Syphilis – Complications, Symptoms, Diagnosis and Treatment

Definition

Syphilis is an infection by the Treponema pallidum bacteria that is transmitted by direct contact with a syphilitic sore on the skin, and in mucous membranes. A sore can occur on the vagina, anus, rectum, lips, and mouth. It is most likely to spread during oral, anal, or vaginal sexual activity. Rarely, it can be passed on through kissing. The first sign is a painless sore on the genitals, rectum, mouth, or skin surface. Some people do not notice the sore because it doesn’t hurt. These sores resolve on their own, but the bacteria remain in the body if not treated. The bacteria can remain dormant in the body, sometimes for decades, before returning to damage organs, including the brain.

History

The history of syphilis has been well studied, but the exact origin of the disease is unknown. There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew of Christopher Columbus as a by-product of the Columbian exchange, while the other proposes that syphilis previously existed in Europe but went unrecognized. These are referred to as the “Columbian” and “pre-Columbian” hypotheses.

The first written records of an outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as “French disease”, and it was not until 1530 that the term “syphilis” was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905.The first effective treatment (Salvarsan) was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich which was followed by the introduction of penicillin in 1943. Many famous historical figures including Franz Schubert and Édouard Manet are believed to have had the disease.

Epidemiology

International statistics

Internationally, the prevalence of syphilis varies by region. Syphilis remains prevalent in many developing countries and in some areas of North America, Asia, and Europe, especially Eastern Europe. The highest rates are in South and Southeast Asia, followed closely by sub-Saharan Africa. The third highest rates are in the regions of Latin America and the Caribbean. In some regions of Siberia, as of 1999, prevalence was 1300 cases per 100,000 population.

Age distribution of syphilis

Syphilis is most common during the years of peak sexual activity. Most new cases occur in men and women aged 20-29 years. In 2013, the rate of primary and secondary syphilis was highest in people aged 25-29 years (27 per 100,000).

The incidence of congenital syphilis has increased to 11.6 cases per 100,000 live births in 2014, the highest congenital syphilis rate reported since 2001. The number of congenital syphilis cases declined in the United States during 2008-2012, from 446 to 334 cases (10.5 to 8.4 cases per 100,000 live births) but is increasing; from 2012-2014, the number of reported congenital syphilis cases in the United States increased from 334 to 458.

Sex distribution of syphilis

Men are affected more frequently with primary or secondary syphilis than women. This difference has varied over time. Male-to-female ratios of primary and secondary syphilis increased from 1.6:1 in 1965 to nearly 3:1 in 1985. After, the ratio decreased, reaching a nadir in 1994-95. The past decade has seen a sharp rise in syphilis cases among men, driven mostly by the MSM community. Males with primary and secondary syphilis outnumber females 10 to 1. Among women, the reported primary and secondary syphilis rate increased from 0.9 to 1.5 per 100,000 population per year during 2005- 2008 and decreased to 0.9 in 2013.

Risk factors

You face an increased risk of acquiring syphilis if you:

  • Engage in unprotected sex
  • Have sex with multiple partners
  • Are a man who has sex with men
  • Are infected with HIV, the virus that causes AIDS

Causes

  • The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.
  • Less commonly, syphilis may spread through direct unprotected close contact with an active lesion (such as during kissing) or through an infected mother to her baby during pregnancy or childbirth (congenital syphilis).
  • Syphilis can’t be spread by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs.
  • Once cured, syphilis doesn’t recur on its own. However, you can become re infected if you have contact with someone’s syphilis sore.

Stages of syphilis

Symptoms

Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with syphilis and not notice any symptoms for years.

Primary syphilis

The first sign of syphilis is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them. The chancre usually develops about three weeks after exposure. Many people who have syphilis don’t notice the chancre because it’s usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within three to six weeks.

Primary syphilis

Secondary syphilis

Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience hair loss, muscle aches, a fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Secondary syphilis

Latent syphilis

If you aren’t treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.

Tertiary (late) syphilis

About 15 to 30 percent of people infected with syphilis who don’t get treatment will develop complications known as tertiary (late) syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.

Tertiary syphilis

Congenital syphilis

Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose  where the bridge of the nose collapses.

Complications

Without treatment, syphilis can lead to damage throughout your body. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.

Small bumps or tumors

Called gummas, these bumps can develop on your skin, bones, liver or any other organ in the late stage of syphilis. Gummas usually disappear after treatment with antibiotics.

Neurological problems

Syphilis can cause a number of problems with your nervous system, including:

  • Stroke
  • Meningitis
  • Hearing loss
  • Visual problems
  • Dementia
  • Loss of pain and temperature sensations
  • Sexual dysfunction in men (impotence)
  • Bladder incontinence
  • Sudden, lightning-like pains

Cardiovascular problems

These may include bulging (aneurysm) and inflammation of the aorta your body’s major artery and of other blood vessels. Syphilis may also damage heart valves.

HIV infection

Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to fivefold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter your bloodstream during sexual activity.

Pregnancy and childbirth complications

If you’re pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.

Diagnosis and test

A doctor will carry out a physical examination and ask about a patient’s sexual history before carrying clinical tests to confirm syphilis.

Tests include:

Blood tests: These can detect a current or past infection, as antibodies to the disease will be present for many years.

Bodily fluid: from a chancre during the primary or secondary stages can be evaluated for the disease.

Cerebrospinal fluid: may be collected through a spinal tap and examined to test for any impact on the nervous system.

If there is a diagnosis of syphilis, any sexual partners must be notified of and tested for the disease.

Local services are available to notify sexual partners of their potential exposure to syphilis, to enable testing and, if necessary, treatment.

Treatment and medications

  • When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. If you’re allergic to penicillin, your doctor will suggest another antibiotic.
  • A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses.
  • Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you’re treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.
  • The first day you receive treatment you may experience what’s known as the Jarisch-Herxheimer reaction. Signs and symptoms include a fever, chills, nausea, achy pain and headache. This reaction usually doesn’t last more than one day.

Treatment follow-up

After you’re treated for syphilis, your doctor will ask you to:

  • Have periodic blood tests and exams to make sure you’re responding to the usual dosage of penicillin
  • Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured
  • Notify your sex partners so that they can be tested and get treatment if necessary
  • Be tested for HIV infection

Prevention

Preventive measures that can decrease the risk of contracting syphilis, include:

  • Abstinence from sex
  • Long-term mutual monogamy with an uninfected partner
  • Condom use, although these protect only against genital sores and not those on the body
  • Use of a dental dam, or plastic square, during oral sex
  • Not sharing sex toys
  • Avoiding alcohol and drugs that could potentially lead to unsafe sexual practices

Having syphilis once does not mean a person is protected from it. Once it is cured, it is possible to contract it again.

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96 comments

  1. please get siphilis for about 10yrs and apart from the penicillin what medicine can use again

    • Your doctor may prescribe another antibiotic in early stages of syphilis, such as doxycycline, tetracycline, ceftriaxone, or azithromycin. Later stages of syphilis may require treatment with penicillin.

  2. Your Name Ssengooba Abdulahuman

    I used to eat Gnuts plus Milung so much, now when i visit toilet there’s short of sparms rinking through my penis, now what to do?

  3. Quite an interesting insight. I would like to know more of staphloccocus aureus. the symptoms, how it can be contacted, how it can be detected, how it can be cured. I lived in warri recommend any good hospital/clinic. Thanks.

  4. I have siphilis for 8yr what should I do

  5. In case you don’t know whether you’re having it or not, can you take the injection and won’t it have any negative effects on you?

  6. fast of all do full Serology Screeing
    then doing Physical Treatment

  7. I had syphillis and I was treated with antibiotics but I still feel some symptoms.. what should I do

    • The disease may reverse back due to unprotected sex or improper hygiene. First, consult with a good doctor to avoid the development of the symptoms.

  8. My sister Rose had sypilis ,she had took penicillin put no way ,what is the nest treatment for this cases .

    • Please consult a doctor to reduce the further complications of syphilis. Discuss with a doctor about the antibiotics to be used. Don’t use your own chosen drugs because it may rise a side effect.

  9. Joyce SowaYour Name

    please every month before l get my mensuration l get some painful rash on my vagina can it be syphilis

    • No it may be due to unchanged napkin for prolonged time during mensuration, causes some rashes on vagina. but consult doctor once.

  10. I have syphilis for more than 12years now and I have spend almost everything I had in my account to no avail. I don’t want to go to the hospital any longer. please what antibiotics can I take?

    • Penicillin is the most common antibiotic which cures syphilis. Though u have syphilis for longer years, you may need additional doses.

  11. Am having pain from my left testicle and am feeling like there are some small sores around the anus, and I went to the clinic, they gave me three injection for three weeks and the doctor told me pus was also coming out of the penis after conducting urine test. But I felt better Only for a week, what can be the problem. Please advise.

    • It may be a symptoms of orchitis. so please consult a doctor and undergo diagnosis and test to find the cause and disease.

  12. Aftet reading through i got to discover i had sypilis cause pls must d treatment be an injection ,cant it be normal drug which contain penicilin antibiotics

  13. my problems is I can get pregnant n my period don’t flow well it flows for two days instead for five days n used to have constant heached what can I take to make me get pregnant or flow normal pls help doctor am thanks sir.

  14. please I have sylphillis for ,5years have take alot drugs what can I take please to cure me am from Adamawa state

  15. please is there any home remedy for syphilis?

    • There is no home treatment for syphilis. It requires medicine prescribed by a doctor. Prescription antibiotic medicine normally cures syphilis infections.

  16. please sir am having syphilis by blood test shows for sometime now, I treated it but it’s seems am seeing de same signs as I was having first. so please how do I treat it with de penicillin. thanks

  17. l’m not getting you very well about penicillin YOU mean PPF or Bezylpenicillin?

  18. I feel small small rashes all over my body and mostly on my ass, dick and my scrutum is that also the sign?

  19. can Azithromycine be use to treat syphilis

    • Yes it will treat syphilis. Azithromycin has been shown to be as effective as penicillin in early syphilis and it should only be used when penicillin or doxycycline are not feasible.

  20. can Amoxi Denk 500 treat a pregnant woman who have syphilis for 5 year’s

    • Amoxicillin is not routinely prescribed for pregnant women because of little evidence of their efficacy in preventing congenital syphilis.

  21. what’s the dosage for the penicillin?

  22. I had syphilis without knowing. i developed black spots all over my body, loss of balance ,weak joints boil in my nose,blurred vision and loss of hearing on my right ear.
    After treatment i regained balance,vision came to normal,boils stopped but the problem is i still can’t hear in my right ear and there is a small lump in my right nose trill left by a boil.when i went to a doctor she examined me that there is no infection in my mouth and ear hence i will never hear again on my right ear.

  23. I have siphilis for 4 months I was treated but nothing is happening am still having the same problem what should I do help me please??

  24. this application it was so much important and also it content alot of knowledge

  25. I’m not sure if what I have is syphilis. But i didn’t see any sexual disease that is as close as what I have to syphilis. It started like rashes but now it’s leaving some dark painless growth on my penis. Can I use penicillin too?

  26. I develop some small rashes on my skin and when I try scratch them they develop into a wound, could this be Syphilis?

  27. I’m havin a 3 spot on ma vagina…. it sometimes itch me when I bath. doc pls is it also a sign of syphilis???

  28. I sincerely thank you all for d wonderful things people have done in the life of many people are infected with this deadly disease. And I also wish to know weather the penicillin drugs, is it only made for the pregnant mothers alone all anybody who has the various can as well take it. Thank u

  29. What is the additional doses for the treatment of
    long term syphilis? apart from the penicillin injection.

  30. syphillis treatment, long term.

  31. Your Name Jordan

    I have body itching for so many years now, especially my. Private parts… I hv been to hospitals but yet still, don’t know welther syphilis or not

  32. Thanks doctor for your well explanations…….. Pls is it advice able for with syphilis to make changes of his or her under wears?

  33. l feel pain on my anus and wait can it be the same

  34. I don’t know when I got this disease but I have it, can I take the infection without going to doctor. thank you

  35. Ohene George Oppong

    I’m 31 years and I have contracted Syphilis for more than 20years now.what should I do to in terms of treatment?

  36. can syphilis kill and how long does it stay in body, if stay too long in body, can it be cure parmanet?

    • Without treatment, the disease can last for years or even decades. Untreated cases of syphilis can lead to destructive tissue lesions known as gummas on the skin, bones, and organs; seizures; damage to the spine that can result in paralysis; heart problems; damage to blood vessels that can lead to stroke and death.

  37. please I have syphilis for over six months what antibiotics should I take please.

  38. I had a blood test for syphilis it came out negative but still am feeling like i still hav it,feeling pain in defication nd stomach itching wat could be the problem?

  39. I have syphilis for 1yrs.
    what should I help me

  40. I would like to know more about chancroid and it’s treatment

  41. I had syphilis And I did test yesterday and it was negative, how is that possible, is that OK

    if I do another test will it come back

  42. is it any other name for the penicillin

  43. I’m having a little swell on my anal tract. Could it be syphilis. There’s also little trace of blood on stool most times. Though it hurts but not much

  44. WalusimbiYourself Name

    am 22years born with syphilis how can I get cured

  45. does too much intake of penicillin drug has effect to the body ?… and what can be done to 18years syphilis in body that refuse to be cured after many injection and drugs ?

  46. My comment here is that, just to thank for your services and sacrifices for what you people are doing for us! you have open our minds about many diseases. I am actually appreciating your efforts.

  47. Your Name Ezron Mwale

    my partner affected by syphilis and saying through toilet.How true is it?

  48. Your Name Ezron Mwale

    all information is clear thanks

  49. How can you know that your diseases in finish while there is some virus still in your penis and some finish How can you know that is finish.

  50. know they have treated me with Benzilic penicillin and l sex Girl l thought that is now finish even now there is some small thing still in my penis while is treated what shall l do now please

  51. Abdul Sataari Moomin

    sore around my penis anytime I have sex with my wife what medicine will I use

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