SYPHILIS

Syphilis is a sexually transmitted infection (STI) caused by a bacteria that spreads through vaginal, anal, or oral sex with an infected person. Without treatment, it can pose serious health risks, including sores and a skin rash. However, antibiotic medication is effective in treating syphilis and preventing its complications. If left untreated, syphilis can lead to severe consequences such as blindness, damage to the brain, heart, eyes, and nervous system.

Causes of Syphilis

Syphilis is caused by the bacteria Treponema pallidum, which is transmitted through vaginal, anal, or oral sex with an infected individual. The bacteria can enter the body through various routes, including the anus, vagina, penis, mouth, or through broken skin. Once inside the body, the bacteria spread throughout, potentially causing damage to organs over time.

Prevalence

Syphilis affects a significant number of people each year, with approximately 134,000 cases reported in 2020 according to the Centers for Disease Control and Prevention (CDC). The infection is more prevalent among men and individuals assigned male at birth (AMAB), particularly among men who have sex with men (MSM), who are diagnosed with this sexually transmitted infection more frequently than any other group.

Risk factors

Anyone who engages in sexual activity is at risk of contracting syphilis, but certain factors can increase your risk, including:

Engaging in unprotected sex, especially with multiple partners.
Being a man who has sex with men (MSM).
Having HIV.
Having sexual contact with someone who has tested positive for this sexually transmitted infection.
Testing positive for another sexually transmitted infection (STI) such as chlamydia, gonorrhea, or herpes.

The spread

Syphilis spreads through direct contact, especially during the primary and secondary stages when sores, ulcers, or a rash are present. It primarily transmits through sexual contact, including vaginal, anal, or oral sex. Importantly, transmission can occur even without penetration or ejaculation. Simply touching the sore or rash of an infected individual can lead to transmission.

Contagiousness

If you have syphilis and engage in sexual activity, you can transmit the infection to your partner. Additionally, if you’re pregnant and have syphilis, you can pass it to your fetus. However, it’s essential to note that this sexually transmitted infection cannot be contracted through contact with objects such as toilet seats, utensils, or doorknobs. This is because the bacteria responsible for syphilis cannot survive on surfaces.

The contagiousness of syphilis persists even in the absence of outward symptoms like sores or rashes. Without treatment, the infection remains in the body, making the individual contagious regardless of visible symptoms. Therefore, seeking prompt treatment upon suspicion of infection or exposure is crucial.

While uncommon, it is possible to contract syphilis through kissing if there is direct contact with a syphilis sore. Even minor breaks in the skin can facilitate transmission. This underscores the importance of seeking treatment if one suspects they have this sexually transmitted infection or have been exposed to it.

Stages of Syphilis

This sexually transmitted infectionprogresses through four stages, each with its own set of symptoms and risks:

Primary Syphilis: This initial stage occurs within two to 12 weeks after exposure to the infection. It manifests as a painless sore called a chancre on the genitals or mouth, which heals on its own within a few weeks or months. Despite the sore disappearing, the infection remains. Without treatment, the infection progresses to the next stage, and transmission is possible through sexual contact.
Secondary Syphilis: Around one to six months after the chancre heals, a rough, bumpy rash appears, covering the body including the palms and soles. Other symptoms may include fever, fatigue, muscle aches, weight loss, headaches, and swollen lymph nodes. Transmission remains possible during this stage. Symptoms can come and go for months or years, but treatment is necessary to eliminate the infection.
Latent Syphilis: If untreated, the infection progresses to this stage, characterized by no outward signs or symptoms. Some individuals may experience occasional mild symptoms. However, without treatment, latent syphilis can damage various organs and can last up to 20 years. Transmission during this stage is rare.
Late (Tertiary) Syphilis: Approximately 20% of untreated individuals progress to this phase, which causes severe health issues such as brain damage, heart disease, movement disorders, nerve damage, seizures, and vision problems, including blindness. Progression to this stage is slow and may not occur for years after initial infection.

Appearance

In its early stages, this sexually transmitted infection presents distinct visual symptoms:

Primary Stage: A small, painless sore known as a chancre appears on the genitals, mouth, or lips. It can resemble a harmless pimple and may go unnoticed. This sore typically heals on its own within about six weeks.
Secondary Stage: A rough, red, or brown rash emerges, starting in one area and eventually spreading to cover the entire body, including the palms and soles. Skin rashes and sores may also occur in the mouth, vagina, or anus during this stage.

Affected body parts

This sexually transmitted infection affects the entire body, but its initial sign is typically the appearance of a chancre, which develops at the site where the bacteria, Treponema pallidum, entered the body during sexual contact. The following areas are commonly affected:

For individuals assigned female at birth (AFAB):

Vulva (external genitals)
Vagina
Anus or rectum
Lips or mouth

For individuals assigned male at birth (AMAB):

Penis or scrotum
Under the foreskin of the penis
Anus or rectum
Lips or mouth

Symptoms of Syphilis

Symptoms of this sexually transmitted infection vary depending on the stage of the infection. You are most contagious during the early stages when symptoms are likely to be present. In the first stage, one or more painless sores may appear on the genitals, which could go unnoticed or mistaken for a pimple or other skin lesion.

During the second stage, a rash may develop along with flu-like symptoms such as fatigue, fever, sore throat, and muscle aches.

After the second stage, syphilis enters a latent stage where symptoms are hidden. However, the absence of symptoms does not indicate that the infection has resolved. The only effective way to treat this sexually transmitted infection and prevent its progression is through medication.

Complications

Untreated syphilis can lead to severe and potentially life-threatening complications as the infection progresses to its final stage. The longer the sexually transmitted infection goes untreated, the more damage it can cause to the body. Therefore, prompt treatment is crucial to prevent these complications. Some of the health complications associated with untreated syphilis include:

Blindness: this sexually transmitted infection can cause damage to the eyes, leading to vision impairment and even blindness.
Paralysis: Damage to the nervous system caused by this sexually transmitted infection can result in paralysis or loss of muscle function.
Cardiovascular problems: This sexually transmitted infection can affect the heart and blood vessels, leading to conditions such as heart disease and aneurysms.
Neurological problems: The infection can damage the brain and spinal cord, resulting in neurological disorders such as dementia, cognitive impairment, and movement disorders.
Organ damage: Untreated syphilis can harm various organs in the body, including the liver, kidneys, and bones.

Given the serious nature of these complications, it’s essential to seek diagnosis and treatment for this sexually transmitted infection as soon as possible to prevent long-term health problems.

Diagnosis

Diagnosing this sexually transmitted infection typically involves a few steps to ensure accurate results:

Medical History: Your healthcare provider will inquire about your sexual history, including practices related to safe sex. It’s crucial to provide honest answers during this discussion, as it helps your provider assess your risk factors and determine the appropriate tests for other sexually transmitted infections (STIs).
Physical Examination: Your provider will conduct a physical examination, looking for any signs or symptoms of this sexually transmitted infection, such as sores or rashes.
Blood Tests: A blood sample will be collected to test for the presence of antibodies that indicate a syphilis infection. These antibodies are produced by the body in response to the Treponema pallidum bacteria, the causative agent of syphilis.
Additional Tests: In some cases, your provider may need to obtain fluid or a small sample from a syphilis sore (chancre) for further examination under a microscope. This step helps confirm the diagnosis, especially if there are visible symptoms.
Laboratory Confirmation: The definitive diagnosis of syphilis is made through laboratory testing of the blood sample. These tests can detect the presence of antibodies to the syphilis bacteria, confirming the infection.

Visiting your healthcare provider for testing is the only way to accurately diagnose this sexually transmitted infection. It’s essential to undergo testing if you suspect you may have been exposed to the infection or if you experience any symptoms suggestive of syphilis. Early diagnosis and treatment are crucial for effectively managing the infection and preventing complications.

Treatment

Syphilis is effectively treated with antibiotics, which are medications designed to combat bacterial infections. The most commonly prescribed antibiotic for syphilis is penicillin. The dosage and duration of antibiotic treatment depend on the stage of syphilis and the presence of symptoms.

It’s crucial to complete the full course of antibiotics prescribed by your healthcare provider, even if your symptoms improve or disappear. Additionally, it’s important to inform any sexual partners you’ve had within the past two years about your syphilis diagnosis so they can seek testing and treatment if necessary.

After completing treatment, your healthcare provider will perform follow-up blood tests to ensure the infection has been eradicated. However, it’s essential to continue practicing safe sex and undergo regular testing if you’re at an increased risk of syphilis, as reinfection is possible.

While syphilis is curable with antibiotics, it’s important to note that any damage to organs caused by the infection cannot be reversed. Therefore, early diagnosis and prompt treatment are crucial to prevent long-term complications.

Prevention

To reduce the risk of contracting syphilis, as well as other sexually transmitted infections (STIs), several preventive measures can be taken:

Abstinence: Refraining from sexual activity is the only sure way to prevent syphilis and other STIs.
Consistent Condom Use: If sexually active, consistently using condoms or dental dams during sexual intercourse can significantly reduce the risk of infection. It’s important to use condoms correctly to maximize their effectiveness in lowering the risk of transmission.
Open Communication with Partners: Have open and honest conversations with sexual partners about their sexual history and whether they have been tested for STIs. If a partner has syphilis or any other STI, it’s crucial that they receive treatment to prevent reinfection and further spread of the infection.

Syphilis and Pregnancy

Syphilis can indeed lead to serious complications during pregnancy if left untreated. If you have syphilis and do not receive treatment, you risk passing the infection to your baby. This can result in severe consequences, with up to 40% of infants born to untreated individuals succumbing to the infection. Transmission usually occurs during pregnancy, but it can also happen during delivery if the baby comes into contact with a syphilis sore in the birth canal.

When a baby is born with syphilis due to transmission from the mother, it is termed congenital syphilis.

Congenital Syphilis, which happens when a pregnant person passes the infection to the fetus. It can lead to severe health complications and even death in babies and young children. Pregnant individuals should be screened for STIs early in prenatal care, and immediate treatment is crucial if syphilis is detected to prevent congenital syphilis.

This condition can lead to various complications, including:

Miscarriage
Premature birth
Low birth weight (less than 5 pounds, 8 ounces)
Issues with the umbilical cord
Stillbirth
Death within the first 28 days of life if the mother does not receive treatment for the sexually transmitted infection.

When to see a healthcare provider

If you develop skin ulcers or a rash on your genitals or mouth, it’s important not to delay seeking medical attention. Contact a healthcare provider promptly for testing and treatment. Early intervention reduces the likelihood of long-term complications associated with this sexually transmitted infection.

These potential complications highlight the importance of attending prenatal visits and undergoing STI testing during pregnancy. Early detection and treatment before 26 weeks of pregnancy yield the best outcomes for both the mother and the baby.

Outlook for individuals diagnosed with syphilis

Early Treatment: Antibiotics are highly effective in treating syphilis, especially in its early stages. When diagnosed and treated promptly, syphilis typically does not cause long-term health problems.
Potential Complications: However, if left untreated, syphilis can lead to severe health complications, affecting various organs such as the heart, bones, brain, eyes, muscles, and nerves. In severe cases, this sexually transmitted infections can be fatal.
Risk of Reinfection: It is possible to contract syphilis again after being treated for the infection. Therefore, practicing safe sex and undergoing regular testing for STIs are essential for individuals at high risk of infection.

Living with syphilis

Taking care of yourself if you’ve been diagnosed with syphilis or any other sexually transmitted infection (STI) involves several important steps:

Seek Immediate Medical Care: Syphilis and other STIs require prompt medical attention from a healthcare provider. Complete the prescribed treatment regimen to prevent further spread of the infection.
Inform Sexual Partners: Contact anyone with whom you’ve had sexual contact to inform them of your diagnosis. Encourage them to seek testing and treatment as well to prevent reinfection and the spread of the infection.
Practice Safe Sex: Consistently use condoms or dental dams during sexual activity to reduce the risk of contracting or transmitting syphilis and other STIs.
Regular Testing: Get tested for syphilis and other STIs regularly, especially if you’re sexually active or have multiple sexual partners. Early detection allows for timely treatment and minimizes the risk of complications.
Limit Sexual Partners: Minimize the number of sexual partners you have to reduce your risk of contracting syphilis and other STIs.
Open Communication: Don’t hesitate to discuss sexual history with new partners and encourage them to do the same. Open communication helps ensure that both parties are informed and can make decisions regarding sexual health.

Sources

CDC (Centers for Disease Control and Prevention):
- “Syphilis – CDC Fact Sheet”
- “The State of STDs – Infographic”
Mayo Clinic:
- “Syphilis”
American College of Obstetricians and Gynecologists:
- “Chlamydia, Gonorrhea, and Syphilis”
Icahn School of Medicine at Mount Sinai:
- “Syphilis – primary”
Minnesota Department of Health:
- “About Syphilis”
BMJ (British Medical Journal):
- “Syphilis”
Merck Manual Consumer Version:
- “Syphilis”
NIH National Library of Medicine:
- “WHO Guidelines for the Treatment of Treponema pallidum (Syphilis)”
Cleveland Clinic:
- “Syphilis”