What Is Syphilis?

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It is a serious condition that can lead to severe health problems if left untreated. Syphilis progresses through four distinct stages, each with its own set of symptoms.

Symptoms and Stages of Syphilis

Primary Stage

The primary stage of syphilis typically begins with the appearance of one or more painless sores, known as chancres, at the site of infection, usually on the genitals, anus, rectum, or mouth. These sores are firm, round, and often go unnoticed. Additionally, there may be swollen lymph nodes near the area of the chancre. The chancre typically lasts for 3 to 6 weeks and heals on its own, but the infection remains in the body.

Secondary Stage

The secondary stage of syphilis can occur 2 to 12 weeks after the chancre appears, and it is during this stage that the infected person is highly contagious. A skin rash may develop, often appearing on the palms of the hands and soles of the feet. The rash can consist of reddish-brown, small, solid, flat, or raised skin sores, or it may resemble other common skin problems. In individuals with darker skin tones, the sores may be lighter in color than the surrounding skin.

Other secondary-stage symptoms may include:

• Fever
• Sore throat
• General weakness or discomfort
• Weight loss
• Patchy hair loss, especially in the eyebrows, eyelashes, and scalp
• Swollen lymph nodes
• Headaches

Latent (Hidden) Stage

Without proper treatment, syphilis progresses to the latent or hidden stage, during which the bacteria remain in the body without causing any visible symptoms. This stage can last for years, and an accurate diagnosis can only be made through blood testing, the person's medical history, or the birth of a child with congenital syphilis. Relapses, where symptoms reappear after a symptom-free period, can occur during the latent stage.

Tertiary (Late) Stage

If left untreated, syphilis can advance to the tertiary or late stage, which can begin several years after the initial infection. During this stage, syphilis can cause severe complications affecting various organ systems, including:

• Gummata: Large sores inside the body or on the skin
• Cardiovascular syphilis: Affecting the heart and blood vessels
• Neurosyphilis: Affecting the nervous system, which can lead to severe headaches, muscle weakness, mental changes, and dementia

Without treatment, syphilis can also spread to the brain and nervous system (neurosyphilis), the eyes (ocular syphilis), or the ears (otosyphilis), leading to additional symptoms such as vision problems, hearing loss, and dizziness.

How is Syphilis Spread?

Syphilis is primarily spread through direct contact with a syphilis sore during vaginal, anal, or oral sex. It can also be transmitted from a mother with syphilis to her unborn baby (congenital syphilis).

Syphilis cannot be contracted through casual contact with objects, such as toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Risks and Complications

Individuals who are sexually active, especially those who have multiple partners or engage in unprotected sex, are at a higher risk of contracting syphilis. Certain groups are also considered high-risk, including:

• Men Who Have Sex With Men
• People living with HIV
• Those taking pre-exposure prophylaxis (PrEP) for HIV prevention
• Individuals with partners who have tested positive for syphilis

Pregnant women with syphilis can pass the infection on to their unborn babies, potentially leading to low birth weight, premature delivery, stillbirth, or serious health problems in the newborn, such as cataracts, deafness, or seizures.

If left untreated, syphilis can cause severe complications, including damage to the cardiovascular system, nervous system, and other organs, which can be life-threatening.

Testing and Treatment

Syphilis is typically diagnosed through blood tests which look for antibodies against the syphilis bacteria. The initial screening test is the Rapid Plasma Reagin (RPR) syphilis test, which looks for antibodies that fight a syphilis infection. If the RPR test is positive, a Treponemal Pallidum Assay (TPA) test is used to confirm the presence of the Treponema pallidum bacteria that causes syphilis.

Healthcare providers may also test fluid from a syphilis sore to diagnose the infection. Regular syphilis testing is recommended for sexually active individuals, especially those in high-risk groups or with multiple partners.

Syphilis is curable with the appropriate antibiotic treatment prescribed by a healthcare provider. However, treatment may not undo any damage caused by the infection. It is essential to receive prompt treatment to prevent the progression of the disease and the potential for severe complications.

After successful treatment, it is still possible to become reinfected with syphilis, as having the infection does not provide immunity. Follow-up testing is necessary to ensure the treatment was effective, and practicing safer sex by using condoms and having open communication with sexual partners about their STI status is crucial.

References:

1. Centers for Disease Control and Prevention (CDC). Syphilis - CDC Fact Sheet (Detailed). https://www.cdc.gov/syphilis/about
2. University of Michigan Health. Stages of Syphilis. https://www.uofmhealth.org/health-library/tm6404#tm6404-sec