Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It progresses through distinct stages if left untreated and can cause serious health complications.

Overview

Syphilis is a bacterial infection that spreads primarily through sexual contact, including vaginal, anal, and oral sex. The disease has been known for centuries and was once a major public health threat before the discovery of penicillin. Today, syphilis remains a significant global health concern, with millions of new cases reported annually worldwide.

The infection is characterized by its progression through distinct stages: primary, secondary, latent, and tertiary. Each stage has unique symptoms and characteristics. Without proper treatment, syphilis can damage the heart, brain, and other organs, potentially leading to serious complications or death.

Syphilis is highly treatable, especially in its early stages. A single injection of penicillin can cure a person who has had syphilis for less than a year. However, treatment cannot reverse damage already done by the infection, making early detection and treatment crucial.

Symptoms

The symptoms of syphilis vary depending on the stage of infection. Many people with syphilis have no symptoms or very mild symptoms that go unnoticed, earning it the nickname "the great imitator" because its symptoms can resemble those of many other diseases.

Primary Stage Symptoms

  • A single sore (chancre) or multiple sores at the infection site
  • The sore is usually firm, round, and painless
  • Appears 10-90 days after infection (average 21 days)
  • Heals without treatment in 3-6 weeks

Secondary Stage Symptoms

  • Skin rash that doesn't itch, often on palms and soles
  • Headache and general malaise
  • Muscle pain and fatigue
  • Fever and swollen lymph nodes
  • Sore throat
  • Patchy hair loss
  • Weight loss
  • Vaginal discharge in women
  • Mucous membrane lesions

Latent Stage

During this stage, there are no visible signs or symptoms. The infection remains in the body and can be detected only through blood tests. This stage can last for years.

Tertiary Stage Symptoms

  • Damage to internal organs including brain, nerves, eyes, heart, blood vessels, liver, bones, and joints
  • Difficulty coordinating muscle movements
  • Paralysis and numbness
  • Gradual blindness
  • Dementia

Causes

Syphilis is caused by the bacterium Treponema pallidum, a spiral-shaped organism called a spirochete. This bacterium is very fragile and cannot survive outside the human body for long, which is why it requires direct contact for transmission.

Transmission Methods

  • Sexual contact: The primary mode of transmission through vaginal, anal, or oral sex with an infected person
  • Direct contact with sores: Contact with syphilis sores on the genitals, anus, rectum, lips, or mouth
  • Mother to child: Pregnant women can transmit syphilis to their unborn children (congenital syphilis)
  • Blood transfusion: Rare in countries with blood screening, but possible through contaminated blood

What Doesn't Cause Syphilis

Syphilis cannot be spread through:

  • Toilet seats
  • Doorknobs
  • Swimming pools or hot tubs
  • Shared clothing or towels
  • Eating utensils

Risk Factors

Several factors increase the risk of contracting syphilis:

  • Unprotected sex: Having vaginal, anal, or oral sex without condoms
  • Multiple sexual partners: Increased number of partners raises exposure risk
  • Men who have sex with men: This population has higher rates of syphilis
  • HIV infection: People with HIV are at increased risk
  • Previous STI history: Having had other sexually transmitted infections
  • Sex work: Commercial sex workers and their clients
  • Substance abuse: Drug or alcohol use that impairs judgment
  • Young age: Sexually active teenagers and young adults

Diagnosis

Diagnosing syphilis requires clinical evaluation and laboratory testing. Healthcare providers use various methods to confirm the presence of the infection:

Physical Examination

A healthcare provider will examine the body for sores or rashes characteristic of syphilis. They will check the genitals, anus, mouth, and skin for any signs of infection.

Laboratory Tests

  • Blood tests: The most common diagnostic method
    • Nontreponemal tests (RPR, VDRL): Initial screening tests
    • Treponemal tests (FTA-ABS, TP-PA): Confirmatory tests
  • Dark-field microscopy: Direct visualization of the bacterium from sore samples
  • Cerebrospinal fluid analysis: If neurosyphilis is suspected
  • PCR testing: Can detect bacterial DNA

Partner Notification

If diagnosed with syphilis, it's crucial to notify all recent sexual partners so they can be tested and treated if necessary. Healthcare providers can assist with partner notification while maintaining confidentiality.

Treatment Options

Syphilis is curable with appropriate antibiotic treatment. The treatment approach depends on the stage of infection and individual patient factors.

Primary Treatment

  • Benzathine penicillin G: Single intramuscular injection for early syphilis
  • Treatment duration:
    • Primary, secondary, or early latent: Single dose
    • Late latent or unknown duration: Three doses at weekly intervals
    • Neurosyphilis: Intravenous penicillin for 10-14 days

Alternative Treatments

For patients allergic to penicillin:

  • Doxycycline: 100mg twice daily for 14-28 days
  • Tetracycline: 500mg four times daily for 14-28 days
  • Ceftriaxone: May be used in certain cases
  • Azithromycin: Limited use due to resistance concerns

Treatment Monitoring

  • Follow-up blood tests at 6, 12, and 24 months
  • More frequent monitoring for HIV-positive patients
  • Retreatment if tests indicate treatment failure
  • Abstain from sexual contact until treatment is complete and sores have healed

Jarisch-Herxheimer Reaction

Some patients may experience a reaction within 24 hours of treatment, including fever, headache, and muscle pain. This is not an allergic reaction but a response to dying bacteria and usually resolves within 24 hours.

Prevention

Preventing syphilis involves reducing exposure risk and early detection:

Primary Prevention

  • Condom use: Consistent and correct use of latex condoms
  • Monogamy: Being in a mutually monogamous relationship with an uninfected partner
  • Regular testing: Annual screening for sexually active individuals at risk
  • Avoid sharing needles: If using injection drugs
  • Limit sexual partners: Reducing the number of sexual partners

Screening Recommendations

  • All pregnant women at first prenatal visit
  • Sexually active gay and bisexual men at least annually
  • People with HIV
  • People taking PrEP for HIV prevention
  • Anyone with symptoms or known exposure

When to See a Doctor

Seek medical attention immediately if you experience:

  • Any unusual sore, rash, or discharge in the genital area
  • Symptoms after having unprotected sex with a new partner
  • A sexual partner who has been diagnosed with syphilis or another STI
  • Symptoms of secondary syphilis such as skin rash or headache
  • Pregnancy, as untreated syphilis can harm the baby

Don't wait for symptoms to appear. Many people with syphilis have no symptoms in the early stages. Regular screening is important for sexually active individuals, especially those with multiple partners or other risk factors.

Frequently Asked Questions

Can syphilis be cured?

Yes, syphilis can be completely cured with appropriate antibiotic treatment, especially when caught early. However, treatment cannot reverse any organ damage that has already occurred.

Can you get syphilis more than once?

Yes, having syphilis once does not protect you from getting it again. You can be reinfected if exposed to the bacteria again.

How long after exposure do symptoms appear?

The first symptom (primary chancre) typically appears 10-90 days after exposure, with an average of 21 days.

Can syphilis be transmitted through kissing?

Yes, if syphilis sores are present in or around the mouth, the infection can be transmitted through kissing.

Is syphilis testing confidential?

Yes, syphilis testing is confidential. However, positive results may be reported to public health authorities for disease tracking and partner notification purposes.

References

  1. Centers for Disease Control and Prevention. Syphilis - CDC Fact Sheet. 2024.
  2. World Health Organization. WHO Guidelines for the Treatment of Treponema pallidum (syphilis). 2023.
  3. Peeling RW, Mabey D, Kamb ML, et al. Syphilis. Nature Reviews Disease Primers. 2017.
  4. U.S. Preventive Services Task Force. Screening for Syphilis Infection in Nonpregnant Adults and Adolescents. JAMA. 2023.
  5. Hook EW. Syphilis. The Lancet. 2017;389(10078):1550-1557.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.