Syphilis is a sexually transmitted bacterial infection, caused by the bacterium Treponema pallidum. It is often categorized into stages: Primary, secondary, latent, and late, or tertiary.
While the incidence of syphilis infections in the United States has decreased in women since 2010, incidence of male infections continue to rise. This is most prevalent in men who have sex with men.
Syphilis is treatable, especially if it is caught early on. However, it will not go away on its own. Anyone who is concerned that they are infected should seek medical advice as soon as possible.
In this article, we will cover the causes, symptoms, diagnosis, and treatment of syphilis.
Fast facts on syphilis
Here are some key points about syphilis. More detail and supporting information is in the main article.
- In 2008 in the United States, there were approximately 55,400 new cases of syphilis with a total of 117,000 combined new and existing cases of the disease
- Sharing toilets, bathtubs, clothing, or eating utensils does not spread syphilis nor does touching door knobs or using the same swimming pools or hot tubs
- Syphilis will not come back after treatment; however, individuals can become reinfected with the bacteria again through exposure to a new syphilis sore
- Those most at risk of contracting syphilis include those who have unprotected sex (anal, vaginal, and oral), men who have sex with men, those with HIV, and those with numerous sexual partners
What is syphilis?
Syphilis is a bacterial infection that is usually caught by having sex with someone who is infected.
Syphilis is an infection that is transmitted by direct contact with a syphilitic sore via skin and mucous membranes such as the vagina, anus, rectum, lips, and mouth.
Most commonly, this occurs during oral, anal, or vaginal sexual activity. Although rare, syphilis can be spread during kissing.
Syphilis initially presents as a painless sore on the genitals, rectum, mouth, or skin surface, and can become dormant and live within the body for years and, at times, decades.
When syphilitic sores are present, there is an increased risk of contracting HIV.
Causes of syphilis
In addition to transmission during sexual activity, syphilis can be spread from mother to baby during pregnancy; this is referred to as congenital syphilis.
Infection can result in a stillbirth or low birth weight, and if left untreated, a baby with syphilis can develop cataracts, deafness, or seizures. In some cases, infants can die from the disease.
Who is at risk for contracting syphilis?
Those most at risk of contracting syphilis include those who have unprotected sex (anal, vaginal, and oral), men who have sex with men, those with HIV, and those with numerous sexual partners.
Symptoms of syphilis
The bacteria that cause syphilis are called Treponema pallidum.
Syphilis is categorized by stages with varied symptoms associated with each stage; however, at times, there can be no symptoms for several years.
Contagious stages include primary, secondary, and, occasionally, early latent phase.
Primary syphilis symptoms include:
- The appearance of one or many painless, firm, and round syphilitic sores called chancres
- An incubation period of approximately 3 weeks following exposure to the bacteria
- Self-resolution of chancres within 3-6 weeks. However, treatment is required to prevent the disease progressing on to the next phase
Secondary syphilis symptoms include:
- A non-itchy rash that starts on the trunk and spreads to the entire body, including the palms of the hands and soles of the feet. The rash may present as rough, red, or red/brown in color.
- Oral, anal, and genital wart-like sores.
- Muscle aches.
- Sore throat.
- Swollen lymph nodes.
- Patchy hair loss.
- Weight loss.
It is important to note that the symptoms of secondary syphilis can resolve a few weeks after its onset or return at various times for a year. If left untreated, secondary syphilis will progress to the latent and late stages.
- Without treatment of secondary syphilis, the disease will progress to the latent stage once symptoms have resolved
- This phase, which can last several years, will consist of the body harboring the disease without there being any symptoms of syphilis
- Even though there are no symptoms during this phase, the disease can at times progress to the late stage of syphilis (tertiary syphilis), or the symptoms may never come back
Late syphilis (tertiary):
- Approximately 15-30 percent of untreated syphilis will develop into tertiary syphilis
- Tertiary syphilis occurs 10-30 years following onset of the infection
- Symptoms include difficulty in coordinating muscles, numbness, blindness, and dementia, as well as damage to the heart, blood vessels, liver, bones, and joints
- Death can at times occur due to organ damage
- Infection is transferred from a mother to her unborn child via the placenta, and also during the birth process
- Most newborns with syphilis show no symptoms
- Symptoms include rash, deafness, teeth deformities, and the collapse of the nasal bone, referred to as saddle nose
Tests and diagnosis of syphilisDiagnosis of syphilis includes the use of various tests, including:
- Blood test - used to determine a current or past infection; antibodies to the disease will be present for many years
- Bodily fluid - during the primary or secondary stages of syphilis, a sample from one of the chancres can be evaluated for the disease
- Cerebral spinal fluid - a spinal tap may be recommended if there is concern that syphilis is affecting the nervous system
There are local services available to notify sex partners of their potential exposure to syphilis so that they can be tested and, if necessary, treated for the disease.
Treatments for syphilis
Early treatment of syphilis with penicillin is important, as long-term exposure to the disease can cause life-threatening consequences.
Typically for those infected with syphilis, either a single dose or multiple doses of penicillin will be recommended based on the infection symptoms and the timing of the syphilis exposure.
Male condoms and female condoms can reduce your risk of catching syphilis, but cannot prevent it altogether.
An alternate medication will sometimes be recommended in the presence of a penicillin allergy.
However, in tertiary and/or neurosyphilis, patients who are allergic to penicillin will be desensitized to penicillin to allow for treatment.
Additionally, pregnant women who are allergic to penicillin will be desensitized as well. Following delivery, it is recommended that newborns exposed to syphilis in-utero undergo antibiotic treatment.
Chills, fever, nausea, achy pain, and headache may be experienced on the first day of treatment; this is referred to as a Jarisch-Herxheimer reaction and does not indicate that the treatment should be stopped.
Until all medication regimens have been completed, and there is a blood test confirmation that the disease has been cured, sexual contact should be avoided. Healthcare providers may additionally recommend HIV testing.
There are preventive measures that can be taken to decrease the risk of contracting syphilis, these include:
- Abstinence from sex
- Long-term mutual monogamy with an uninfected partner
- Condoms (note: condoms are only able to protect against sores covered by the condom and will not protect against exposure to sores on other areas of the body)
- Use of a dental dam (a plastic square) during oral sex
- Avoidance of shared sex toys
- Avoidance of alcohol and drugs that could potentially lead to unsafe sexual practices
For individuals who have additional questions about syphilis, its treatment, or prevention, or if they or their partners have either been exposed to the disease or think they may have syphilis, it is important to contact a doctor for evaluation.