Syphilis: Symptoms, Treatment, Causes, and Prevention

How Is Syphilis Transmitted?

Transmission of syphilis occurs through direct contact with a syphilitic sore during vaginal, anal, or oral sex. Sores can be found on the external genitals, vagina, anus, or in the rectum. They can also appear on the lips and in the mouth. Pregnant women with the disease can transmit it to their unborn children, which can result in congenital syphilis.

Symptoms of Syphilis

Primary Stage

The first sign of syphilis is the appearance of a small sore, called a chancre. The chancre is typically painless and appears at the spot where the bacteria entered the body. While many people only develop one chancre, some might develop several. If not treated, the sore heals on its own within three to six weeks.

Secondary Stage

Within a few weeks of the initial chancre healing, you might notice a rash that starts on the body's core but eventually covers the entire body, including the palms of your hands and the soles of your feet. Other symptoms might include mild fever, fatigue, sore throat, and swollen lymph nodes. These signs and symptoms may disappear within a few weeks, or repeatedly come and go over a period of up to one year.

Latent Stage

If you don't seek treatment for syphilis, the disease moves from the secondary stage to the hidden, or latent, stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms might never return, or the disease might progress to the tertiary stage.

Tertiary Stage

Tertiary syphilis is the most destructive to health. It can develop years or decades after the initial infection. Tertiary syphilis can damage multiple organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Symptoms vary depending on which organs are affected.

Diagnosing Syphilis

Syphilis can be diagnosed by testing samples of blood, or fluid from sores. Blood tests can detect antibodies to the bacterium, indicating an infection either present or past.

Treatment of Syphilis

Early Stage Treatment

For primary, secondary, and early latent syphilis, the preferred treatment is a single intramuscular injection of penicillin G benzathine. Penicillin, a very effective antibiotic, has the advantage of being able to kill the bacterium and has a long history of effectively curing syphilis. The dose can eliminate the pathogen from the patient's system and prevent further progression of the disease.

Late Stage Treatment

For those in the late latent or tertiary stages of syphilis, treatment requires a more aggressive approach. This typically involves multiple doses of penicillin G benzathine administered over three weeks. This extended regimen is crucial to ensure that the infection is fully eradicated, especially since the bacteria might have spread to multiple organ systems and can be more difficult to eliminate.

Neurosyphilis Treatment

Patients diagnosed with neurosyphilis, where the bacteria infect the nervous system, require intravenous penicillin G administered every four hours for 10-14 days. This intensive treatment ensures that sufficient antibiotic levels cross the blood-brain barrier to eradicate the bacteria effectively from the central nervous system.

Alternative Antibiotics

For patients allergic to penicillin, alternative treatments include doxycycline or tetracycline for 14 days for early stages, and the same antibiotics for a longer period for late latent or tertiary syphilis. Azithromycin may also be used but is generally considered less effective and is not recommended if other treatment options are available.

Preventing Syphilis

Prevention of syphilis involves practicing safer sex, using latex condoms correctly, and having regular STI screenings. Long-term monogamous relationships where both partners are tested prior to becoming sexually active can also prevent the spread of syphilis.

Impact of Untreated Syphilis

Untreated syphilis can lead to severe medical problems affecting the heart, brain, and other organs. Death can occur from direct damage or complications from secondary infections.