helps
sexual practices particularly in MSM and in progression of Syphilis.[5] Although the organism
pregnancy from mother to fetus. If left untreated Treponema pallidum has still maintained sensitivity
Syphilis can worsen into primary to secondary or to penicillin decades after its proven efficacy by
tertiary.[2] As the disease presents in varied Arnold and Mahoney in year 1943 but because of low
morphology it escapes the clinical diagnose by investments and limited resources to health care setup
inexperienced eyes. It is a matter of concern that in our country, it keeps challenging the public health
systems.[6] However, most of the new cases can be

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ISSN (O): 2687-5365; ISSN (P): 2753-6556
attributed to changing ways of finding sexual partners complete blood count, liver function test, renal
due to widespread use of social media and dating function test, erythrocyte sedimentation rate, RPR,
application particularly in younger population.[7] VDRL, HIV, HBsAg, HCV, Blood sugar in tertiary
Apart from that lack of education, socio-cultural care hospital, Baripada & clinical examination &
practice and lack of awareness of the disease also laboratory findings (TPHA) are recorded in available
contribute to the disease progression. In recent years records & files. A data extraction sheet was
different parts of our country has registered increase developed & used to collect data regarding the
in cases of syphilis but no such study has been done patients as per study objective. Detailed information
in our area.[8] The aim of this study was to ascertain of all patients regarding demography such as age,
the recent trend of syphilis and to investigate various gender, area of residence, occupation, marital status,
aspect of clinic-demographic feature of the disease in education & clinical such as types of lesions,
our area. systemic involvement, co morbidities, association of
other STD, HIV were extracted from records.
MATERIALS AND METHODS Analysis of Data
After compilation of all required data, it was cleaned
The current study is a record based cross-sectional & analyzed with the IBM statistical package for the
descriptive study of 113 patients of syphilis who social sciences (SPSS) statistics for windows, version
reported to the tertiary care hospital. Detailed history 21.0 (Developed by IBM corps, Armonk New York).
& demographic data of patients visiting the Pandit Descriptive data were presented with frequency &
Raghunath Murmu Medical College and Hospital, percentage.
Baripada a tertiary care center of Northern Odisha
was taken. Those details were always recorded in the RESULTS
available registered & files. The study was initiated
after due approval from the institutional ethics Total 25,236 number of samples were collected for
committee. All patients were RPR positive & testing of syphilis in central laboratory, PRM,
confirmed by TPHA. Patients from different sources Medical college & Hospital, Baripada. Out of which
between January 2018 & December 2022 were 12,266 samples collected from O&G Department, in
identified from available records & included in the which 17 samples were positive for syphilis and
study. Data were extracted from available records 12,970 samples collected from other sources, of
using a case data extraction sheet. To study the which 96 were syphilis positive. All 113 were found
change in trends, patients were divided year wise to be RPR positive Among 113 syphilis patients,
from 2018 - 2022. males, female and transgender were 76(67.2%),
Study Tools 30(26.5%), 7(6.1%) respectively. Male outnumbered
There is a norm of proper history taking & clinical female & transgender having a proportion of 11:4:1.
examination (general & systemic), dermatological The gender details of all 113 patients attending the
examination, laboratory investigations such as facility are shown in Table 1.

Table 1: Showing the gender details of Patients (N=113)

Study period 2018 2019 2020 2021 2022
Number of patients 6 14 13 26 54
Male 2 7 8 19 40
Female 4 7 4 4 11
Transgender 0 0 1 3 3

There was gradual increasing number of syphilitic cases in all genders over the years from 2018-2022 as depicted
in Figure 1.

There was an overall increase in the trend of syphilis

except 2020. Again, syphilis patients have been
increased remarkably in 2021 and 2022 in
comparison to previous year as shown in Figure 2.

Figure 1: Gender of syphilitic patients over the year Figure 2: Trend of syphilis patients ranging from 2018-
2022

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ISSN (O): 2687-5365; ISSN (P): 2753-6556
Percentage of patients from Different sources is Most of the syphilis patients belong to age group 31-
depicted in Figure 3. 40(40.7%), Mean age 34.6 year as shown in Table 2.

Figure 3: Total pool of patients from different sources

Table 2: Age distribution of syphilis patients (n=113)

Year
Age group 2018 2019 2020 2021 2022
≤20 0 0 2 0 2
21-30 5 4 3 6 21
31-40 0 6 6 14 20
>40 1 4 2 6 11
Total 6 14 13 26 54

Majority of the patients belong to rural area 61 (54%) as shown in Table 3.

Table 3: Area wise distribution of syphilis patients (n=113)

Year
Age group 2018 2019 2020 2021 2022
Rural 4 9 11 12 25
Urban 2 5 2 14 29
Total 6 14 13 26 54

The patients had received higher education 30 (26.6%) as shown in Table 4.

Table 4: Educational Status of syphilis patients (n=113)

Year 2018 2019 2020 2021 2022
Illiterate 4 2 2 5 10
Primary Education 1 2 3 1 4
Secondary Education 1 7 7 14 20
Higher Education 0 3 1 6 20

Among syphilitic cases 23.8% patients were doing business as shown in Table 5.

Table 5: Distribution of occupation of syphilis patients (n=113)

Type of profession 2018 2019 2020 2021 2022
Farmer 1 1 0 2 3
Independent profession 0 2 2 4 5
Business 1 3 4 6 13
Labourer/Unskilled worker 2 2 1 4 12
Unemployed 1 2 3 5 10
None 1 4 3 5 11

When the marital status was assessed 68 (60%) patients found to be married. Data shown in Table 6.

Table 6: Marital Status of syphilis patients (n=113)

Marital Status 2018 2019 2020 2021 2022
Married 4 13 9 18 24
Unmarried 2 0 3 8 26
Widow 0 0 0 0 3
Separated 0 1 1 0 1

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There was gradual increase in number of HIV positivity among syphilis patients as shown in Table 7.

Table 7: Clinical details of syphilis patient (n=113)

Study period 2018 2019 2020 2021 2022
No. of syphilis positive patients 06 14 13 26 54
HIV positive among syphilis patients 0 0 1 5 5

There was increasing trend of syphilis patients from

2018-2022 and the increase is more marked in the
year 2021 and 2022. Among the patients, 25 were
asymptomatic (without STI). In addition to that there
is concurrent 11 HIV positive patient found among
the patients of syphilis (9.76%) as shown in Figure 4.

Figure 4: HIV positivity among syphilitic patients

Plaque type was the most common form of lesion

32(47.7%) found in syphilis patients, while ulcerative
lesions were found in 11 (16.4%) number of patients.
Table 8.

Table 8: Types of lesions observed among syphilis patients (n=113)

Types of lesions 2018 2019 2020 2021 2022
Papular 1 2 2 4 5
Plaque 2 4 3 9 14
Scaly 0 0 0 1 2
Ulcerative 1 1 0 3 6
Vasculitic 0 1 1 2 3

Lymphadenopathy was the most common systemic involvement found among syphilis patients 18 (36.7%)
followed by myalgia16 (32.7%) and pneumonitis 12(24.5%) respectively, as shown in Table 9.

Table 9: Systemic involvement among syphilis patients (n=49)

Systemic Findings 2018 2019 2020 2021 2022
Pneumonitis 0 2 0 4 6
Lymphadenopathy 1 3 2 3 9
Myalgia 1 1 0 5 9
Hepatitis 0 0 0 1 1
Orchitic 0 0 0 1 0

Among the Co-morbidities diabetes was the most common 19 (34%). Among the other associated STDs genital
herpes was found in 8(14.2%). As shown in Table 10.

Table 10: Co-morbidities observed among syphilis patients (n=113)

Co-morbidities 2018 2019 2020 2021 2022
Diabetes 1 3 2 4 9
Hypertension 0 2 2 3 7
Pulmonary TB 0 1 1 2 3
Alcoholic Liver disease 0 0 0 1 3
Genital wart 0 0 0 0 2
Herpes 1 1 1 2 3
Oral Candidiasis 0 0 0 0 2

DISCUSSION study, there was overall rising trend of syphilis from

year 2018 to 2022 except 2020, which could be due
There has been a steady rise of various STD cases all to less reporting of STD cases during Covid-19
over the world in the recent years, this is due to rising pandemic. This finding is similar to various other
trend of HIV and changing sexual practices.[2] In our studies conducted in different parts of India &

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western countries.[3] Increasing trend of syphilis in while expression of CCR.[5] on human monocyte by
our study may be attributed to lack of awareness Treponema pallidum enhances HIV shedding and
about the disease, safe sexual practices, and transmission. Lymphadenopathy was most common
migration & socio- cultural issues as majority of systemic involvement (36.7%) found in our study; it
patients were from tribal community. is due co-existence with other bacterial STD as well
It should be noted that there was sharp rise of cases as HIV infections whereas Lymphadenopathy was
in year 2021 & 2022 as compared to previous years found in 83% & 50% in studies by Jain A et al & Shah
in this study. This could be due to less public health BJ et al respectively. Two cases of genital wart were
expenditure to contain the spread of sexual encountered in our study which signified the act of
transmitted diseases as most of the resources were unnatural sexual practice.
spent in preventing and containing the spread of There were 25 asymptomatic cases (without STI)
Covid-19 virus.[9] Male outnumbered females in could be attributed to hematogenous transmission
most of the studies i.e. Sundararaj S et al and Nair N (syphilis d' embele) or patients may unaware of
et al which is in accordance with our study.[10,11] lesions in primary stage.
This might be due to less reporting to STD clinic by Limitations of The Study
female patients due to social stigma & health seeking This was a record based cross-sectional descriptive
behavior. study in a tertiary care hospital which reflects the tip
By the age group, most of the patients belong to 31- of iceberg. It was a single center study with small
40 years (40.7%) similar to other studies conducted sample size. Multicentric studies with larger sample
by Behera SK et al (46.7%) & Sundaraj S et al size at the community level should be carried out to
(56.5%).12 This finding indicates that there is higher establish better trends of disease.
rate of sexual activity in this age group. Majority of
patients belong to rural area (54%) contrary to urban CONCLUSION
population (61%) was found by Behera SK et al.[10]
This may be due to migration and other socio-cultural There was over all rising trend of syphilis from 2018
practices in tribal community. to 2022 reporting to a tertiary care center in Odisha.
Educational status has been revealed in many studies. Most of the patients belong to age group 31-40
Studies by Jain A et al and Saha BJ et al shows lack (40.7%) with rural background (54%). Among 113
of higher education, consent and awareness play a patients of syphilis 11 were HIV positive (9.76%).
contributing factor for spread of STD & syphilis. [14] The rationale behind increasing trend of syphilis
This observation reflected in our study where only should be searched for factors like public awareness,
26.5 % had received higher education. Among the socio cultural issues & health seeking behaviors.
syphilis patients 18.5% were laborer, 18.5% Findings from this current study will be helpful for
unemployed & 23.8% were doing business similar to monitoring better trend of disease at community level
study carried out by Olokoba AB et al.[15] Migration & future control & prevention strategy.
& use of social media & dating applications No Conflict of Interest
particularly in young unemployed population seems
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