What is Syphilis? Understanding the Disease, Its Stages, and Treatment
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It is a chronic disease that can progress through multiple stages if left untreated, affecting various organs and tissues in the body over time. While syphilis was once a leading cause of serious illness and death, modern antibiotics have made it treatable and preventable. However, syphilis cases have been rising in recent years, making awareness and early detection essential for preventing long-term complications.
In this article, we’ll explore what syphilis is, how it spreads, its symptoms, stages, and how it is treated.
How is Syphilis Transmitted?
Syphilis is primarily spread through sexual contact (vaginal, anal, or oral) with an infected person. It can also be transmitted through direct contact with a syphilis sore (chancre), which typically appears on the genitals, anus, or mouth during the early stages of infection. Less commonly, syphilis can be spread through close skin contact, blood transfusions, or from mother to baby during pregnancy, leading to congenital syphilis.
It’s important to note that syphilis sores are often painless and may go unnoticed, so a person may be unaware that they have the infection, which increases the risk of spreading it to others.
The Stages of Syphilis
Syphilis progresses through several stages, each with distinct symptoms. The disease can lie dormant for years, making it known as the "great imitator" because its symptoms mimic those of other conditions.
1. Primary Syphilis
Incubation period: 10 to 90 days after exposure (typically around 3 weeks).
Symptoms: The first sign of syphilis is the appearance of a painless sore, known as a chancre, at the site of infection (typically the genitals, anus, or mouth). This sore is highly infectious and may last for 3 to 6 weeks. If left untreated, it will heal on its own, but the infection will progress to the next stage.
2. Secondary Syphilis
Timeline: Begins weeks to months after the initial infection, often when the chancre has healed.
Symptoms: Secondary syphilis is characterized by skin rashes, which may appear as rough, reddish-brown spots on the palms of the hands or soles of the feet. These rashes are not itchy and may spread to other parts of the body. Other symptoms include fever, swollen lymph nodes, sore throat, hair loss, muscle aches, and fatigue.
Highly infectious: During this stage, the infection can easily spread through direct contact with the rash.
3. Latent Syphilis
Timeline: After the symptoms of secondary syphilis resolve, the infection enters the latent stage. During this period, there are no visible symptoms, but the bacterium remains in the body.
Early latent stage: Occurs within the first year after infection and is still potentially infectious.
Late latent stage: After the first year, syphilis is no longer infectious but can remain dormant for years or even decades. If untreated, the infection can eventually progress to the most severe stage, tertiary syphilis.
4. Tertiary Syphilis
Timeline: This stage may occur years or even decades after the initial infection in untreated individuals.
Symptoms: Tertiary syphilis can cause severe damage to various organs and tissues, including the heart (cardiovascular syphilis), brain (neurosyphilis), bones, and eyes. Symptoms can include difficulty coordinating movements, paralysis, numbness, blindness, dementia, and heart problems. This stage can be fatal if not treated.
5. Neurosyphilis and Ocular Syphilis
Neurosyphilis: In some cases, syphilis can invade the nervous system at any stage of the infection, leading to neurosyphilis. Symptoms may include headaches, difficulty concentrating, memory loss, personality changes, and problems with movement or balance.
Ocular syphilis: This form of syphilis affects the eyes and can cause vision changes or even blindness if not treated promptly.
Congenital Syphilis
Syphilis can be transmitted from an infected mother to her baby during pregnancy, leading to congenital syphilis. If left untreated, it can cause miscarriage, stillbirth, or severe health problems for the baby, including deformities, neurological damage, or developmental delays. Early detection and treatment during pregnancy can prevent transmission to the baby.
Diagnosis of Syphilis
Syphilis is diagnosed through blood tests that detect antibodies to the bacterium Treponema pallidum. These tests can identify both active infections and past infections that may have been treated. If neurosyphilis or ocular syphilis is suspected, additional tests like a lumbar puncture (spinal tap) may be performed to check for signs of infection in the brain or spinal cord.
Treatment of Syphilis
Syphilis is treatable at any stage with the right antibiotics, most commonly penicillin, which is the preferred treatment. The dosage and duration of treatment depend on the stage of the infection:
Primary, secondary, and early latent syphilis: A single injection of benzathine penicillin G is usually sufficient to cure the infection.
Late latent or tertiary syphilis: A more prolonged course of treatment is required, typically involving multiple injections of penicillin over several weeks.
Neurosyphilis or ocular syphilis: This may require more intensive treatment with intravenous (IV) penicillin over a longer period.
For individuals allergic to penicillin, alternative antibiotics like doxycycline or tetracycline may be used, though penicillin remains the most effective treatment.
Prevention of Syphilis
Preventing syphilis involves practicing safer sexual behaviors and being aware of one’s sexual health. Key prevention strategies include:
Consistent use of condoms during vaginal, anal, and oral sex. Although condoms reduce the risk of transmission, they do not eliminate it entirely, as syphilis sores can appear in areas not covered by a condom.
Regular STI screenings for sexually active individuals, particularly those with multiple partners or those in higher-risk groups.
Prompt treatment of any STI and informing sexual partners if one tests positive, allowing them to seek treatment as well.
Pregnant women should undergo routine syphilis screening during prenatal visits to prevent congenital syphilis.
Complications of Untreated Syphilis
If syphilis is left untreated, it can cause a wide range of serious health problems, including:
Damage to the heart and blood vessels (cardiovascular syphilis), leading to aortic aneurysms or heart valve disease.
Brain and nervous system damage (neurosyphilis), resulting in dementia, paralysis, or strokes.
Vision loss or blindness from ocular syphilis.
Chronic skin and bone damage, leading to disfigurement.
These complications can be severe and irreversible, highlighting the importance of early diagnosis and treatment.
Conclusion
Syphilis is a highly infectious, yet treatable, sexually transmitted infection that can have serious long-term consequences if left untreated. It progresses through several stages, each with its own set of symptoms, and can remain dormant in the body for years. Early detection through regular testing and effective antibiotic treatment can prevent complications and stop the spread of the infection. Practicing safer sex, getting routine STI screenings, and seeking prompt medical care for any suspicious symptoms are key to managing and preventing syphilis.
References
Centers for Disease Control and Prevention (CDC). (2020). Syphilis – CDC Fact Sheet. Available from: https://www.cdc.gov.
World Health Organization (WHO). (2020). Global health sector strategy on sexually transmitted infections. Available from: https://www.who.int.
Mayo Clinic. (2021). Syphilis: Symptoms, Diagnosis, and Treatment. Available from: https://www.mayoclinic.org.