Syphilis is a sexually transmitted disease caused by the Treponema pallidum pathogen. Although effective and accessible treatment is available, this disease continues to be a worldwide public health priority, with more than 12 million people infected each year. Colombia has areas where venereal syphilis is endemic, which is evident from the high incidence rates of syphilis during pregnancy, as high as 5.6 cases per 1000 live births. The state of Valle del Cauca is one of the most affected in the country, reporting 12 cases of infected pregnant women per 1000 live births in 2010. Undiagnosed syphilis, in addition to threatening the life of the patient, can increase the risk of HIV transmission. In addition, when the disease is undiagnosed in pregnant women, there is a high probability of transmission to the fetus. This leads to congenital syphilis, one of the main causes of perinatal morbidity and mortality in the world.

Various obstacles for the study of syphilis exist, including the inability to culture the microorganism, the lack of an animal model, and a dearth of attention by clinical, academic, scientific and public health groups. For these reasons, our understanding of the disease, including is natural history, diagnosis, microbiology, genetics and epidemiology, has not advanced adequately. In response to this need, CIDEIM has worked since 2001, in collaboration with the University of Connecticut and the Center for Disease Control and Prevention (CDC), to better understand the immunopathogenesis and molecular epidemiology of the disease, and to propose more effective health interventions.

Strategic objectives

• To study alternative diagnostic tests for congenital syphilis.
• To contribute to the knowledge base on the host immune response to T. pallidum and the molecular epidemiology of the disease.
• To train health personnel in the management of sexually transmitted diseases (STDs), with an emphasis on venereal, gestational and congenital syphilis.
• To generate knowledge that will inform the design of prevention and control strategies for gestational and congenital syphilis by public health authorities.
• To improve health intervention strategies for congenital syphilis, taking into account the diagnosis, treatment, registry and follow-up of the disease.

Current research and services

• Molecular characterization of T. pallidum in patients with early-stage syphilis in Cali, Colombia: the goal of this study is to understand the host immune response to the bacteria, while at the same time characterizing T. pallidum strains in the region.
• Clinical, immunopathological and molecular diagnosis of congenital syphilis, a pilot study: this project, conducted at the University Hospital of Valle and the San Juan de Dios Hospital, studies alternative diagnostic tests for syphilis, including PCR and immunohistochemistry.
• Study of congenital syphilis cases in Buenaventura, Valle: the goal of this project is to epidemiologically characterize the congenital syphilis cases in Buenaventura during 2011, including eight perinatal deaths caused by this disease.

Achievements

Our research team has made several innovative contributions regarding the human immune response to T. pallidum. We were the first to identify bacterial burdens in blood of patients with active disease, information which contributed to a better understanding of the pathogenesis of the disease (Cruz AR, et al. PLoS NTD 2010). In addition, we described some of the T. pallidum subtypes for the first time in Latin America, and found a great heterogeneity between strains. These findings suggest that syphilis is an ancient disease, endemic rather than epidemic in our region. The knowledge generated feeds into the design of syphilis control strategies. In parallel to our scientific research, we have trained the medical community in Cali, strengthening STD management with a special emphasis on syphilis.

Contact

Luisa Consuelo Rubiano, MD, MSc
Coordinator for Syphilis Research
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