Syphilis is a sexually transmitted infection that manifests in various stages that each has its signs and symptoms depending on the overall progression of the disease in the body. It is divided into stages known as primary, secondary, latent, and tertiary – all describing a certain point in the cycle of the microorganism wherein it manifests differently, varying depending on where the symptoms do manifest and the severity of its various manifestations. Syphilis is likewise easily transmitted through sexual contact, including vaginal, anal, and oral sex – much like any other sexually transmitted infection. With the additional risk in pregnant women where it can cause congenital Syphilis, a variation of the disease that manifests when the microorganism likewise infects the baby, all individuals who are sexually active and at risk must be treated immediately with proper medications.
According to the Centers for Disease Control and Prevention, there were a total of 129,813 cases of Syphilis in all its stages in 2019 which then had around 38,992 cases of primary and secondary Syphilis – the stage where the disease is at its peak pathogenic state. Despite the previously observed massive drop in the number of cases in 2000 and 2001, the numbers exponentially increased since then and have been likewise found to be growing still at a rate of roughly 11.2% based on the data from 2018 to 2019.
With this observed increase, the Centers for Disease Control and Prevention is recommending various interventions to prevent the spread of this infection. The disease is caused by the microorganism known as Treponema pallidum, an agent discovered in the 1950s which takes around 30 hours to multiply. With its sole existence within humans and with its major transmission pathway, sexual contact, the infection could easily be prevented through abstinence and using contraceptives and condoms when participating in some form of sexual intercourse. Do note, however, that Syphilis is not transmitted through skin contact or even through blood transfer – a relieving note, for that matter.
Generally, Syphilis is easily managed with the proper antibiotic regimen at its right doses, such as Benzathine Penicillin G. The usual dose is 7.2 million units in total, but this is divided into three different doses of 2.4 million units each to manage the concentration within your body at its optimal levels. While this might seem like an easy task to perform, do note that simple antibiotics do not quickly address severe progressions as this may result in further complications that are far more challenging to resolve. In cases such as in Tertiary Syphilis, the condition may manifest in various organs such as the brain, nerves, eyes, and even the heart – making the manifestation vary depending on the organ and ultimately making the disease fatal if not addressed immediately. Consult your doctor immediately if you feel like you have been exposed or are at risk of contracting the disease.
Syphilis is caused by a microorganism known as Treponema pallidum – a bacterial strain that can manifest various signs and symptoms that resemble other conditions, coining it the title of the “great imitator and mimicker” or “the great pretender,” according to some researchers. Although this is the only strain within the Treponema genus that causes venereal conditions through sexual contact, it does, however, only survive within human reservoirs and is therefore not transmitted through animal products or even through blood transfusion or skin contact with other infected individuals.
Based on the data collected by the Centers for Disease Control and Prevention in 2019, there were a total number of 129,813 reported new diagnoses of Syphilis, with around 38,992 cases being primary and secondary stages – the stages where the bacteria are easily transmitted and most pathogenic. However, what is intriguing about this number is that most of these cases manifesting as primary and secondary Syphilis were observed in homosexual men who participate in homosexual intercourse. Specifically, 47% of the 38,992 primary and secondary stage cases were from the homosexual men demographic, while it also accounted for 56% of all male primary and secondary stage cases.
On the one hand, it is also alarming to note that the number of Congenital Syphilis cases (an infection that occurs when an infected pregnant mother passes on the condition to that baby) has also been on the rise based on the CDC’s 2019 data. There were around 1870 cases of Congenital Syphilis in 2019, wherein the numbers are likewise higher in American Indian, Alaska Native, African American, and Hispanic mothers.
Considering that the condition itself is sexually transmitted, the number one criterion when assessing whether an individual is at risk of contracting the infection is sexually active, especially those who are participating in homosexual male to male sexual intercourse. With the presence of genital sores when the disease manifests, it is effortless to transmit the condition while likewise contracting another infection such as HIV or Human Immunodeficiency Virus. If you are sexually active and regularly participate in oral, anal, or any type of penetrative sex, you should have yourself tested at the nearest health center in your area.
In addition to that, you should also have yourself tested through your routine testing procedure if you are pregnant, a sexually active homosexual man who participates in male to male intercourse, if you are living with someone who is HIV-positive and are sexually active, or if you are taking PrEP as HIV preventive measure. All these specifications are risk factors that increase your predisposition to contract the disease as opposed to other individuals.
Various treatment options are available for Syphilis, but the primary treatment that should always be chosen is an empiric antimicrobial therapy. In adults and adolescents with primary, secondary, or latent Syphilis, the recommended medication is Benzathine Penicillin G at an individual dose of 2.4 million units intramuscularly. In cases where the latent syphilis condition is already at its late stages or if the duration is unknown, the recommended dosage is roughly 7.2 million units in total, divided into three doses of 2.4 million units each intramuscularly in weekly intervals. Although complicated such as neurosyphilis or ocular Syphilis would require different medications, the concept remains constant that an empiric antimicrobial therapy at varying doses for this case is necessary to address the condition and prevent its further progression.
The progression of the disease will depend entirely on how your body responds to the medications that were administered. Although the resolution of sores is usually a sign that the infection is starting to fade, you may wait until your treatment regimen is over to partake in any sexual activity. In addition to that, you may also confirm with your doctor if you are already non-infectious to make sure that your partner is not placed at any unnecessary risk.
The primary transmission of Syphilis is through sexual contact (vaginal, oral and anal sex) or perinatal transmission. Listed below are some detailed transmissions of the infection:
Symptomatic syphilis cases would usually form syphilitic sores known as chancres. This typically appears around the external genitalia region, in the vaginal area, in the anus, in the rectum, or even inside the mouth. These chancres contain the bacterial strain that causes the disease known as Treponema pallidum. Treponema pallidum cannot exist in other organisms except humans – making it only pathogenic in human-to-human sexual contact specifically. With this, it is impossible to contract the condition from eating certain types of food or through non-sexual contacts like a blood transfusion or skin contact.
Upon contact with the infected chancres containing the bacterial strain Treponema pallidum, the bacteria can enter the body of the subsequent individual through minuscule pores known as microtraumas – small areas usually found within the mucosal membranes that are a result of minor breaks in the skin. When sexual intercourse is performed and contact with the chancre occurs, the bacteria then proceeds to these microtraumas and then begins its 10 to 90-day incubation cycle within the individual. From there, the disease may remain asymptomatic or latent, or it may progress to its initial symptomatic form known as primary Syphilis within the 10 to 90 day period.
Syphilis is treated with antibiotics. Later stages of the illness could require more aggressive treatment, possibly in a hospital. Act immediately and get tested today!Get tested for STDs today
With the coined title of “the great imitator” attached to Syphilis, it is no wonder that its signs, symptoms, and manifestations are incredibly similar to those exhibited by other conditions, sexually and non-sexually transmitted alike. In addition to that, there are also cases wherein individuals would not present with any symptom completely – only detectable when the individual opts for serological testing during their routine physical exam. Due to the broad range of classification that Syphilis ultimately covers, the condition was instead separated into different phases or stages that describe a specific set of occurrences in the disease's life cycle.
The Primary Stage, also known as Primary Syphilis, is the very point wherein a single chancre or syphilitic sore appears – indicating that the condition has now progressed into its symptomatic state. While this might be the case in some instances, it is also possible to classify the appearance of multiple sores under primary Syphilis for as long as it is classified under the following criteria:
The chancre would usually present as a bump or sore that is firm, round, and painless. Still, this manifestation may vary from each person depending on how their body responds to the bacteria's progression. As it is its initial manifestation, these chancres are usually hard to notice. They would even appear in hard-to-locate areas around the vagina or the anus – making its early detection an arduous task at best. When the lesions are likewise left untreated, they would usually resolve on their own after around 4 to 5 weeks with a range of healing of approximately 3 to 10 weeks. However, this does not necessarily connote that the individual is no longer infectious and may instead progress to its secondary stage – the point where more symptoms start to appear.
After around 6 to 12 weeks or rather, 4 to 8 weeks following the manifestations of primary Syphilis, secondary Syphilis then occurs – the point where the infection of the disease migrates from being a local infection with the chancres to a systemic infection that then causes bacteremia. In this case, the condition now presents as skin rashes or mucous membrane lesions in the mouth, vagina, and anus. The rash usually appears to be a symmetrical maculopapular rash that spreads throughout the body, involving even the scalp, palms, and soles. They commonly manifest weeks after their healing process. The rash would generally not be itchy, it may appear as reddish-brown spots, and it may also appear different depending on the part of the body that is infected – indicating either Syphilis or a manifestation of another co-existing condition that the individual might have, further complicating the diagnostic process for the disease. In addition to that, another variation of lesions known as condyloma lata – white, raised, and large lesions – may also appear in warm and secluded areas that are prone to moisture, such as the mouth, underarm, or groin. These are called “snail track” lesions when they do appear and coalesce in the mouth.
Apart from these symptoms, a secondary syphilis infection may also cause further manifestations, which may include, but is not limited to the following:
Tertiary Syphilis is perhaps the most advanced manifestation of a syphilis infection, but this condition is relatively rare and is only observed in around 35% of individuals with late latent Syphilis. It is essentially a complication caused by subsequent untreated syphilis conditions, resulting in various other types of Syphilis known as neurosyphilis, cardiovascular Syphilis, and gummatous Syphilis. It would usually appear roughly around 10 to 30 years after the initial infection was acquired. Still, at this point, the condition could now affect multiple organs, including the brain, nerves, eyes, blood vessels, liver, bones, and joints – making this stage extremely fatal to many. The symptoms would likewise vary depending on the affected organ, manifesting apparent symptoms depending on the part that is compromised by the extreme proliferation of the bacteria in the individual’s body.
The latent stage or latent Syphilis is essentially the point in the cycle wherein the bacteria is entirely dormant and does not manifest any symptoms altogether. However, the bacteria remain alive and viable within the patient’s body – making it imperative that proper treatment and diagnosis is still performed to ensure that the disease will not progress to further stages wherein it could cause severe complications such as neurosyphilis.
The latent stage is divided into two stages: the early latent stage and the late latent stage. The early latent stage is characterized by an asymptomatic condition that has persisted for less than two years since the time of the presumed initial infection, while the late latent stage is the point when the individual has already had Syphilis for more than or equal to 2 years since the supposed initial time of infection. It is also important to note, based on this characterization, that latent Syphilis could persist for years on end. Still, it remains detectable through routine testing – making it even more imperative to include STD tests in regular physical checkups to ensure that any latent conditions are met with rigorous care before they progress to their lethal and fatal manifestations.
With the odd progression mechanism of Syphilis, the condition can penetrate other sensory organs when the bacterial infection becomes systemic and causes bacteremia. As such, conditions such as neurosyphilis (also known as meningovascular Syphilis) and ocular Syphilis are possible in cases where the progression of the disease is so severe that it has already reached the brain as the eyes. Despite the understandable misconception that this level of proliferation is only apparent in tertiary or late-stage Syphilis, neurosyphilis could likewise be observed in secondary syphilis cases with an incubation period of around 5 to 12 years. It usually presents upon invasion of the nervous system - causing symptoms such as headache, altered behavior, difficulty in coordinating muscle movements, paralysis, sensory deficits, and even dementia. In addition to that, the condition could likewise involve the spinal cord and brain to cause a further disease known as parenchymatous Syphilis. In this state, the situation could either cause “tabes dorsalis” (when the spine is involved) or “general paralysis of the insane” (when the brain is now involved). In “tabes dorsalis,” the following signs and symptoms are commonly observed:
On the one hand, “general paralysis of the insane” usually manifests as:
On the other hand, ocular Syphilis, a further manifestation that could likewise appear in other stages, is a condition that involves most of the structures of the eye – commonly causing posterior uveitis and panuveitis. With such a condition, the following manifestations are usually observed from the patient upon examination:
Congenital Syphilis is a condition obtained by the baby when the mother is coincidentally infectious during labor or even during pregnancy. Due to the possible vertical transmission of the bacteria from the mother to across the placenta and then to the baby, infections are standard but otherwise manageable and treatable when addressed immediately. While it may be possible that babies who have contracted congenital Syphilis would remain asymptomatic for the first few years of their lives, congenital Syphilis could also remain latent and persist in the later years, only to come back in its fatal form wherein it could cause seizures or even death when it is left untreated. Symptoms would usually appear during the first few weeks following delivery. However, the baby should still be checked and provided with proper treatment if the mother is positive for Syphilis during her pregnancy.
Congenital syphilis cases could result in various health problems with the baby – some being minor and manageable. At the same time, some are severe depending on how long the condition was allowed to persist and how soon the treatment was provided to the child. In general, congenital Syphilis would usually present with the following manifestations while the mother is pregnant or in labor:
If the baby survives the delivery while still being Syphilis positive upon testing, the following manifestations could then be observed:
The previous conclusive diagnostic test that was performed for Syphilis was known as darkfield microscopy – the process wherein instead of staining the bacteria with a particular color to show it under the microscope, the background is stained instead to highlight the contrast between the hard-to-stain spirochete Treponema pallidum and the rest of the microscope slide. By doing so, no additional process is necessary to force the color into the bacteria’s structure and instead utilizes the superficial structures of the bacteria to identify it against the colored background.
However, with the developments that have been made in histopathology, as well as with the additional concerns of negative stains (stains used in darkfield microscopy) being carcinogenic and toxic, new methods are now being used instead of the previous ones. New tests now mainly focus on using blood tests, and two types are used in the diagnosis of Syphilis: treponemal and non-treponemal tests.
A treponemal test detects the presence of antibodies produced by the body when infected by the bacteria. These antibodies could likewise be present for a lifetime – making it an ideal testing medium for a general differential diagnosis as to what is causing the patient’s symptoms. However, with its unique mechanism, this is usually performed secondary to a non-treponemal test due to the possibility of detecting previously treated syphilis cases, untreated or incompletely treated syphilis cases, or people with false-positive results. This procedure is usually known as a reverse sequence testing method, and it is no longer commonly applied due to its problematic interpretation.
In a non-treponemal test, the process is simple and inexpensive but is also less accurate due to the high possibility of false-positive results upon examination. They are often used for screening; however, they remain an insufficient option for individualized testing. In this case, when the results for the non-treponemal test comes back positive, the physician would usually require a treponemal test to verify the presence of antibodies within the body – ensuring that the patient is indeed infected by T. pallidum while avoiding the conflict between past infections and current infections completely with a presumptive analysis beforehand.
Considering that Syphilis is a bacterial infection that could progress to further complications when left untreated, there are no recommended home remedies or cures to the condition other than the general recommendation of having it checked by a physician to receive a proper antibiotic prescription. With an immediate resolution and diagnosis of the symptoms, the condition could likewise be immediately addressed with a standard course of antibiotics that will help in ensuring that the disease will no longer progress to its more fatal stages.
In the treatment for primary and secondary Syphilis, the common antibiotic of choice is parenteral penicillin to achieve the necessary healing of chancre sores and the prevention of the further progression of the condition. However, no substantial evidence is available to support the use of oral penicillin dosage forms in this matter, and even less evidence is available for non-penicillin variants.
The following are the recommended treatment guidelines by the Centers for Disease Control and Prevention when it comes to primary and secondary syphilis cases:
Infants or children aged less than one month or yet to reach sexual maturity and awareness should be reported to the corresponding authorities (child-protection services). These are signs of possible abuse. On the other hand, pregnant women showing signs of primary and secondary Syphilis, especially those who are allergic to penicillin, should be desensitized beforehand and then treated with the appropriate penicillin for their current stage of progression.
Latent Syphilis is a variation that is not sexually transmitted by any means. As such, the main priority in this treatment regimen is to prevent further complications and severe progressions and prevent vertical transmission in pregnant women who are currently under the latent syphilis classification.
The following medications are indicated for individuals who were classified under the latent syphilis category following diagnosis and examination:
In this context, tertiary Syphilis specifically refers to cardiovascular and gummatous syphilis cases, while neurosyphilis cases are discussed separately. Much like with the treatment for the secondary stage of a syphilis infection, tertiary syphilis cases should be addressed with the following treatment regimen:
Based on the standardized treatment guidelines of CDC and based on the evidence provided by various studies, the treatment for neurosyphilis remains similar to the standard treatment for other syphilis stages, with the exception that a cerebrospinal fluid examination (CSF) is necessary when neurological problems are suspected. In addition to that, a CSF examination is likewise essential for all ocular syphilis cases, and the patient should be managed in collaboration with an ophthalmologist even if the CSF examination returns normally. The following treatment regimens are therefore recommended for these cases:
In cases where an individual with a positive HIV result likewise tests positive for Syphilis, the following treatment guidelines are likewise recommended by the CDC:
According to various studies, the transmission of Syphilis only occurs after the appearance of the syphilitic sores or lesions known as chancres. As such, the Centers for Disease Control and Prevention likewise recommends the treatment of partners who have been exposed to a syphilis-positive individual to begin pre-emptive treatment and various preventive measures immediately.
The CDC established the following guidelines and recommendations to guide people as to how to proceed when managing the possible infection of sexual partners:
Upon administering the appropriate antimicrobial therapy against Syphilis, an acute reaction known as Jarisch-Herxheimer Reaction could be observed wherein the patient may experience myalgia, fever, and other symptoms within the first 24 hours due to the inflammatory response of the dying microorganisms within your body. In this case, the best treatment or management option is completely supportive treatment only with relieving medications such as antipyretics to address the symptoms. However, this reaction could also cause early labor in pregnant women or fetal distress. Still, the CDC’s recommendation included a clause stating that delaying therapy is not an option even in these cases as the antimicrobials have already been administered. Close observation is advised, and counseling regarding the possible adverse reactions to therapy is likewise expected from the attending physician.
In the case of pregnant women, the only medication that is effective against Syphilis from various document studies is Parenteral Penicillin G. If the patient is sensitive to penicillin, desensitization is first performed, then a standard course of penicillin antibiotics is then administered to the patient.
Considering that the therapy and drugs utilized for a bacterial infection are antimicrobials, proper care and discretion are advised for all patients who are showing possible signs and symptoms of Syphilis. Do not, and we repeat, do not self-medicate with antibiotics as this could lead to antimicrobial resistance – a condition wherein the bacteria no longer respond to the given medication as it has already developed resistance from the improper doses that were provided previously. As such, always consult your doctor beforehand when apparent symptoms are bothering you. We repeat, DO NOT SELF-MEDICATE.
Syphilis is commonly transmitted upon contact with the infectious syphilitic sores or chancres – making latex condoms an effective tool in reducing the risk of contracting the disease even if contact is performed when the patient is contagious. However, note that areas not covered by the condom, especially those with present chancres, remain infectious and pathogenic. With that in mind, the surefire way to avoid transmission is, of course, abstinence. By opting out from any sexual contact completely, the transmission pathway of the bacteria is entirely cut – keeping you safe from possible infections, or in some cases, other people from your current disease. Monogamous relationships are likewise efficient in ensuring that you could trace back possible conditions to one partner and ensure that both of you are protected when participating in any form of sexual intercourse.
To summarize, the following are the key points to remember about preventing syphilis transmissions:
Who is at the highest risk of contracting Syphilis?
In a sense, individuals who are extremely sexually active, young adults, men who have sex with men, women in general, and people who do sex work are significantly at risk of contracting Syphilis. However, the possibility of the bacteria proliferating is dependent on how eager the individual is to have themselves tested and treated immediately following the positive result.
Can you get Syphilis from kissing?
Due to the presence of chancre sores in the mouth due to oral sex, it is possible to transmit Syphilis through intense kissing and saliva contact. However, note that this is only possible in cases where chancre sores have manifested in the individual’s mouth, and even at this point, the risk remains extremely low.
Can you get Syphilis from a toilet set?
Fortunately, you cannot. The bacteria itself could not survive in inanimate objects and would therefore be no longer pathogenic on surfaces. However, always remember that toilet seats are still full of various other bacteria you should likewise be mindful of.
How long does it take to cure Syphilis after receiving a penicillin shot?
The treatment duration would depend on the severity of your condition and the response of your body or even the bacterial strain to the medication. Coordinate with your physician to obtain a solid approximation of your treatment’s timeframe.
How long can you have Syphilis before it ultimately becomes untreatable?
There is no definite guideline for this instance, as even latent infections could span years before they eventually progress to their tertiary stage. Nevertheless, do not use this as a guideline when treating your condition. Always manage the symptoms early to avoid any complications and permanent damage.
If I get treated for Syphilis, could I get the infection again?
Unfortunately, yes. Immunity following an infection is not possible in this case.
Will I always test positive for Syphilis after I get infected?
In a sense, yes, especially in Treponemal tests. Treponemal tests detect the presence of antibodies in your body – resulting in a positive result even if you do not have a current infection if you have had a previous infection or an untreated or incompletely treated case previously.
Can Syphilis be cured naturally?
In the strictest sense, no. Natural healing is not necessarily evidence-based and effective against microbial infections – leading to complications and permanent damages when the condition is left untreated and improperly managed. Always consult your doctor regarding your possible treatment options when you are experiencing some sort of discomfort.
Does Syphilis pose unique problems in people with HIV?
It may pose particular problems, especially when it comes to diagnosis, as it can interfere with the accuracy of the results. In addition to that, people with HIV are likewise more susceptible to neurosyphilis – a complication that could be fatal when left untreated.
Centers for Disease Control and Prevention
National Institute of Allergy and Infectious Diseases
World Health Organization
Lab Tests Online
Written by Mark Riegel, MD
Yes. Early stage syphilis is easily curable; Treatment is more difficult at later stages.
Bacterial. Syphilis is caused by the bacterium ema pallidum.
Antibiotics. A single injection of penicillin at early stage; Later stage treatment may require hospitilzation.
Varies. Recovery from syphilis is not complete until all the sores are healed; Damage from the disease may be permanent.
No. Avoid sexual activity until the disease is fully cured.
Yes. Sexual intercourse with an infected partner can lead to re-infection.
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