The Role of Immunity in The Epidemiology of Adolescent Syphilis
Main Article Content
Introduction. Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and remains a global health problem with a significant increase in prevalence. Adolescents are vulnerable to syphilis because they lack sufficient sexual health information and services. This study aims to explore the role of cellular immune response in the pathogenesis of syphilis in adolescents and the factors that influence it. Methods. This research study adopted a systematic literature review methodology, sourcing data from PubMed, Scopus, Web of Science, and Google Scholar databases. Results. The results demonstrate a crucial involvement of macrophages, dendritic cells, and T lymphocytes in the cellular immune response against Treponema pallidum causes Syphilis. The immune response is principally influenced by variables such as age, nutritional status, and the presence of HIV infection. High infection rates are also attributable to factors such as risky sexual behaviour and socioeconomic conditions. Enhanced interventions, including comprehensive sexual health education and improved access to healthcare services, are crucial for mitigating the adverse effects of syphilis in adolescents. Conclusion. In conclusion, this research underscores the necessity of a deeper understanding of the immunopathogenic mechanisms of syphilis in adolescents to facilitate the development of more effective preventive, diagnostic, and therapeutic strategies.
Keywords:
Syphilis
Immunosupression
Epidemiology
Adolescents
Immune cells
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11. Avelino ME, Silva AS, Figueiredo LG, Fonseca RR, Menezes CR, Lima SS, Mendes AL, Silva CH, Reis IV, Nunes HB, Sequeira BJ. Exposure to Treponema pallidum infection among adolescent and young adult women in Roraima, Amazon region of Brazil. Microorganisms. 2023;11(10):2382.
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17. Rana A, Deb M. A Review on Syphilis: Clinical Manifestation and Epidemiology. J Pharm Res Int. 2021;64–70.
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21. Vives N, Garcia de Olalla P, González V, Barrabeig I, Clotet L, Danés M, Borrell N, Casabona J, Catalan HIV and STI Surveillance Group. Recent trends in sexually transmitted infections among adolescents, Catalonia, Spain, 2012–2017. International journal of STD & AIDS. 2020 Oct;31(11):1047-54.
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24. Fan L, Yu A, Zhang D, Wang Z, Ma P. Consequences of HIV/syphilis co-infection on HIV viral load and immune response to antiretroviral therapy. Infect Drug Resist. 2021;14:2851–62.
25. Kara M, Hançerli-Törün S, Köksal MO, Kaba Ö, Köseoğlu-Yildirim E, Ağaçfidan A, Somer A. Secondary syphilis in a HIV infected adolescent patient. Turk Hijyen ve Deneysel Biyoloji Dergisi. 2019;76(1):93–8.
26. Llavero-Molino I, Sánchez-Torres M, Hueso-Montoro C, González-García A, García-García I, Jiménez-Bautista F, Pérez-Morente MÁ. Epidemiological Profile and Risk Factors Related to Sexually Transmitted Infections in Sex Workers in Granada (Spain). Nurs Rep. 2025;15(3):82.
27. Matovu JK, Bukenya JN, Kasozi D, Kisaka S, Kisa R, Nyabigambo A, Tugume A, Bwanika JB, Mugenyi L, Murungi I, Serwadda D. Sexual-risk behaviours and HIV and syphilis prevalence among in-and out-of-school adolescent girls and young women in Uganda: A cross-sectional study. PLoS one. 2021;16(9):e0257321.
28. Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med. 2024;13(6).
29. Brewer TH, Schillinger J, Lewis FMT, Blank S, Pathela P, Jordahl L, Schmitt K, Peterman TA. Infectious syphilis among adolescent and young adult men: Implications for human immunodeficiency virus transmission and public health interventions. Sex Transm Dis. 2011;38(5):367–71.
30. Giantini A, Wulandari D, Suparmin S. Comparison of syphilis rapid diagnostic test to rapid plasma reagin, treponema pallidum haemagglutination assay and fluorescent treponemal antibody-absorption for syphilis and yaws diagnostics. Indonesian Biomedical Journal. 2020;12(2):136–42.
31. Houston S, Schovanek E, Conway KME, Mustafa S, Gomez A, Ramaswamy R, Haimour A, Boulanger MJ, Reynolds LA, Cameron CE. Identification and Functional Characterization of Peptides With Antimicrobial Activity From the Syphilis Spirochete, Treponema pallidum. Front Microbiol. 2022 May 3;13: 888525.
32. Alcedo S, Newby R, José Montenegro J, Rondan P, Arevalo J, Chiappe A, Soria J. Immune reconstitution inflammatory syndrome associated with secondary syphilis: dermatologic, neurologic and ophthalmologic compromise in an HIV patient. International journal of STD & AIDS. 2019;30(5):509-11.
33. Mitra D, Singh G, Mitra B, Talukdar K, Dhillon A, Singh T. A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome. Indian J Sex Transm Dis AIDS. 2021;42(2):156–8.
2. Djohan H, Sutriswanto S, Nurhayati E, Ratika M, Salim M. Hubungan Seks Bebas Dengan Kejadian Sifilis Di Wilayah Kerja Puskemas Kom Yos Sudarso Kota Pontianak. Jurnal Laboratorium Khatulistiwa. 2024;7(2):133-8.
3. Xiong S, Liu Z, Zhang X, Huang S, Ding X, Zhou J, Yao J, Li W, Liu S, Zhao F. Resurgence of syphilis: focusing on emerging clinical strategies and preclinical models. J Transl Med. 2023;21(1): 917.
4. Bolmont M, Bornhauser P, Cloppet Mouchet J, Michaud M, Toutous Trellu L. Psycho-sexological impact(s) of syphilis among infected persons. Journal of Sexual Health Psychology. 2024;3(1):1–13.
5. Farahani M, Killian R, Reid GA, Musuka G, Mugurungi O, Kirungi W, Nuwagaba-Biribonwoha H, El-Sadr WM, Justman J. Prevalence of syphilis among adults and adolescents in five sub-Saharan African countries: findings from Population-based HIV Impact Assessment surveys. The Lancet Global Health. 2024 Sep 1;12(9):e1413-23.
6. Jibirilla FM, Peter VO, Imam AB, Talba H. Sexually Transmitted Infections Among Adolescents: A Current Issue Facing the Health System in Nigeria. Int J Health Sci Res. 2024 Feb 17;14(2):214–21.
7. Irawan Y, Chelsea E, Surya R. Syphilis Elimination in Indonesia by 2030: Keeping in the Right Track. Cermin Dunia Kedokteran. 2023;50(4):234-7.
8. Lubis YH. Analysis of HIV and syphilis transmission prevention programs: how to implement for adolescents? Social Medicine. 2023;16(2):76-82.
9. Musonda P, Halwiindi H, Kaonga P, Ngoma-Hazemba A, Simpungwe M, Mweemba M, Tembo C, Zyambo C, Chisoso J, Munakampe M, Choonga P. HIV, syphilis and sexual-risk behaviours’ prevalence among in-and out-of-school adolescent girls and young women in Zambia: A cross-sectional survey study. PLoS one. 2024;19(6):e0294545.
10. Westin MR, Martinez YF, Silva AP, Greco M, Marques LM, Campos GB, Alves MD, Mancuzzo A, Tupinambás U, Greco DB. Prevalence of syphilis and sexual behavior and practices among adolescents MSM and TrTGW in a Brazilian multi-center cohort for daily use of PrEP. Cadernos de Saúde Pública. 2023;39:e00118721.
11. Avelino ME, Silva AS, Figueiredo LG, Fonseca RR, Menezes CR, Lima SS, Mendes AL, Silva CH, Reis IV, Nunes HB, Sequeira BJ. Exposure to Treponema pallidum infection among adolescent and young adult women in Roraima, Amazon region of Brazil. Microorganisms. 2023;11(10):2382.
12. European Centre for Disease Prevention. Syphilis Annual Epidemiological Report for 2021. ECDC, European Centre for Disease Prevention and Control; 2023.
13. Fajemiroye JO, Moreira AL, Ito CR, Costa EA, Queiroz RM, Ihayi OJ, Moreira CV, Costa RF, Teixeira CC, Bortolini MJ, Silva ON. Advancing syphilis research: Exploring new frontiers in immunology and pharmacological interventions. Venereology. 2023;2(4):147-63.
14. Hernández-Pliego A, Vergara-Ortega DN, Herrera-Ortíz A, Toledano-Jaimes C, Esquivel-Guadarrama FR, Sánchez-Alemán MÁ. IL-10 and IL-17 as Progression Markers of Syphilis in People Living with HIV: A Systematic Review. Biomolecules. 2022;12(10).
15. Liu D, Chen R, Wang YJ, Li W, Liu LL, Lin LR, Yang TC, Tong ML. Insights into the protective immune response by immunization with full-length recombinant TprK protein: cellular and humoral responses. npj Vaccines. 2023;8(1):146.
16. Wen J, Li Z, Zhao W, Li F, Hou J, Li Z, et al. Analysis of Th1 cells, Th2 cells, Treg cells and Th17 cells related cytokines in peripheral blood of the serofast syphilis patients. China Journal of Leprosy and Skin Diseases. 2021 Jun 1;37(6):356–9.
17. Rana A, Deb M. A Review on Syphilis: Clinical Manifestation and Epidemiology. J Pharm Res Int. 2021;64–70.
18. Draeger E. Diagnosis and management of syphilis: a guide for GPs . Prescriber. 2021;32(8–9):13–7.
19. Yanuar F, Diana EDN, Nugraha W, Murastami A, Ellistasari EY. Late latent syphilis with early syphilis titer in pregnancy: A case report. Jurnal Kedokteran dan Kesehatan Indonesia. 2022;13(1):96-101.
20. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574-588.
21. Vives N, Garcia de Olalla P, González V, Barrabeig I, Clotet L, Danés M, Borrell N, Casabona J, Catalan HIV and STI Surveillance Group. Recent trends in sexually transmitted infections among adolescents, Catalonia, Spain, 2012–2017. International journal of STD & AIDS. 2020 Oct;31(11):1047-54.
22. Maciel NS, Ferreira D da S, Oliveira AWN, Santos MP, Da Costa CC, de Sousa LB. Aplicativo móvel sobre sífilis para adolescentes: validação de aparência e conteúdo. Enfermería Global. 2023;22(1).
23. Tang Y, Zhou Y, He B, Cao T, Zhou X, Ning L, Chen E, Li Y, Xie X, Peng B, Hu Y. Investigation of the immune escape mechanism of Treponema pallidum. Infection. 2023;51(2):305-21.
24. Fan L, Yu A, Zhang D, Wang Z, Ma P. Consequences of HIV/syphilis co-infection on HIV viral load and immune response to antiretroviral therapy. Infect Drug Resist. 2021;14:2851–62.
25. Kara M, Hançerli-Törün S, Köksal MO, Kaba Ö, Köseoğlu-Yildirim E, Ağaçfidan A, Somer A. Secondary syphilis in a HIV infected adolescent patient. Turk Hijyen ve Deneysel Biyoloji Dergisi. 2019;76(1):93–8.
26. Llavero-Molino I, Sánchez-Torres M, Hueso-Montoro C, González-García A, García-García I, Jiménez-Bautista F, Pérez-Morente MÁ. Epidemiological Profile and Risk Factors Related to Sexually Transmitted Infections in Sex Workers in Granada (Spain). Nurs Rep. 2025;15(3):82.
27. Matovu JK, Bukenya JN, Kasozi D, Kisaka S, Kisa R, Nyabigambo A, Tugume A, Bwanika JB, Mugenyi L, Murungi I, Serwadda D. Sexual-risk behaviours and HIV and syphilis prevalence among in-and out-of-school adolescent girls and young women in Uganda: A cross-sectional study. PLoS one. 2021;16(9):e0257321.
28. Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med. 2024;13(6).
29. Brewer TH, Schillinger J, Lewis FMT, Blank S, Pathela P, Jordahl L, Schmitt K, Peterman TA. Infectious syphilis among adolescent and young adult men: Implications for human immunodeficiency virus transmission and public health interventions. Sex Transm Dis. 2011;38(5):367–71.
30. Giantini A, Wulandari D, Suparmin S. Comparison of syphilis rapid diagnostic test to rapid plasma reagin, treponema pallidum haemagglutination assay and fluorescent treponemal antibody-absorption for syphilis and yaws diagnostics. Indonesian Biomedical Journal. 2020;12(2):136–42.
31. Houston S, Schovanek E, Conway KME, Mustafa S, Gomez A, Ramaswamy R, Haimour A, Boulanger MJ, Reynolds LA, Cameron CE. Identification and Functional Characterization of Peptides With Antimicrobial Activity From the Syphilis Spirochete, Treponema pallidum. Front Microbiol. 2022 May 3;13: 888525.
32. Alcedo S, Newby R, José Montenegro J, Rondan P, Arevalo J, Chiappe A, Soria J. Immune reconstitution inflammatory syndrome associated with secondary syphilis: dermatologic, neurologic and ophthalmologic compromise in an HIV patient. International journal of STD & AIDS. 2019;30(5):509-11.
33. Mitra D, Singh G, Mitra B, Talukdar K, Dhillon A, Singh T. A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome. Indian J Sex Transm Dis AIDS. 2021;42(2):156–8.
