What is syphilis?

Syphilis is a bacterial infection that can be transmitted through sexual contact. It forms part of the infections known as sexually transmitted infections (STIs). This infection can also be transmitted from a pregnant woman to her baby. In some cases, syphilis can also be transmitted through blood transfusion. The bacterium responsible for causing syphilis is called Treponema pallidum.

In 2016, there were 19.9 million cases of syphilis around the world in adolescents and people aged between 15-49 years. In many countries, syphilis have become a notifiable disease, which means that any new cases should be reported to concerned authorities.

After the first infection, the bacteria may remain dormant in your body for a long period of time before manifesting itself again. The diagnosis of syphilis should be confirmed as soon as the condition is suspected so that treatment can be initiated rapidly to prevent the occurrence of threatening complications.

How is syphilis transmitted?

Syphilis is caused by a bacterium known as Treponema pallidum. This bacteria is transmitted via contact with mucous membranes and infected lesions or sores. This is usually during sexual contact. However, it can also be transmitted through blood contact or from a pregnant woman and her baby.

Transmission through blood transfusion is rare as all blood donors are screened nowadays. Furthermore, the bacterium cannot survive for more than 24-48 hours under the conditions in which blood is stored at the blood bank.

Sexual transmission is possible if open infected lesions are present. These lesions are very infectious. You can get syphilis by kissing or touching a person with open infected lesions on the lips, mouth, breast or genitals.

Syphilis has also commonly been found to be transmitted and acquired along with other STIs, for examples, human immunodeficiency virus (HIV).

What are the symptoms of syphilis?

Once you get the infection, the clinical presentation will vary according to stages. Syphilis is classified into 4 stages:

·         Primary syphilis: This is the first stage of infection. During this stage, the first sign present may be a sore also known as a chancre. It appears as a painless, raised red bump located where the infection entered the body. This further progresses to a small ulcer with a raised border. They are most commonly located on the penis, vagina or anus. In some cases, the sores may be found in less obvious locations such as the back of the throat or inside of the vagina and rectum. These symptoms usually start around 2-3 weeks after infection. They usually go on their own within a few weeks.

·         Secondary syphilis: This is the second stage of infection. This begins few weeks or months after the symptoms of primary syphilis. Secondary syphilis usually present with a widespread rash and large grey or white patches on the body. Other symptoms may include fever, headache, sore throat, flu-like symptoms, weight loss and swollen nodes in the neck, armpit and groin area.

·         Latent syphilis: As the name suggests, this stage does not present with any symptoms. Some people can be at this stage for years without knowing.

·         Tertiary or late stage syphilis:  During this stage, the infection has spread to other organs and causing damage. These may include the heart, brain, and skin, amongst others.

Neurosyphilis is when syphilis infection has reached the brain and the spinal cord. This can happen at any stage of infection. It can manifest with the following symptoms:

·         Headache

·         Nausea

·         Vomiting

·         Confusion

·         Neck stiffness

·         Changes in vision

How is the diagnosis of syphilis made?

To make the diagnosis of syphilis, your doctor will start by taking a history from you including your symptoms and your sexual history. Some personal questions might be asked but it is important for you to answer sincerely as this will help in making an accurate diagnosis and prevent further spread.

Once the history is taken, your doctor will examine you thoroughly to look for any signs of syphilis. To confirm the diagnosis, further tests may be requested including:

·         Blood tests: Your doctor may order blood tests to identify the presence of antibodies against Treponema pallidum which will be positive if syphilis infection is present. You may be called to do the test if your sexual partner has been confirmed to have the disease.

·         Lumbar puncture: This procedure is also known as spinal tap. It is usually indicated if Neurosyphilis is suspected. In this procedure, your doctor will insert a needle in your back to collect some of the fluid found around your spinal cord. This sample is then sent to a laboratory for further analysis, more specifically, to look for the bacteria that causes syphilis.

Screening for syphilis is also done in people who are at risk of having the infection. These include people who have multiple sexual partners, intravenous drug users, sex workers, people with other STIs and all pregnant women.

How is syphilis treated?

The earlier the diagnosis of syphilis is made, the easier it is to cure and the less likely you will end up with complications. The mainstay of treatment for syphilis is antibiotic therapy. The antibiotic used for the treatment of syphilis is penicillin. This medication can be given at any stage of the infection. 

If you are allergic to penicillin, your doctor will prescribe you with an alternative drug such as tetracycline, erythromycin and ceftriaxone. In some cases, desensitization to penicillin may be necessary.

In pregnancy, the only used treatment is penicillin. You will imperatively have to go through penicillin desensitization if you are pregnant and allergic to penicillin. Once you deliver your baby, he/she will also have to be tested despite you have had treatment for syphilis during your pregnancy.

You may experience what is called Jarish-Herxheimer reaction during the first few days of the start of treatment. This is due to the release of inflammatory substances from the dying bacteria when the antibiotic is taken. During this reaction, you may experience the following symptoms: muscular pain, fever, headache and increased heart rate. You may also notice that the syphilitic lesions become worse. This is a common reaction which resolves within 24 hours of its onset.

What are the complications of Syphilis?

The following complications may arise from syphilis:

·         Neurosyphilis: This is when the infection affects the brain and surrounding structures

·         Cardiovascular problems: Syphilis can cause inflammation in the major blood vessels and affect the heart valves

·         Increased risk of catching other STIs

·         Increased risk of miscarriage and stillbirth during pregnancy

How can syphilis be prevented?

The following can help to prevent you from getting or spreading syphilis:

·         Use a latex condom each time you have sexual intercourse

·         Abstain from sexual activities

·         Limit yourself to one sexual partner given that both of you are not infected

·         Do not have sex with someone who has suspicious lesions on the skin or any other symptoms that may be due to an infection

Get yourself tested if you think you are at a high risk of having the disease

Hicks, C., 2020. Syphilis: Epidemiology, Pathophysiology, And Clinical Manifestations In Patients Without HIV. 

Hicks, C., 2019. Syphilis: Screening And Diagnostic Testing. 

Hicks, C., 2020. Syphilis: Treatment And Monitoring.