Syphilis is a sexually transmitted infection (STI) caused by a bacteria called Treponema pallidum. It is an infectious disease that spreads when you have vaginal, anal or oral sex with someone who has the infection.
The disease starts as a painless sore, typically on the genitals, rectum or mouth. It spreads from person to person via skin or mucous membrane contact with these sores.
If left untreated, it can lead to serious health problems, including blindness and damage to your brain, heart, eyes and nervous system.
According to the Centers for Disease Control and Prevention (CDC), there were about 134,000 cases of syphilis in 2020. The infection is more common in men and people assigned male at birth (AMAB). Men who have sex with men (MSM) are diagnosed with syphilis more than any other group.
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Symptoms of syphilis
The symptoms of this disease vary depending on the stage of the infection. You’re most contagious in its early stages, when you’re most likely to notice symptoms.
During the first stage, one or more sores develop on your genitals. You may not notice them or mistake them for a pimple or other skin lesion.
During the second stage, you may get a rash and experience flu-like symptoms, such as fatigue, fever, sore throat and muscles aches.
After the second stage, the symptoms of syphilis are hidden (latent stage). Just because you don’t have symptoms doesn’t mean the infection is gone. The only thing that cures the infection and prevents it from progressing is treatment with medication.
Stages of syphilis
The following are the four stages of syphilis, which include:
- primary
- secondary
- latent
- tertiary
Primary stage
The first sign of infection is a small sore, called a chancre. The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them.
The chancre usually develops about three weeks after exposure. Many people who have this infection don’t notice the chancre because it’s usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within three to six weeks.
Secondary stage
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body, even the palms of your hands and the soles of your feet.
This rash is usually not itchy and may be accompanied by wartlike sores in your mouth or genital area. Some people also experience hair loss, muscle aches, a fever, a sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.
Latent stage
If you aren’t treated for this bacteria infection, the disease moves from the secondary stage to the hidden (latent) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the third (tertiary) stage.
Tertiary stage
About 15% to 30% of people infected with this infection, who don’t get treatment will develop complications known as tertiary syphilis. In the late stage, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.
What is Neurosyphilis
At any stage, syphilis can spread and, among other damage, cause damage to the brain and nervous system and the eye.
What is congenital syphilis
Congenital syphilis occurs when a pregnant person passes the disease to the fetus during pregnancy. It causes severe health problems (including death) in babies and young children. Your pregnancy care provider should screen you for STIs at one of your first prenatal visits. It’s important to receive treatment right away if you have the infection.
Seek medical attention if you or your child experiences any unusual discharge, sore or rash, particularly if it occurs in the groin area.
You can also read about symptoms and causes of cholera.
Causes of syphilis
The bacteria Treponema pallidum causes syphilis. An infected person spreads the bacteria through vaginal, anal or oral sex. The bacteria can enter your body through your anus, vagina, penis, mouth or broken skin. The bacteria continues to spread throughout your body, which can eventually damage certain organs.
This bacteria infection is contagious during its primary and secondary stages, and sometimes in the early latent period.
Less commonly, it may spread through direct contact with an active lesion, such as during kissing. It can also be passed from mothers to their babies during pregnancy or childbirth.
Contrary to myth, you cannot get the infection by:
- sharing a toilet
- wearing another person’s clothing
- using another person’s eating utensils
This is because the bacteria that cause this disease can’t live for very long time outside the human body.
Risk factors of syphilis
Anybody can contract the bacteria. However, certain factors may increase your chances of contracting the infection. The following groups of people have an increased risk of contracting the disease:
- people who have HIV
- people who have sex without a barrier method, like a condom, with multiple partners
- people who have partners with syphilis
- men who have sex with men
Complications of syphilis
Not getting proper treatment and the bacteria infection progresses to the last stage (tertiary stage), you’re at risk for life-threatening complications. Damage to your body gets worse the longer you have syphilis. That’s why it’s so important to get treatment right away.
The following are some of the complications of this disease, which include:
- Small bumps or tumors. In the late stage of syphilis, bumps (gummas) can develop on the skin, bones, liver or any other organ. Gummas usually disappear after treatment with antibiotics.
- Neurological problems. Syphilis can cause a number of problems with the nervous system, including Headache, Stroke, Meningitis, Hearing loss, Visual problems including blindness, Dementia, Loss of pain and temperature sensations, Sexual dysfunction in men and Bladder incontinence.
- Cardiovascular problems. These may include bulging and swelling of the aorta, your body’s major artery and of other blood vessels. Syphilis may also damage heart valves.
- HIV infection. Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to fivefold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter the bloodstream during sexual activity.
- Pregnancy and childbirth complications. If you’re pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.
You can also read about risk factors and complications of typhoid fever.
Prevention of syphilis
The best way to prevent syphilis infection is to practice safe sex and use condoms during any type of sexual contact.
Other preventive measures is to:
- Use a dental dam (a square piece of latex) or condoms during oral sex.
- Avoid sharing sex toys.
- Get screened for STIs and talk with your partners about their results.
- Avoid sharing needles if using injected drugs.
If tests show that you have syphilis, your sex partners, including current partners and any other partners you’ve had over the last three months to one year, need to be informed so that they can get tested. If they’re infected too, they can then be treated as well.
Partner notification can help limit the spread of the infection. The practice also steers those at risk toward counseling and the right treatment. And since you can contract the disease more than once, partner notification reduces your risk of getting reinfected.
Diagnosis of syphilis
Your doctor will ask about your sexual activities and history, including whether you practice safe sex or not. It’s very important to be honest during this conversation. Your doctor will then help assess your risk and recommend tests for other STIs.
The following are the test needed to diagnose syphilis infection:
- Blood test. Your healthcare provider will take your blood sample to run tests, and also conduct a thorough physical examination. If a sore is present, they may take a sample from that sore to determine if the syphilis bacteria are present or not.
- Fluid from a sore. A laboratory can study this fluid under a microscope to confirm that syphilis caused the sore.
- Cerebrospinal fluid. If your healthcare provider suspects that you’re having nervous system problems because of tertiary syphilis stage (and you have positive screening blood tests), you may undergo a lumbar puncture, or spinal tap. During this procedure, your spinal fluid is collected so that your doctor can test for the syphilis bacteria.
You can also read about diagnosis and treatment of Japanese encephalitis.
Treatment of syphilis
Primary and secondary syphilis are easily treated with a penicillin injection. Penicillin is one of the key most widely used antibiotics and is usually effective in the treatment of syphilis. People who are allergic to the drug (penicillin) will likely be treated with a different form of antibiotics, which can include:
- ceftriaxone
- doxycycline
In the case of neurosyphilis, you’ll get daily doses of penicillin intravenously. This will mostly require a brief hospital stay.
The damage caused by late syphilis can’t be reversed. The bacteria can be killed, but treatment will most likely focus on easing pain and also discomfort.
During your treatment, do make sure to avoid sexual contact until all sores on your body are healed and your healthcare provider tells you it’s safe to resume sex. If you’re sexually active, your partner should be tested and treated too. It’s advisable not to resume sexual activity until you and your sexual partner have undergo a complete treatment. You can ask your doctor about the side effects of your medications and how long the treatment will last.
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