Clearing an Immigration medical examination for getting green card for United States is one big challenge that many immigrants face. There are several tests one needs to undergo before they can apply their application for further process. And an important immigration related medical screening is for Syphilis, a Sexually transmitted disease.

What is Syphilis?

Syphilis is caused by a bacterial spirochete Treponema pallidum. A spirochete is a thin spiral or coil-shaped bacterium that enters the body through the mucous membranes or breaks in the skin. It is transmitted sexually or vertically (from mother to child). In 90% of cases, the spirochete is transmitted by sexual contact.

Under Sexually transmitted syphilis there are

Primary Syphilis:

• The infection goes unnoticed when the organism enters the body.
  After a gestation period of 10 – 90 days, a small painless pustule on the skin can be noticed. Usually it erodes forming a painless bloodless ulcer called Chancre is visible. The disease may resolve within a few days or the fluid that swarms with spirochetes may result being highly contagious.
• Secondary Syphilis:
  Secondary syphilis are seen anywhere between six to eight weeks and six months after the infection begins.
• It is a systemic infection marked by the eruption of skin rashes and ulcers in the mucous membranes which is characterized by general malaise, anorexia, nausea, fever, headache, alopecia, bone and joint pain, or the appearance of a morbilliform rash that does not itch, flat white sores in the oral cavity and throat, and condylomata lata papules on the moist areas of the skin.
• The disease appears with a coppery color having no pain or itching, occurs on the palms of the hands and soles of feet. This is highly contagious during this stage.
  Latent Syphilis
• Patient has no clinical signs or symptoms of the disease being present. It is usually discovered by serologic tests
  Tertiary Syphilis
• Untreated syphilis usually occur in about 35-40% of patients anywhere between 1-30 years after infection.
• This is characterized by neurological, cardiovascular or gummatous complications.
  Vertically transmitted syphilis
  Congenital syphilis:
• This is usually transmitted prenatally by the mother to the fetus ( around 50% of infants are affected)
• This leads to Hutchinson’s incisors, mulberry molars, or rhagades
• Causes stillbirth in about 30% of infected mothers
• Symptomatic neurosyphilis occurs in 1-5% of these children, often characterized by sudden deafness (usually around 8-10 years or age) and/or interstitial keratitis or chorioretinitis.
  Diagnosis
• Detection of syphilis is often delayed because of the varying length of the incubation period, and the possibility of not noticing at the initial chancre stage.
• Doctor can detect the possibility of the disease while taking the patient’s history, to determine if the patient falls into high risk based on their recent sexual contacts.
• Other symptoms, such as skin rashes or swollen lymph nodes, are also noted with respect to the dates of the patient’s sexual contacts.
• Only by a thorough diagnosis based on blood test will prove if the disease is positive or negative.
  Blood tests
• Non-treponemal tests are serological tests that detect lipoidal substances released from cells during syphilis infection. These tests usually correlate with disease activity and become negative after adequate treatment.
• Treponemal tests are serological tests that detect syphilis antigens. These tests are generally more specific and less sensitive than non-treponemal tests.
• Darkfield microscopy can be used to visualise treponemes from a primary chancre or nasal secretions. Failure to identify treponemes does not exclude a syphilis diagnosis.
• Syphilis PCR can be performed on swabs from a primary chancre, nasal secretions or CSF. It is not adequately sensitive for screening (e.g. to blood)
• CSF should be collected for VDRL, FTA-Abs or PCR testing where neurosyphilis is suspected.

• What if the applicant has/ had syphilis?
• The form I-693 has check box which says no A or B condition exists and also Class A condition and Class B condition. Applicants with untreated syphilis are Class A condition.
  Aliens applying for US Immigration should be correctly diagnosed with Syphilis, as to ensure that the affected applicants receive timely treatment. This will minimize the waiting time not only about the immigration process but also reduces the further spread of disease.
•  Applicants with syphilis are treated using a standard syphilis treatment regimen before any medical report form is completed or signed. The result and treatment information, including medication, dose, and dates of treatment and route of administration are recorded for the purpose of medical examination for an immigrant from.
• Syphilis treated patient must present the panel doctor with a written certificate, signed by a doctor or public health official, proving that the applicant was effectively treated, then they are re-classified as a Class B condition, and the applicant may be medically cleared for Immigration process.