Syphilis: Causes, Symptoms, Treatment, Prevention and Care

Syphilis is a very contagious sexually transmitted disease generally spread due to sexual activity. Know more about syphilis causes, symptoms, diagnosis, treatment, and prevention.

What Is Syphilis?

Syphilis, a highly contagious infection, caused by the bacterium Treponema pallidum. It primarily spreads through sexual activity, encompassing vaginal, oral, and anal intercourse. It may remain asymptomatic in the body for an extended period, potentially leading to transmission to sexual partners without one’s awareness.

Initial stages of syphilis manifest with sores, rashes, and related symptoms. Without treatment, it can lead to severe, long-lasting complications impacting various organs such as the brain, eyes, and heart. 

While early syphilis responds well to prescribed medications, its treatment becomes more challenging as the disease progresses. Therefore, it is crucial to promptly consult a healthcare professional /doctor upon observing any symptoms or suspecting exposure to the bacteria.

Dr Monga’s in Delhi has the best doctors who have years of experience in treating patients suffering from syphilis. You should immediately book a consultation with Dr Monga’s in Delhi to get rid of this problem.

What are the stages of syphilis?

Syphilis progresses through four distinct stages, each exhibiting unique symptoms. 

Individuals are highly contagious during the initial and secondary stages, facilitating easy transmission to sexual partners.

The stages of syphilis include primary, secondary, latent, and late (tertiary) syphilis.

Primary syphilis

Primary syphilis, the initial stage, typically occurs within two to 12 weeks following exposure to the infection. Characterised by the development of a painless, firm sore known as a “Chancre” (SHANG-kur) on the genitals or mouth, this stage often goes unnoticed due to the sore’s small size and lack of discomfort. 

Despite the Chancre resolving on its own within a few weeks or months, the presence of syphilis persists without treatment. Without medication, the infection progresses to the second stage, during which transmission can occur through vaginal, anal, or oral intercourse.

Secondary syphilis

Roughly one to six months following the disappearance of the syphilis sore, a distinctive rough and bumpy rash emerges.

The rash associated with secondary syphilis can present in various forms, often manifesting as rough, red, or reddish-brown patches on the palms and soles. It can also appear on other areas, including the torso, arms, chest, abdomen, pelvis, and back. This rash might be painless, flat, and copper-colored, or it could be a combination of flat and raised spots, starting as flat lesions and developing into small reddish-brown bumps with slight scaling. Sometimes, the rash is so subtle that it is barely noticeable.

This rash has the potential to spread across the entire body, including the palms and soles of the feet. Notably, the rash typically does not induce itching. Additionally, other symptoms may accompany the rash, such as:

• Fever
• Fatigue
• Sores, appearing like wart
• Muscle ache
• Weight loss
• Headaches
• Hair loss
• Swollen lymph nodes

During this stage, you can pass on the infection through vaginal, oral or anal sex. These symptoms can keep cropping up and disappearing for months or years. 

Even if the rash has healed and you are not having any of the above symptoms, it does not mean that you do not have the infection anymore. You still have to undergo the treatment procedure as ascertained by your doctor as leaving it untreated may allow the infected to reach the latent stage.

Latent syphilis

If you avoid getting a treatment in the first two stages of the infection, it moves into the third stage, better known as the latent stage. In this stage, the infected person generally does not experience any outward symptoms of syphilis, but some people may suffer from mild flare-ups occasionally. 

The alarming thing about this infection is that it may damage your vital body organs like nerves, heart, bones, etc. This stage can affect you for up to 20 years. In this stage, the infection usually does not transmit to the healthy sex partner. If this stage is also left untreated, the infection progresses on to the late (tertiary) stage.

Late (tertiary) syphilis

Syphilis does not progress past latent stage in many patients, either because the infection cures itself or the symptoms are so mild that they often go unnoticed. Around 20% syphilis patients move from latent stage to tertiary or late stage, which leads to a series of severe health complications, which include:

• Brain damage, dementia and cognitive health problems
• Heart disease
• Movement disorders and muscle problems
• Nerve damage
• Seizures
• Vision problems, including blindness

Neurosyphilis : Overview

What is neurosyphilis?

Neurosyphilis is a potentially life-threatening complication of syphilis, a sexually transmitted infection (STI). Neurosyphilis happens when the Treponema pallidum bacterium (the bacterium that causes syphilis) invades your brain and/or spinal cord. Not everyone who has syphilis develops symptoms of this complication.

Neurosyphilis and syphilis are distinct — but related — conditions. Neurosyphilis affects your central nervous system (CNS) and causes neurological symptoms. Syphilis is an STI with different signs and symptoms.

Untreated neurosyphilis can result in serious medical complications, including permanent paralysis, dementia and death. Seeking treatment as soon as syphilis or neurosyphilis symptoms appear is essential.

What are the forms of neurosyphilis?

There are five forms of neurosyphilis. Researchers break them up into two groups: early neurosyphilis and late neurosyphilis.

Early neurosyphilis

Early forms of neurosyphilis include:

• Asymptomatic neurosyphilis (ANS): This form doesn’t cause any neurological symptoms. It occurs before you develop symptoms of syphilis, too. Healthcare providers diagnose this form when a cerebrospinal fluid (CSF) analysis finds evidence of syphilis but you don’t have symptoms. If you have syphilis and don’t receive treatment, ANS generally occurs between the first few weeks to the first few years of getting the infection.

• Meningeal neurosyphilis: This form happens when the syphilis bacteria cause inflammation of your meninges — the three layers of tissue that protect your brain and spinal cord. It causes symptoms such as headache, nausea and vomiting. If you have syphilis and don’t receive treatment, this form can occur within the first few months to several years after infection.

• Meningovascular neurosyphilis: This form happens when the syphilis bacteria cause inflammation of your meninges arterial walls (endarteritis). This causes thrombosis (when blood clots block veins or arteries) and obstructs blood flow to brain tissue. It causes a variety of issues, including stroke. If you have syphilis and don’t receive treatment, this form can develop within the first few months to several years after infection.

Late neurosyphilis

Late neurosyphilis (parenchymal) forms include:

• General paresis: This form happens due to chronic inflammation of your meninges (meningoencephalitis), resulting in a breakdown of brain tissue. It causes a variety of psychological symptoms and conditions. Early symptoms include mood disturbances and personality changes. If you have syphilis and don’t receive treatment, this form can occur three to 30 years after the initial infection.

• Tabes dorsalis: This is the most severe form of neurosyphilis. It results from the breakdown of the posterior (dorsal) column and roots of your spinal cord. It causes a variety of symptoms, including movement issues, nerve pain and bladder dysfunction. If you have syphilis and don’t receive treatment, tabes dorsalis can occur anywhere from five to 50 years after infection.

Whom does neurosyphilis affect?

Neurosyphilis can affect anyone who has a syphilis infection, especially if you don’t receive treatment for syphilis for months or years.

People who have unprotected sex are at high risk for the transmission of syphilis. Men who have sex with men (MSM) account for about 80% of syphilis cases in the United States.

People with HIV tend to develop symptoms of neurosyphilis sooner than people without HIV. Researchers aren’t sure why this happens, but they think it might be because people with HIV have weakened immune systems.

How common is neurosyphilis?

It’s difficult for researchers to determine how common neurosyphilis is because the reporting of cases is inconsistent. But they do know how common syphilis is — there were over 133,000 cases in the U.S. in 2020. It’s one of the most common STIs.

Syphilis Symptoms

The very first symptom of syphilis is a Chancre, which is a small sore. Usually, it is round in size, firm in texture and does not cause any pain. It is usually located where the syphilis made the entry into your body, including penis, anus, vagina, lips or mouth.

As it does not cause any pain, it may be mistaken for a pimple or may also be hidden from view inside the vagina or rectum.

You may experience the following symptoms after some time:

• Rash
• Sores
• Fever
• Swollen lymph nodes
• Sore throat
• Headaches
• Patchy hair loss
• Weight loss
• Muscle aches
• Fatigue

Syphilis rash

The rash may manifest on various body regions, such as the palms of the hands and the soles of the feet, occurring predominantly on the trunk initially, encompassing the chest, stomach, pelvis, or back. Its onset may coincide with the presence of a sore or emerge weeks afterward. Typically devoid of itching, the rash can exhibit a red or reddish-brown hue and possess a rough texture. Occasionally, it may be so faint that it goes unnoticed.

Syphilis sore

After suffering from Chancre, you may see some sores that appear like warts. These may appear in your mouth, penis, anus or vagina.

Syphilis Causes

Syphilis is a bacterial-infection triggered by bacteria known as Treponema pallidum. It infects you when you come in direct contact with a syphilis sore or an infected person’s body. The bacteria can also get into your body through cuts on your skin or mucous membranes. This usually happens during sexual activities. You can also contract it if you share a needle with an infected person while taking intravenous drugs.

Babies can also contract congenital syphilis if their mother was suffering from the sexually transmitted infection (STI) at the time of pregnancy. Babies can also contract it at the time of breastfeeding.

Syphilis, however, cannot be transmitted through toilet seats, swimming pools, bathtubs, eating utensils, sharing clothes, doorknobs, or hot tubs. This is because the bacteria that causes the syphilis infection can not survive on objects.

How does syphilis spread?

Transmission

Syphilis is a contagious infection, especially in the primary and secondary stages when you have sores, ulcers and a rash. The typical method for the bacteria to spread is from person to person through sexual intercourse, even if there was no ejaculation. You can also contract it if any part of your body comes in contact with the sore or rash on the body of an infected person.

If you have intercoure while suffering from syphilis, you can transmit it to your partner. If you are pregnant while suffering from syphilis, you can pass it on to the foetus.

Where can you get syphilis?

Syphilis impacts the entirety of your body. Nevertheless, the initial indication of syphilis manifests as a sore resembling an ulcer as mentioned above. This sore emerges at the site where the bacteria encountered your skin during sexual activity. The subsequent regions are the ones where you are most prone to encountering a syphilitic sore, known as a chancre:

Syphilis appearance in women:

• On your vulva, i.e. external part of your genitals
• In or near your vagina
• Near your anus or inside the rectum
• On your lips or inside the mouth

Syphilis appearance in men:

• On the penis or scrotum
• Under the foreskin of the penis
• Near your anus or inside the rectum
• On your lips or inside the mouth

Who Might Get Syphilis or Syphilis Risk Factors

Any person who is having sexual intercourse is at risk of getting infected with syphilis. The risk-enhancing activities include:

• Having unprotected sex
• Having multiple partners (51.3% increased risk of infection)
• Men having sex with men (7.5% increased risk of infection)
• Being infected with HIV
• Having had sex with someone who has been diagnosed with syphilis
• Being infected with another STI, like chlamydia, gonorrhoea or herpes

Syphilis Complications

Without receiving treatment, syphilis can lead to complications affecting various parts of your body:

• Small bumps: Gummas, which are bumps, may develop on your skin, bones, or organs, causing tissue damage in their vicinity.
• Nervous system issues/Neurosyphilis: Neurosyphilis is a serious complication of syphilis. It occurs when the Treponema pallidum bacterium infects the brain or spinal cord, leading to neurological risks like headaches, strokes, brain damage, permanent paralysis, bladder dysfunction, erectile difficulties, dementia, and death if left untreated.
• Cardiovascular complications: The disease can harm your heart valves, trigger the formation of bulging blood vessels (aneurysms), or cause inflammation in the aorta, the vital blood vessel responsible for distributing oxygen and nutrients throughout your body.
• HIV: Syphilis can heighten the risk of contracting HIV. Additionally, Syphilis and HIV co-infection is considered particularly dangerous because each disease can worsen the other’s treatment outcomes. Previous research has shown that patients with both infections often experience poor serological response to syphilis treatment, cognitive impairment, and failure of antiretroviral therapy (ART). In a study, nearly one-fourth of participants were co-infected with HIV, with reported co-infection rates in the literature varying from 6.4% to 34%. Among 52 patients with follow-up data, 47% of those with HIV showed serological non-responsiveness to syphilis treatment, compared to 24% of non-HIV patients, though this difference was not statistically significant.
• Pregnancy and childbirth complications: If you’re pregnant, syphilis can be transmitted to your unborn child, leading to congenital syphilis, which can culminate in miscarriage, stillbirth, or neonatal death.

Syphilis in Pregnancy aka Congenital Syphilis

Congenital syphilis is the condition in which a pregnant woman passes on the infection to the foetus during pregnancy. It is passed on to the foetus through placenta, an organ responsible for providing nutrients and oxygen in the womb. Syphilis can also infect the baby at the time of birth.

Depending upon how long the woman had syphilis, the chances of stillbirth increase. Even if the baby survives, syphilis is known to cause severe health issues and even death in babies and young children.

Hence, it is very important that your doctor conducts a screening for STIs on your very first prenatal visit. It is very critical to take treatment for syphilis right away. If the infection is left untreated in babies, they can suffer from delayed development, seizures and even death.

Babies who are born infected with syphilis may have:

• Sores and rashes
• Fever
• Jaundice
• Anaemia
• Swollen spleen and liver
• Sneezing or stuffed, drippy nose
• Bone changes

The signs may later develop into:

• Deafness
• Teeth problems
• Collapse of the bridge of the nose also known as saddle nose

Syphilis Diagnosis

Your physician will conduct a physical examination and may conduct the following tests:

• Blood tests: Syphilis can be diagnosed through a rapid test conducted at your doctor’s clinic or hospital. This method is the primary means of diagnosing syphilis.
• Cerebrospinal fluid tests: If your doctor suspects neurosyphilis, they will examine fluid extracted from around your spinal cord.
• Darkfield microscopy: Syphilis bacteria are observable under a microscope in fluid obtained from a skin sore or lymph node. 

Syphilis Treatment

Yes, syphilis is absolutely curable, given it has been diagnosed at an early stage and a proper treatment has been conducted. Being late in getting it diagnosed and treated can even result in permanent damage to your heart, and brain, even after the infection has disappeared.

As syphilis is a bacterial infection, doctors prescribe a course of antibiotics to treat it. Penicillin is the most commonly prescribed antibiotic to treat syphilis, still, you should never self-administer the medication as it may not be effective for everyone because every person’s needs are different.

It is also very important to complete the course of prescribed medication as leaving it mid-way can result in recurrence of the infection.

You are advised to avoid sexual contact with anyone until the infection completely heals. You should also inform your sexual partner, current as well as from the past few years, to get tested, and take treatment if necessary. If you get treatment for the infection and your partner, who got the infection from you is left untreated, they may reinfect you.

Several hours after taking the first treatment for syphilis, a few people experience an immune system reaction known as a Jarisch-Herxheimer reaction. This may cause symptoms like chills, upset stomach, fever, headaches, rash, or joint or muscle pain. These symptoms usually disappear within 24 hours.

Once you have completed your treatment procedure, your doctor may ask you to do some additional tests, such as blood work, to ensure that the infection has completely gone.

Syphilis medication

Depending upon the stage of your disease, your doctor decides the medications, dosage and duration of the treatment. Penicillin, doxycycline and ceftriaxone are some of the medications often administered to the syphilis patients. You, however, should never self-administer any of these medications without consulting with your doctor.

Living With Syphilis

Syphilis and any other sexually transmitted infections (STIs) can lead to serious health complications. They need immediate attention from a healthcare provider. Hence, if you have been diagnosed, it is of paramount importance that you take complete treatment so that the infection does not spread any further. Other things that you should do include:

• Get in touch with anyone with whom you have had a sexual intercourse and tell them to take a test too
• Practise safe sex by using a condom or a dental dam
• Frequently undergo tests of syphilis and other STIs
• Reduce the number of sexual partners
• Do not shy away from asking your sexual partners about their sexual history or behaviours

Syphilis and HIV

Co-infection with syphilis and HIV is considered particularly dangerous, as each disease can hinder the treatment of the other. Previous research has shown that patients co-infected with syphilis and HIV often experience poor response to syphilis treatment, cognitive impairments, and failure of antiretroviral therapy (ART).

In a recent study, nearly one-fourth of the participants had both HIV and syphilis. The co-infection rates reported in the literature vary widely, ranging from 6.4% to 34%.

Among 52 patients with available follow-up data, 47% of those with HIV showed serological non-responsiveness to syphilis treatment, compared to 24% of non-HIV patients. However, this difference was not statistically significant.

Prevention

As they say – prevention is better than cure! You should also focus on preventing this infection and lead a healthy life.

Takeaways

Syphilis is a highly transmissible disease primarily transmitted through sexual contact. When treated correctly with antibiotics, it is entirely curable. However, if left untreated, syphilis can lead to severe, enduring health complications and potentially fatal outcomes, even if symptoms subside. If you suspect you have contracted syphilis or have been exposed to it, you should consult with Dr Monga’s immediately.