Sexually transmitted infections are widespread in developing countries and constitute a major public health problem in sub-Saharan Africa. More recently, there has been a resurgence of syphilis in North-eastern Nigeria. Kasim Sumaina write on its prevalence and prevention
When recently, the Head of Prevention, Department of Public Health and HIV/AIDS Division, Ministry of Health, Dr.chukwuma Anyaike, raised the alarm that Borno State was recording an increased incidence of Syphilis in the country, one would think the report must be several decades ago, considering that the disease is no more a burden to most countries of the world, especially in the 21st century.
But the highly preventable disease, which has become the least of burdens to several countries around the globe, including some developing countries, has once again taken prominence in the North-eastern part of a country that prides itself as the giant of Africa, with Borno State leading the pack as the state with the highest prevalence rate of the disease in the geo-graphical region.
Anyaike, while noting that a national survey conducted on the virus, nine years ago, showed that the prevalence of the virus was 1.5 per cent, argued that despite the fact that the ratio has dropped between then and now, its continuous prominence in specific states must be curbed by programmers, who should have a target prevention strategy in high impact areas.
Syphilis, according to research is a Sexually Transmitted Infection (STI), caused by the Treponema Pallidum spirochete, although, there may be congenital syphilis through the transmission from mother to child in the womb. The disease is widely known to be transmitted through contact with body fluids, blood and blood products.
If not treated, experts believed it could cause serious consequences, such as damage to the aorta, brain, eyes, bones, and in some cases, could lead to death.
Despite its eradication in most countries of the world, it is still arguably one of the most killer diseases in Africa. The rash/boil causing plague is responsible for the infection of up to 12.2 million people in the world every year with a quarter of these cases occurring in Africa due to poor sexual health education and proper hygiene.
On the average, over 157,000 people lose their lives to syphilis every year and according to World Health Organisation, infection rates in major African cities of Zambia; an East African country and Cameroon; a country in the Central Africa were reported to be as high as 10 per cent and six per cent in both genders respectively and studies done suggested that infection rates may be up to 30 per cent.
Anyaike, who explained that Syphilis has a lot of drivers, like unprotected sex, stressed that despite the fact that the North-eastern state has a high prevalence rate of the disease, he could not scientifically say if it was caused by the security challenges caused by the Boko Haram insurgency.
Adding, “we need to be scientific in our judgement or conclusions. We can’t link that with the security situations in Borno State. However, one could allude that. But, scientifically, we have to prove that it could be possible that the security challenges in that region prevented the people from having access to medical treatment,” he noted.
He stressed that government’s efforts alone cannot solve every problem, noting that government at various levels were doing their best in terms of medical health interventions in the country. “STI has a lot to do with attitudinal linkages. Government could give you prevention or barrier materials to use and you may refuse to use it. You won’t say it is government that got you exposed to Syphilis. It is an individual thing. You could be in a state where there are no security challenges and you keep risky behaviours, as this would expose you to being infected.
“Syphilis has also acquired a new potential for morbidity and mortality through association with increased risk for HIV infection, as experts have suggested that this may make it increasingly difficult to get safe blood because of the blood borne infection and it’s neglect during blood donation and transfusion,” he said.
In a related development, a research conducted in 2014 by International Journal of Research (IJR), showed that 108 consenting pregnant women were recruited and examined for the presence of Syphilis infection. The result showed that the prevalence rate of the infection among pregnant women attending State Specialist Hospital in Maiduguri was 1.9 per cent, a figure that is higher than the national average of 0.3 per cent for Syphilis among pregnant women in Nigeria.
The implication of the findings noted that even in pregnant women, the incidence level is higher than in pregnant women on the average in the country. Experts believed syphilis infection in pregnant women could result in severe impact on pregnancy outcome, primarily as spontaneous abortion, stillbirth and vertical transmission or congenital syphilis.
But why could there be high incidence rate of a disease that is sister to HIV/AIDS, which is experiencing a decline in the country. A medical expert, Dr. Saliu Hamed provides a guide. According to him, lifestyle and lack of proper information among the citizens could be a likely reason for its high incidence level in some areas, over others.
He explained that, since Syphilis is an STI, it was very possible that majority of persons infected by the virus do not protect themselves against the disease, especially among people with multiple partners. “When an infected person have sexual intercourse with someone without the virus, there is a likely tendency for the uninfected person to contract the virus and become infected. That is why it is highly recommended that we adhere to being faithful in our relationships. Condom use is also very encouraged.”
According to him, the primary goal of syphilis prevention was to limit its spread by educating people on the need to avoid harmful indiscriminate sexual practices. “Abstinence and faithfulness to one partner is key. Consistent and correct use of condoms also significantly reduces risk of contracting the disease,” adding that, although condom method was not fail-proof or absolutely protective.
The Centres for Disease Control and Prevention recommends a long term, mutually monogamous relationship with an uninfected partner. Finally, pregnant women are supposed to undergo screening for syphilis early in pregnancy and get treated if necessary, to prevent transmitting the infection to their babies.
Stressing, he said, syphilis spreads very fast and remains a silent killer, since most infected persons may not notice any sign of the disease until it was in its latter stages and caused extensive health problems in the body. “That’s the reason you need information on how to cure syphilis.”
Still surprised that in a 21st century, Nigeria was still having incidence of the disease, Hamed noted that Syphilis was long eradicated from many countries, even since 1970 and 1980. “It was a very common disease during the 1940s and 1950s, especially at the time when HIV/AIDS was very rampant on the continent. HIV weakens the immune system, making is susceptible to syphilis and other opportunistic infections,” he explained.
But, what are the signs and symptoms of the disease, and how can it be treated? According to Hamed, the symptoms may appear in four different stages depending on the severity of the infection. “There are the primary, secondary, latent and tertiary stages. The primary stage of the infection is characterised by small, painless sores that appear mostly on the sex organs and in the inner and outer areas of the mouth. In the secondary stage, rashes start appearing mostly on the palms of the hand and soles of the feet with moist warts in the groin region. But that of latent syphilis, as the name implies, is invisible, because the symptoms are not seen.
The tertiary stage is marked by neurological and cardiac problems which can lead to blindness, brain damage, arthritis, heart attack and eventually, death, if the necessary treatment is not administered promptly.” He said on treatment, it was important that people present early to the hospital, as it remains cheaper and quicker to treat the scourge at an early stage than when symptoms are obvious.
He, therefore called on stakeholders and the government to educate people on the disease, as this would go a long way in reducing the prevalence rate in the country.