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A Journal on Dermatology and Sexually Transmitted Diseases

Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2017 Dec 01

DOI: 10.23736/S0392-0488.17.05830-8


language: English

Relevance in biology and mechanisms of immune and treatment evasion of Treponema pallidum: a review

Francesco DRAGO, Sanja JAVOR , Aurora PARODI

Department of Dermatology, DISSAL, Policlinic Hospital San Martino-IST, University of Genoa, Genoa, Italy


INTRODUCTION: During syphilis a compelling fight is engaged between the host’s humoral and cellular immune responses that work to eliminate the infection and Treponema pallidum (T. pallidum) that manages to evade eradication and cause chronic infection. Different mechanisms are utilized by treponemes to overcome immunological response. Although penicillin (BPG) proved to be effective in quelling the early manifestations of the disease and consequently its contagiousness, questions remain about its ability to prevent the late complications and to provide a microbiological eradication in vivo. In fact, both serological and microbiological failures have been reported following conventional treatment.
EVIDENCE ACQUISITION: We reviewed some biologic properties of T. pallidum in order to establish a relationship with the persistence of the infection and the alleged treatment resistance.
EVIDENCE SYNTHESIS: The host humoral response, sometimes, may not protect completely against T. pallidum and accounts for the persistent infection and tertiary damages. In fact, the cell mediated response during infection may be downregulate in response to pathogen-derived molecules, or indirectly by generating Treg cells. It is also possible that there are strain types of T. pallidum with higher ability of evasion determining neurosyphilis. In addition, apart the impressive results that BPG has made on the syphilis cutaneous lesions, concerns still remain on its efficacy in preventing late complications.
CONCLUSIONS: Understanding the biology of the T. pallidum may help researchers in this field to develop future target therapies in order to prevent persistent infection and progression of the disease.

KEY WORDS: Treponema pallidum - Antigenicity - Pathogenicity - Phenotypic resistance - Immunological clearance

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Publication History

Article first published online: December 01, 2017
Manuscript accepted: November 14, 2017
Manuscript received: October 26, 2017

Cite this article as

Drago F, Javor S, Parodi A. Relevance in biology and mechanisms of immune and treatment evasion of Treponema pallidum: a review. G Ital Dermatol Venereol 2017 Dec 01. DOI: 10.23736/S0392-0488.17.05830-8

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