Syphilis 101: Symptoms, Causes, Diagnosis & Treatment

What is Syphilis?

If left untreated, syphilis can cause harmful effects on the body and may even lead to death. Pregnant women are also at risk, as mothers infected with syphilis can unknowingly pass it on to their unborn babies. It can potentially lead to death or a host of health complications after the baby is born if not treated immediately.

STDs are basically diseases or infections that spread through sexual intercourse, either through close contact with the genitals or bodily fluids. Practising safe sex and getting early treatment are the best ways to protect oneself from STDs; the latter is the more permanent (and important) option.

Types of Syphilis

Syphilis progresses in four stages, each with different signs and symptoms; they are primary, secondary, latent, and lastly tertiary (or late) syphilis. While we will discuss the signs and symptoms later in the article, you should know that syphilis can spread to other parts of the body – in particular, three major systems: the nervous system, the eyes, and the auditory/vestibular system (the ears).

If it affects the nervous system, it is known as neurosyphilis. Syphilis affecting the eyes is ocular syphilis, while syphilis infecting the ears is otosyphilis. Meanwhile, congenital syphilis is when a pregnant person passes the disease to their unborn baby.

Causes of Syphilis

Syphilis is caused by the bacteria treponema pallidum. The disease begins as a painless sore, called a chancre, that forms either on the genitals, anus, or mouth. Any direct contact (either from skin or mucous membrane contact) with a sore can transmit the infection to another person. The bacteria can enter the body from minor cuts or scrapes on the skin or mucous membranes. The most common point of contact is during sexual activity.

Syphilis is highly contagious in the early stages. Once a person is infected, syphilis can remain inactive in the body for a very long time. Since it only spreads through direct skin/mucous membrane contact, you are not at risk of being infected if you use the same washroom, facilities, clothing or other items as an infected person; the bacteria cannot survive for very long outside the human body. It may be possible to be infected via blood transfusion, but this is a very rare occurrence.

Risk Factors of Syphilis

Anyone is at risk of syphilis, but certain risk factors make some persons more susceptible to infection.

Note that having any of these risk factors does not mean you will be infected; however, prevention is always better than cure.

Symptoms of Syphilis

As mentioned earlier, syphilis progresses in four stages, each with different signs and symptoms. Stages can overlap, however, and some symptoms associated with one stage may occur in another stage.

Primary Syphilis

The first sign of syphilis is the appearance of a single or multiple, chancre(s) at the spot where the bacteria entered the body. The chancre is a round,  reddish sore that has a somewhat firm texture. Chancres form within two to 12 weeks after initial exposure to the bacteria. Because it does not cause any pain, it can be easy for a person to not notice the chancre(s), especially if they form in areas that are hard to see. In rare cases, it may even cause swollen lymph nodes.

After some time, the chancre will disappear on its own, but the infection will persist and lead to secondary syphilis (or even spread to other people).

Secondary Syphilis

Weeks or months after the chancre heals, skin rashes and/or sores in the mucous membranes (mouth, vagina or anus) may start to form. The rashes may form on one or many parts of the body and have a reddish-brown colour. These rashes do not cause any itchiness and some people might not even notice them even when the rashes disappear after some time.

Other symptoms that may appear include:

• Fever
• Fatigue
• Sore throat
• Muscle aches
• Hair loss
• Unexpected weight loss
• Headaches
• Swollen lymph nodes
• Aching joints

Symptoms may persist for some time, or disappear then reappear without warning. With treatment, symptoms will be resolved in time. Because of how it causes nonspecific symptoms that some people might shrug off as something mild, syphilis is sometimes known as the “great imitator.”

Latent Syphilis

Sometimes known as the late, hidden or sleeping stage, the latent stage is where symptoms no longer occur. Blood tests or other diagnostic checks may indicate that a person has syphilis, but apart from that, everything will seem to have returned to normal.

However, without any treatment, syphilis will persist in the body and lead to the final stage in a matter of months or years. In most cases, signs and symptoms will no longer appear as the infection has somehow cured itself.

Tertiary Syphilis

It is estimated that 14 to 40 per cent of people with syphilis will progress into the final stage of a syphilis infection. This is a rare occurrence that affects a particular subset of untreated syphilis infections (10 to 30 years after the initial infection). At this stage, syphilis affects multiple organ systems, causing a number of health complications depending on which organ systems are affected. Symptoms may include:

• Blindness (eyes)
• Deafness (ears)
• Neurological damage (brain)
• Nerve damage (nervous system)
• Heart disease (heart)
• Deterioration of bone and tissue

At this stage, the disease can potentially be fatal and lead to a person’s death.

Congenital Syphilis

For pregnant women, congenital syphilis can potentially cause miscarriage, stillbirth, prematurity, low birthweight or death shortly after birth.

Some babies may not have any symptoms at birth, while others will have complications that arise at a later time. Symptoms can include:

• Developmental delays
• Bone deformities
• Skin rashes
• Jaundice
• Anaemia
• Impairment of organs or other bodily functions

Diagnosing Syphilis

If you suspect that you might have contracted syphilis, see a doctor immediately; the sooner you can receive treatment, the sooner you can be treated. They may ask a number of questions to gauge your overall health; be sure to answer truthfully so as to help them make an accurate diagnosis. They will also conduct a physical examination to look out for any possible signs of syphilis, such as a chancre or rashes caused by the infection. They may even take a swab test, or have a skin biopsy done, on any sores and take it to the lab for further analysis.

A more thorough diagnosis can be made with a blood test; specifically, a treponemal test may be performed to look for antibodies specific to syphilis. The antibodies take time to develop, so early screenings may be negative at first. These antibodies also remain in the body for a very long time, allowing doctors to determine if the infection is current or otherwise.

If the doctor suspects that you may be experiencing nervous system complications due to syphilis, a lumbar tap, or puncture, may be performed. This test involves taking a sample of cerebrospinal fluid to look for any syphilis-causing bacteria.

If you are pregnant, you may need to have a thorough screening for syphilis and other STDs as part of your prenatal care. STDs are all liable to cause unwarranted complications to your pregnancy, such as miscarriage or inherited diseases or conditions.

Treating Syphilis

Treatment will depend on which stage of syphilis you are currently at. For primary, secondary and early-stage latent syphilis, the antibiotic penicillin is the best option and administered intramuscularly. For persons who might be allergic to penicillin, an alternative medication (i.e., doxycycline) may be prescribed; otherwise, penicillin desensitisation may be recommended. This means you will be given small doses of penicillin and then progressively increase the dosage every 15 to 30 minutes over the course of hours or days. Doctors will carefully monitor your progress to ensure that adverse reactions that may occur do not significantly affect you.

If the syphilis infection is fairly recent, spanning no more than two years, a single dose will be sufficient to treat it. For tertiary syphilis, the recommended treatment plan is a weekly intramuscular dose of penicillin for three consecutive weeks. For syphilis that affects other parts of your organ systems (such as neurosyphilis), the recommended treatment plan is a dose administered every four hours, or continuous infusion, for a specific period of time.

Note that pregnant women must be prescribed penicillin for treatment; alternatives are not recommended for administration with pregnant women. As such, if you are pregnant and are allergic to penicillin, you will need to undergo penicillin desensitisation.

After a treatment regimen is completed, your blood will be tested to make sure that the infection has been cleared from your body. It is still possible to be reinfected in future, so you should take extra care to prevent such a scenario from occurring. Follow-up sessions will be helpful to monitor your condition.

Syphilis Prevention

As of today, there is still no vaccine for syphilis. Thankfully, it is curable at the early stages of the infection, which is why early screenings and preventive measures are needed to keep yourself safe. As the infection progresses, however, treatment cannot do anything to reverse the damage that the infection caused.

Practice safe sex

Since syphilis spreads primarily through sexual contact, prevention is relatively straightforward: practice safe sex with your partner or abstain from any sexual contact. For people who may have multiple sexual partners, it is suggested that you abstain from any sexual activity, or only have a single sexual partner. If anyone were to contract syphilis, they will need to inform their respective partners and seek diagnosis/treatment immediately to prevent the infection from persisting. Abstain from any sexual contact until treatment is complete and the infection has been cured.

Do your annual check-up

If you are sexually active, an annual check-up would be warranted to ensure that you are free of syphilis or any other STDs. The same applies if you are at greater risk of contracting an STD. If you notice any sores or rashes that appear sometimes after sexual contact, seek medical advice immediately and notify your partner about this development.

Have an STD test first before planning a family.

If you or your partner are planning for a pregnancy, make sure to go for an STD test first before you start family planning. This preventive measure will ensure that you and your partner are free of any STDs, preventing the possibility of transmitting the infection to your unborn baby.