Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum, resulting in a syphilitic sore or chancre started as a pimple that ruptures into a sore in the mouth, genitals, or anus. If left untreated, primary syphilis will progress to secondary, latent, and tertiary stages, damaging the nervous and cardiovascular systems and eventually leading to death. Those who suspect they have syphilitic symptoms should seek medical attention as soon as possible for curative treatment.
What causes syphilis?
Syphilis is a sexually transmitted disease caused by infection by the bacterium Treponema pallidum through direct contact with secretions of an infected person, such as having sex without a condom, oral sex, kissing that contacts saliva, exposure to skin or mucous membrane sores, or mother-to-child transmission during pregnancy or at birth.
What are the symptoms of syphilis?
Syphilis has four clinical stages based on the natural history of the disease, which manifests differently in each individual. It may progress stagewise from primary to tertiary stage, or the symptoms may overlap with the succeeding one. In some cases, syphilis remains latent for years without causing any symptoms.
Stage 1: Primary syphilis
Symptoms of stage 1 syphilis, or ulcerative stages, manifest as small, red, raised sores known as chancre on the genitals, mouth, anus, urethra, or vaginal mucosa within three weeks of the infection. Sores are infectious and painless when pressed. The lesions may be single or multiple that heal by themselves in 3–8 weeks, but syphilis remains hidden in the body and can progress to the secondary stage if not treated.
Stage 2: Secondary syphilis
Symptoms of stage 2 syphilis, syphilis rash appear, usually 3–12 weeks after infection. It is the stage in which syphilis spreads into the lymph nodes and through the bloodstream to various body organs, causing macular, papulosquamous, lues maligna, or papular lesions that are painless when pressed without itching and may cover the whole body, including the genitals, palms, and soles of the feet, accompanied by enlarged lymph nodes, fever, sore throat, fatigue, weight loss, and joint pain. At this stage, the blood test results are usually positive. After 2-3 weeks, the symptoms will gradually fade or occur intermittently, but the bacterial infection remains hidden in the body and continues to develop into a latent stage.
Stage 3: Latent syphilis
Untreated primary and secondary syphilis will advance into stage 3, or latent syphilis. It is the “clinically silent” stage without outward symptoms, but internal organ damage continues. It is the longest stage of the disease, which can linger for over 20 years before progressing to stage 4 or tertiary syphilis. Those with syphilis at this stage may have mild recurring symptoms and rarely transmit the bacterial infection to others via sexual intercourse.
Stage 4: Tertiary syphilis
Approximately 15-30% of untreated syphilis will progress to stage 4 or tertiary syphilis. The syphilitic lesions manifest as painless sores, abscesses, or thick, raised red rashes blooming on the skin or mucosal surfaces. It is the stage in which the bacterial infection in the lymph nodes and bloodstream further damages the internal organs, resulting in complications in various organ systems such as the nervous system, the brain, the cardiovascular system, the liver, eyes, bones, and joints that cause various diseases and abnormalities such as movement disorders, aortic regurgitation, aortitis, dementia, blindness, deafness, paralysis, and convulsions, and may eventually lead to death.
How is syphilis diagnosed?
The doctor will make a diagnosis of syphilis by taking a history to determine if there is a disease exposure risk, performing a physical examination to look for the signs of the disease, and performing laboratory tests using the following methods:
- Dark-field microscopy test: to detect live treponema pallidum bacteria by taking a sample from the secretion or pus from the sore in stage 1 or ulcerative stage with high-performance microscopy.
- Blood tests to look for specific antibodies in stage 1 and 2 syphilis against the syphilis-causing bacteria Treponema pallidum. This test is highly accurate, with the results available within 1-3 days. The blood tests are of two types:
- Blood tests for non-specific syphilis immunity, such as the VDRL (Venereal Disease Research Laboratory Test) or the RPR (Rapid Plasma Reagin).
- Blood tests for specific syphilis immunity, such as FTA-ABS (fluorescent treponemal antibody absorption), TPHA (Treponemal pallidum hemagglutination test), TP-PA (Treponema pallidum particle agglutination), or ICT (immunochromatography).
- Lumbar puncture: For those with symptoms of stage 3 syphilis or manifest neurological disorders and other complications, the doctor will confirm the disease by performing tests on cerebrospinal fluid.
How is syphilis treated?
The doctor will treat syphilis by injecting a high-dose penicillin antibiotic to kill the bacteria and eradicate the infection. In addition to those presenting with stage 1 syphilis, an asymptomatic sexual partner with a negative blood test will receive a single intramuscular antibiotic injection.
For those who progress to stage 2-3 syphilis, doctors will consider three weekly intramuscular penicillin antibiotic injections or intravenous administration if there are various organ system infections or in cases with severe symptoms. The doctor will give appointments for repeated blood tests after the initial treatment at 3 and 6 months and annually to monitor syphilitic signs and symptoms and prevent the disease from progressing to the final stages, which may cause systemic complications.
In addition, the doctor will advise the patient to refrain from sexual activities until the blood test is negative or to use a condom if sex is unavoidable. One should inform the sexual partner of the need for syphilis testing as well.
What are the complications of syphilis?
Untreated syphilis will progress to the final tertiary stage, causing several complications with potential damage to several organ systems, including:
- Neurological and brain diseases, such as stroke, meningitis, hearing loss, visual impairment, blindness, dementia, loss of pain and temperature senses, sexual dysfunction in men, or urinary incontinence
- Cardiovascular systems, such as arterial aneurysms, aortic regurgitation, or inflammation of the large arteries (Aortitis)
- Soft mass (gummas), In the late stages of infection, gummas may appear, which are large benign masses on the skin or internal organs such as bones or the liver. However, gumma can resolve with antibiotics.
- HIV infection: Syphilis can cause bleeding sores around the genitals and mouth, increasing the risk of HIV infection by 2-5 times during sexual activities. HIV infection is the cause of AIDS.
- Mother-to-child transmission: fetal infection during pregnancy or childbirth of a pregnant syphilitic woman. It increases the risk of fetal complication and death in utero or of newborns after birth, including premature birth, low birth weight, or congenital syphilis.
What is congenital syphilis?
Congenital syphilis is secondary to mother-to-child infection during pregnancy. The disease transmission can occur at any stage of pregnancy or during childbirth when the baby comes into contact with the mother's secretions or mucous membranes during delivery. Congenital syphilis is a common cause of premature birth and fetal, postnatal, and maternal death, with symptoms ranging from asymptomatic to rash on the palms and soles, deafness, abnormal tooth structure, abnormal nasal structure, known as syphilitic nose, and other serious health issues. Pregnant women should be tested for syphilis and other sexually transmitted diseases to ensure the safety of the fetus and receive appropriate treatment if needed.
What are the preventions for syphilis?
Syphilis is a sexually transmitted disease with no current vaccine. Therefore, practicing safe sex, seeing a doctor immediately after unprotected sex with a new partner, or noticing sores in the mouth or the genitals is the best way to prevent the spread of syphilis. Other preventive measures include the following:
- Always use a condom for sexual intercourse (particularly unsafe sex, or sexual partner)
- Avoiding multiple sexual partners and refraining from risky sexual behaviors
- Avoid kissing or having oral sex with a one-night-stand sexual partner.
- Refrain from sharing sex toys.
- Never share needles.
- Do not touch the wounds of others.
- Inform the partner if you are known to have syphilis.
- Enroll in a prenatal care program to detect syphilis (for expectant mothers)
- Screening for other sexually transmitted diseases
- Premarital Checkup,
- Annual health check
- Always maintain body cleanliness.
- Exercise to maintain a healthy physical state.
What are the symptoms of syphilis in females?
Typically, syphilis symptoms for both men and women present with painless sores or chancre and sometimes warty growth on the genitalia. A sore mouth or a white patch on the tongue, lips or the mouth may be found, along with associated symptoms, such as fever, enlarged lymph nodes, sore throat, headache, weight loss, muscle aches, hair loss, and tiredness. Syphilis symptoms in females include genital lesions sores on the labia, cervix, or vaginal wall.
What are the symptoms of syphilis in males?
Symptoms of syphilis in males are the same as females include sores or chancres growth on the genitalia and mouth similar to sores in herpes simplex, or genital warts. Syphilis symptoms in males include lesions are on the penile head, shaft, or under the foreskin, including those around the scrotum, anus, groin, and lips, and a sore in the urethra.
Is syphilis treatable?
Syphilis is treatable with antibiotics. Those with suspected symptoms or having unprotected sex should urgently see a doctor at the hospital for an examination and treatment to prevent syphilis from developing into further stages.
Syphilis, a treatable sexually transmitted infection
Syphilis is a sexually transmitted infection, curable with antibiotics, that can pass on from person to person via unprotected sex, kissing, contact with an infected person's secretions or sores, or mother-to-child transmission during pregnancy or at birth, which may result in fetal death.
Syphilis and other STDs are preventable by always using a condom for sex, avoiding kissing one-night-stand sexual partners, or touching an infected person's sore. Those with suspected symptoms or who engaged in unprotected sex with a new partner should urgently see a doctor for an examination and treatment to cure the infection and prevent the disease from progressing to later stages, which could lead to potentially life-threatening future health issues. Having only a sexual relationship with your partner can help reduce your risk of contracting syphilis.