Syphilis

Overview

Syphilis is a bacterial infection primarily transmitted through sexual contact. It initiates as a usually painless sore, manifesting on the genitals, rectum, or mouth, and can spread from one person to another via direct contact with these sores. This disease is not only transmissible during sexual activities but can also be passed from a pregnant person to their baby during pregnancy, childbirth, and, in some cases, through breastfeeding.

After initial infection, the syphilis bacteria can reside in the body for years, potentially reactivating after periods of dormancy. Without proper treatment, this infection can inflict severe damage to major organs such as the heart and brain, escalating to a life-threatening condition. Fortunately, early-stage syphilis can be effectively cured, often with just a single dose of penicillin. This underscores the importance of prompt medical evaluation upon noticing any indicative symptoms, and it is crucial for all pregnant individuals to undergo syphilis testing early in their prenatal care.

Stages of syphilis: Syphilis progresses through four distinct stages, each characterized by a set of symptoms:

• Primary syphilis: This initial phase occurs two to 12 weeks post-exposure, marked by the appearance of a chancre—a smooth, hard, and usually painless sore at the infection site. Despite the sore healing on its own, the infection remains and can progress if untreated. This stage is highly contagious.
• Secondary syphilis: Following the healing of the chancre, a non-itchy, bumpy rash may spread over the body, including on the palms and soles. Accompanied by fever, fatigue, muscle aches, and other symptoms, this stage is also highly contagious.
• Latent syphilis: Absent treatment in the earlier stages, the infection enters a latent phase where no symptoms are apparent, though internal damage may continue. This stage can persist for up to 20 years.
• Late (tertiary) syphilis: Approximately 20% of untreated individuals progress to this final stage, experiencing severe health complications over time, including brain and heart disease, nerve damage, and vision issues.

Congenital syphilis is a critical concern, with the infection being transmitted from the pregnant person to the fetus. This can lead to grave health complications, or even death, in babies. Early screening for syphilis during pregnancy is vital to prevent these severe outcomes.

Symptoms

Syphilis, a sexually transmitted infection, progresses through various stages, each presenting distinct symptoms. It’s essential to recognize that these stages can overlap, symptoms might not follow a strict order, and it’s possible to carry the syphilis bacteria for years without displaying any symptoms.

Primary syphilis

• Initial symptom: The appearance of a small, often painless sore known as a chancre at the bacteria entry point. Typically, it arises about three weeks post-exposure.
• Visibility and healing: Chancres can be inconspicuous, especially if located within hidden areas like the vagina or rectum, and usually heal independently within 3 to 6 weeks.

Secondary syphilis

• Rash development: Concurrent with or following the chancre’s healing, a non-itchy rash may emerge, starting from the trunk to possibly extending to limbs, palms, and soles. It can be rough and red or reddish-brown, sometimes faint.
• Additional symptoms: May include wartlike sores in oral/genital areas, hair loss, muscle aches, fever, sore throat, fatigue, weight loss, and swollen lymph nodes.

Latent syphilis

• Symptom-free phase: If untreated, the disease enters a hidden stage with no symptoms, potentially lasting years. Symptoms might not reappear, yet the disease can still lead to severe complications.

Tertiary syphilis

• Complications: Without treatment, 30%-40% of infected individuals may develop tertiary syphilis, causing damage to major organs such as the brain, nerves, eyes, heart, blood vessels, liver, and bones. These complications can manifest years after the initial infection.

Syphilis that spreads

• Severe outcomes: At any stage, untreated syphilis can progress to affect the brain, spinal cord, and other organs, posing serious health risks.

Congenital syphilis

• Transmission: Syphilis can be passed from pregnant individuals to their unborn babies via the placenta or during birth.
• Symptoms in newborns: Newborns might exhibit sores, rashes, fever, jaundice, anemia, swollen organs, sneezing or rhinitis, and bone changes. Untreated syphilis in newborns can lead to severe conditions such as deafness, dental issues, and saddle nose.

When to seek medical advice

• Symptoms presence: Consult a healthcare provider if you notice any syphilis symptoms, such as unusual discharge, sores, or rashes, especially around the groin.
• Risk factors: Testing is advised for individuals who have had sexual contact with a potentially infected person, have another sexually transmitted disease like HIV, are pregnant, engage in sex with multiple partners, or have unprotected sex.

Causes

Syphilis, caused by the bacterium Treponema pallidum, is primarily transmitted through direct contact with the sores of an infected person during vaginal, oral, or anal intercourse. The bacteria can enter the body through minor cuts or abrasions on the skin or the mucous membranes of various body parts. Transmission is most likely during the primary and secondary stages of the disease, and occasionally during the early latent stage, which occurs within the first year after initial infection. Even without penetration or ejaculation, sexual contact with an individual displaying sores or rashes associated with syphilis can facilitate the spread of the infection. Additionally, pregnant individuals with syphilis can pass the disease to their unborn child, and there is also a risk of transmission through breastfeeding.

Syphilis cannot be transmitted by touching objects like doorknobs, cutlery, or toilet seats, as the bacteria responsible for the disease cannot survive on inanimate surfaces. Although less common, syphilis can be transmitted through kissing or touching an infected individual’s open sore located on areas such as the lips, tongue, mouth, breasts, or genitalia. Once treated, syphilis does not recur on its own; however, re-infection can occur through contact with the sores of an infected person. This highlights the importance of prevention and the potential for re-infection despite successful treatment.

Risk factors

Your risk of contracting syphilis increases with unprotected sex and multiple partners, particularly if you’re also infected with HIV. Men who have sex with men are at higher risk, partly due to lower condom usage and limited access to healthcare. Additionally, engaging in recent sexual activity with partners found through social media apps poses a heightened risk for certain individuals within this demographic.