Blood person may not notice or recogniseBlood person may not notice or recognise

Blood transfusion is a life-saving intervention and
millions of lives are saved each year globally through this procedure. However,
blood transfusions are associated with certain risks which can lead to adverse
consequences. It may cause acute or delayed complications and carries the risk
of the transmission of infections. Globally, more than 81 million units of
blood are donated each year . (Manzoor  et al., 2009)

transfusion is a therapeutic procedure, as there is no genuine substitution.
But contaminated blood transfusion can transmit infectious diseases and can be
fatal instead of saving life.Safety and protection of human life are two major
points adopted in blood transfusion globally after revelation of Transfusion
Transmissible Infections (TTIs) .(Tessema et al., 2010)

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transmissible infections can be classified as viral, bacterial and parasitic
infections. The most commonly encountered transfusion infection is of viral
origin. In many cases, post transfusion diseases have been caused by human
immunodeficiency virus (HIV), hepatitis B and C virus.(Ameevero et al., 2013)


of the main threats to humanity are Sexually Transmitted Diseases (STD’s) those
can lead to persistent disability, infertility issues, stillbirth, serious
neonatal infections and can also be fetal. Infections caused by STD’s like syphilis
increase the chances of acquiring Human Immunodeficiency Virus (HIV) through
sexual contact.  (Faseehaye  et al., 2011)

is a sexually transmitted diseases (STD). It is not as common as some sexually
transmitted infections but if left untreated it can cause very serious health
problems in both men and women.and can also be transferred down from mother to
baby.(Bhawani  et al., 2010)

is caused by bacteria known as Treponema
pallidum which belongs to spirochete group of bacteria.  This is easily passed from one person to
another through sexual contact.

men and women can have syphilis, and pass it on because symptoms can be mild
and person  may not notice or recognise
them. Following mode  may spread


women to their child

?       Blood Transfusion

 et al., 2010)


results from infection by the corkscrew-shaped bacterium, Treponema pallidum.
Initial inoculation occurs via visible or microscopic abrasions of the skin or
mucous membranes which can result from sexual contact. The average incubation
period of syphilis (ie. time from exposure to the development of primary
syphilis) is 3 weeks but can be as long as 3 months and as short as 9-10
days.(Minde et al.,, 1989)

 Some inoculating organisms lodge at the site
of entry, proliferate and sensitize lymphocytes and macrophages, resulting in
the development of a primary syphilis lesion or “chancre” – a dermatologic
lesion which progresses from macule to papule to ulcer, typically remaining painless,
demonstrating induration and a nonpurulent base. Multiple chancres are noted in
up to 40% of primary syphilis cases (Chapel et al., 1978)

chancre heals spontaneously, usually without scarring, within 1-6 weeks,
heralding the end of the primary stage. After hematogenous dissemination,
generalized or local skin and mucous membrane eruptions can occur, often
accompanied by generalized lymphadenopathy and constitutional symptoms,
signaling the onset of secondary syphilis. Lesions of secondary syphilis
generally occur 3-6 weeks after the appearance of the primary ulcer but up to
one third of patients with signs of secondary syphilis have a primary lesion
still present at the time of diagnosis (Chapel et al., 1980)

 The rash of secondary syphilis is nonspecific
in appearance (ie. macular, papular, or any combination), with usually
nonpruritic lesions scattered on the trunk and extremities and involves the
palms and soles (discrete, scaly, oval lesions) in more than half of cases.

 Other findings of secondary syphilis include
mucous patches (flat, silver-grey erosions involving the mouth, pharynx,
larynx, genitals, or anus), condyloma lata (moist, grey-white, wartlike growths
appearing on the genitals, perianal area, and perineum, in gluteal folds, nasolabial
folds, axillae, between toes, and under breasts), and patchy alopecia which
often has a moth-eaten appearance.(Bailey and Love’s short practice
of surgery : 27th Ed )


 Secondary syphilis (ie. condyloma lata) should
be included in the differential diagnosis of any lesion with the appearance of
condyloma acuminata (ie. Human Papillomavirus infection), and a syphilis
serology should be performed when treating any anogenital wart. Many cases of
secondary syphilis have nontreponemal serologic titers in the range of 1:128 or
higher, although in general, the height of the titer should not be used for
staging purposes.(Taseem et al., 2010)

 Symptoms of secondary syphilis may persist
weeks to months before spontaneously remitting, even without treatment. A
relapse of secondary signs/ symptoms can occur, usually during the first year
of infection. The host immune response suppresses infection enough to eliminate
any signs or symptoms of disease, but does not eradicate the infection
completely, resulting in latent stage infection. During latency, either early
latent (duration of infection ? 1 year) or late latent (> 1 year), no
clinical manifestations are evident, and infection can only be detected by
serologic screening.

natural history of late latent syphilis in the immunocompetent patient follows
the rule of thirds: one third of patients will sero-revert to a nonreactive
nontreponomal syphilis serology, with no recurrence of disease; one third will
remain reactive by nontreponomal syphilis serology but remain free of symptoms
or signs of disease; and the remaining one third will go on to develop tertiary
syphilis, sometimes after decades of chronic, persistent, asymptomatic
infection. Patients with tertiary syphilis may develop granulomatous lesions
(gummas) of the skin or viscera, cardiovascular disease (including aortic
aneurysm, aortic valve insufficiency, coronary stenosis, and myocarditis), or
neurologic disease (acute meningitis, meningovascular disease, general paresis,
tabes dorsalis, and gummatous disease of the brain and spinal cord).(French et
al., 2011)

 Therefore, untreated syphilis can ultimately
lead to devastating, irreversible sequelae which include the complications of
neurosyphilis and tertiary syphilis. In addition, untreated syphilis infection
in a pregnant woman can have tragic consequences for a developing fetus when
transmitted in utero (ie. congenital disease). It has also become well
recognized that STDs such as syphilis interact synergistically with HIV. The
likelihood of HIV acquisition by an HIV-negative individual is markedly
increased in the presence of syphilis or other sexually transmitted infections
(Quinn et al., 1990). Similarly, in the presence of a genital ulcer, persons
infected by HIV more effectively transmit HIV to uninfected partners
(Hutchinson et al., 1991)

susceptibility to syphilis re-infection is decreased immediately after an
episode of adequately treated infection, any acquired immunity is short-lived
after which time, exposure can result in reinfection. Therefore a person can
become re-infected multiple times over their sexually active lifetime and each
infection may have a similar natural history, passing through the primary,
secondary, and latent stages, as described above.

syphilis includes primary and secondary stages and acute stage is referred as
tertiary stage. Syphilis becomes fetal in the tertiary stage of its infections.
The most susceptible organs for the Treponema
Palladium are oral and genital mucous membrane. Syphilis is a prevalent STD
in both developed and developing countries.

 et al., 2009)

people with syphilis have no recognizable symptoms. If symptoms are
experienced, they can include rashes (especially on the palms of the hands and
soles of the feet). Painless, open sores called chancres (pronounced
“shankers”) can appear on the penis, the anus, inside or outside the vagina, on
the mouth or lips, or on any skin exposed during sex. Other symptoms include
patchy hair loss, fever, swollen lymph glands, muscle aches, and fatigue.
Symptoms (when they are noticed) usually last several weeks and disappear, even
without treatment. Although the symptoms go away, syphilis infection remains in
the body. If left untreated, over the years, syphilis can permanently and
seriously damage the heart, brain, and nervous system. (Robbins basic pathology 8th

can cure syphilis, often in a single dose. To be cured, however, syphilis must
be treated early, before permanent damage occurs. Long-term damage caused by
syphilis (years after exposure) cannot be cured. A person can become reinfected
after treatment if exposed to syphilis again.


was no known study done in faisalabad & this study was planned to analyze
data of  blood bank of tertiary care hospital of  Faisalabad to   evaluate 
the prevalence of syphilis among the blood donors that are asymptomatic
but had positive serum findings  to
get  a vivid picture of current
situation  in Faisalabad population to provide
quantitative data of disease for further research & to notify  Health
authorities. So that  steps for
 public awareness & safety could 
be taken.

























study done by Nazir  et al. ( 2013) in
which total 14,352 individual of Lahore population were included.  ARCHITECT syphilis Treponema Pallidum (TP) assay was performed to detect the
syphilis.There were 449 (3.1%) confirmed cases found to be syphilis positive
out of total 14,352 tested individuals. We found that male population is at far
higher risk than female population. Out of 14173 males, 446 (3.1%) were having
syphilis infection. Out of 179 females, only 3 (1.6%) were found to be syphilis


Another  study conducted by   Saeed  et al ( 2017) 
at the Allama Iqbal Medical College and Jinnah Hospital, Lahore,
Pakistan, from December 2014 to November 2015, and comprised healthy
asymptomatic blood donors. Every sample was screened for the presence of
antibodies/antigens of hepatitis C virus, human immunodeficiency virus,
treponemapallidum, hepatitis B virus and malaria parasite through rapid
immunochromatographic technique.Of the 18,274 blood donors, 17,276(94.53%) were
found healthy and 998(5.46%) were infected. Besides, 71(0.38%) had multiple
infections. The overall frequency of anti-hepatitis C virus, treponemapallidum
(syphilis), hepatitis B surface antigen, malaria parasite and anti-human
immunodeficiency virus was 480(2.62%), 284(1.55%), 210(1.10%), 20(0.10%) and
4(0.02%), respectively.


study conducted by Sultan  et al. ( 2007)
in which they analyze   prevalence of
TTIs in Multan population.Data on serologic testing of blood donors (using
commercial assays) were reviewed for the years 1996–2005. Data from 2004 and
2005 were also analyzed with respect to age and type of donor (volunteer versus

frequency of serologic evidence of various infectious pathogens ranged as
follows: hepatitis B 1.46–2.99%, with a downward trend over time, hepatitis C
3.01–4.99%, HIV 0–0.06%, and syphilis 0.19–0.57%. Amongst replacement donors,
younger individuals (<35 years) had lower seroprevalence of hepatitis markers as compared to older persons. Overall, volunteer donors (6.98% of all donors) had the lowest seroprevalence for the diseases   A study conducted by Manzoor  et al (2009) at Blood Bank of Ghurki Trust Teaching Hospital, Lahore to determine the seropositivity of TTIs in blood donors. Records were collected  during January 1st to December 31st, 2008. Six thousand, six hundred and fifty nine blood donors were included in the study (n =6659).  Enzyme linked immunesorbent assay (ELISA) was used for detection of Hepatitis B, C and HIV and Venereal Disease Research Laboratory Test (VDRL) for Syphilis.Only 663 persons had positive serum findings.Result were: HIV3 (0.045%)  HBV113 (1.696%)  HCV512 (7.689%)  Syphilis 35 (0.49%)    Waheed et al. ( 2012) conducted a study in Islamabad population to check prevalence of TTIs. Among  these infections Shypllis was found in 0.89% population. Hussain  et al. (2013) conducted a study in Multan population to check prevalence of TTIs. Among  these infections Shypllis was found in 0.07% population Current burden of the disease worldwide is as; Australia reported 146 cases, UK 20, Canada 47 and Germany 3700 for the year 2012 .Syphilis has also increased rate of incidence in the last 10 years, from 6.5 cases/100,000 of syphilis per year in 1999 and 24.66 cases/100,000 of syphilis per year in 2009.  According to WHO, approximately 12 million people suffer from syphilis each year worldwide.(Yan   et al 2012)                             CHAPTER#3 3.0 MATERIAL AND METHODS: 3.1 Study area:    Allied Hospital Faisalabad.  (Population of Faisalabad city & Periphery) 3.2 Study design:     Retrospective study. 3.3 Data collection instrument:   The data was  collected through performa. 3.4 Duration of study:      Twelve month (september 2016 to september 2017). 3.5 Sampling technique:   Convenient (non-probability) sampling technique. 3.6 Sample collection:  3.6.1 Inclusion criteria ?     Both gender ?     Age range: 20-55y ?       Weight: 50kg or more.  3.6.2 Exclusion criteria:   Following patients are excluded from the above mentioned criteria: ?     Persons with some drug Addiction ?     Persons having Tatoo ?       Persons visit abroad ?       Immunocompromised patient.  3.7 Equipment & Technique: Samples of blood were taken & serum were  separated and screened for the detection of syphilis, by using ARCHITECT syphilis TP assay. ARCHITECT (a two step immunoassay) syphilis Treponema Pallidum (TP) assay was utilized for the qualitative detection of antibodies against TP in human serum or plasma. In the first step of this immunoassay sample, micro particles that were coated with recombinant TP antigens (TpN47, TpN17 and TpN15) and also assay diluents are combined. Anti-TP antibodies those are present in the sample made a synapse with TP coated micro particles. In the second step, after washing, acridinium-labeled anti-human IgM and IgG conjugates were mixed. Again washing was done before adding pre-Trigger and Trigger solutions in reaction. Relative units (RLUs) were measured for the resultant reactions' chemilumenescence. Straight connection was revealed between numbers of anti-TP antibodies, those were present in the sample, and RULs those were detected by ARCHITECT optical system. Determination of presence or absence of anti-TP antibodies in the specimen was done by comparing the chemilumenescent signal in the reaction to the cut off signal determined from a previous ARCHITECT syphilis TP calibration. The specimen is considered reactive for anti-TP if the chemilumenescent signal in the specimen is greater than or equal to the cut off signal.  3.8 Data analysis procedure:                         Appropriate statistical data analysis technique by using SPSS (Vol. 20) was applied. Numerical or quantitative variable such as age  was  expressed. Frequencies of gender mentioned in results. Strip test  findings were  calculated & expressed in the form of pie chart.     CHAPTER # 4 RESULTS & DISCUSSION In order to check suspected increase trend, we analyzed data in two group. September 16  to March 17  & April 17 to September 17.   Total 34943  blood samples were taken  from September 16 to March 17. Mean age of  population was 35 ±10 .Out of these 34453 (99%) were negative for syphilis & 490 (1%) samples were positive.As shown in Pie chart 4.1. In 490 positive persons female were only 3 in number. Male were 487.   Pie Chart 4.1: Summary of  Results for  Sep16 - Mar17     From April 2017 to September 2017: Total 29413 blood sample were collected & analyzed in blood bank. . Mean age of  population was 35 ±10 . Out of these 28913 (98%) were negative for Syphilis & 500 (2%) were  positive for Syphilis. Results also expressed in form of  Pie chart.(Pie chart 4.2) . In 500 positive persons female were only 4 in number. Male were 496.           Pie Chart 4.2:  Summary of Results for Apr17 – Sep17   When we  calculated overall 13 month serum incidence of  Syphilis, It was 2%  as shown in Pie Chart 4.3.   Total bleeding were 64356, out of those  990 (2%) persons were positive for Syphilis.In 990, Male were 983(99.3%)  & female were 7 (0.7%). It show greater extent of  prevalence in Males. Female were less in number in our data  because in Pakistan society mostly Males come for  blood replacement in Government setup. Society trends  & norms are possible cause for this.      Pie chart 4.3: Summary of Results for  Sep16 – Sep17.         When we compare our results with previous studies done in different cities of Pakistan, Prevelance of Syphilis in Faisalabad population is more than Islamabad & Multan but less than Lahore population. There are multiple studies done in Lahore & results show different ratio.Size of sample & different area selection are reason for this difference but overall  incidence of Syphilis is increasing. Result of our study also show increase trend of Syphilis that is 1%  increase in 6 month. Health  authorities should take notice about that & should conduct seminar about prevention of  these diseases     5.2 CONCLUSION:   2% of the blood donors, were found to be syphilis positive in Faisalabad population that is higher than Islamabad(0.89%) & Mulatn(0.57%) but less than Lahore (3.1%) Syphilis infection is more prevalent among males than females. Syphilis prevalence is found to be 1% increase in 6 month. 5.3 SUGGESTIONS: Health  authorities should take notice about increasing trend & should conduct seminar to educate people more about infection of  Syphilis so that  prevention of  this diseases could occur.