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Syphilis, its symptoms, causes, and treatment

What is Syphilis?

Syphilis, its symptoms, causes, and treatment

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. It can spread through sexual contact or from a mother to her baby during pregnancy or childbirth. Syphilis causes symptoms such as painless sores, rashes, and fever, and can lead to serious health problems if left untreated. It can be treated with antibiotics and disappear with a single shot of penicillin. But in some cases, after its first appearance syphilis remains dormant in the body for decades, until it reactivates again.

Syphilis is primarily transmitted through sexual contact, including vaginal, anal, or oral sex. It can also be transmitted from a mother to her baby during pregnancy or delivery, a process known as congenital syphilis. Sharing needles or syringes with someone who is infected with syphilis can also result in transmission. It is important to practice safe sex and use condoms to prevent the spread of syphilis. Syphilis, its symptoms, causes, and treatment

Symptoms of Syphilis

Syphilis generally passes through various phases with varied symptoms. But the stages may overlap one another, and symptoms don’t always occur in the same order. Even you may be infected with syphilis without noticing any symptoms for years.

1. Sores or chancres: This is the first symptom of syphilis and usually appears as a   small, painless sore or blister on the skin.

2. Rash: A rash can appear anywhere on the body, including the palms of the hands and soles of the feet.

3. Flu-like symptoms: People with syphilis may experience fever, fatigue, and muscle aches.

4. Swollen lymph nodes: The lymph nodes near the site of the initial infection may become swollen and tender.

5. Later-stage symptoms: If left untreated, syphilis can progress to the later stages, causing neurological problems, heart problems, eye damage and vision loss, and even death.

6. Mental illness: People with advanced syphilis may develop symptoms of mental illness, including memory loss, paranoia, and delusions.

It is important to note that not all people with syphilis experience all of these symptoms, and some may be asymptomatic for years.

Stages of Syphilis

Primarily Syphilis develops in the form of a painless sore in the genitalia. It may be hidden inside the vagina and rectum. Being painless and hidden, people may not feel its existence. A hidden sore may heal on its own without any treatment. A syphilis infection changes its symptoms with the passage of time. Variations in symptoms of syphilis can be classified into stages. Each stage has its own signs, however, these stages can overlap one another, and symptoms do not occur in the same order. These stages are:

Initial Appearance

Primary Syphilis usually appears as a single, painless sore (known as a chancre) at the spot, from where the bacteria had entered the body. The sore can appear anywhere from 10 to 90 days after the first exposure to the infection. Most people develop only one chancre, while in rare cases people may develop multiple sores/ chancres. However, many people may not feel the symptoms, as the sore is painless as well as if it is hidden inside the vagina or rectum.

Other symptoms of primary syphilis can include swollen lymph nodes and fever. If left untreated, primary syphilis can progress to later stages, which can lead to serious health problems. It is important to seek medical attention and get tested if you have been exposed to the bacterium. Treatment with antibiotics is effective in curing primary syphilis. Syphilis, its symptoms, causes, and treatment

Secondary Stage

The secondary stage of Syphilis starts after the healing of the primary syphilis sore. The secondary stage develops with the appearance of rashes. The rashes start appearing on the trunk but soon overlap the whole of the body, even the palms and the sole of the feet. These rashes are usually not itchy and may be accompanied by wartlike sores in your mouth or genital area. Some people also experience hair loss, muscle aches, a fever, a 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.

The symptoms of the secondary stage of syphilis include:

  • Rash on the body, soles of the feet, or palms of the hands
  • Sores or ulcers in the mouth, anus, or genital area
  • Swollen lymph nodes
  • Fever, fatigue, muscle aches
  • Weight loss
  • Hair loss

Liver and renal disorders in secondary syphilis are well-known complications. However, coexistence of liver and renal disease in secondary syphilis is very rare.

It’s important to note that some individuals with secondary syphilis may not have any symptoms. If left untreated, syphilis can progress to the tertiary stage, which can cause serious and potentially life-threatening health problems.

Hidden Stage of Syphilis

If the condition is not treated in the primary or secondary stage, the infection gets hidden for years with no symptoms. The signs and symptoms will never return until the condition enters the tertiary stage.

The Tertiary Stage of Syphilis Syphilis, its symptoms, causes, and treatment

After a long-term hidden stage, more severe signs appear once again. More than 25% of untreated cases enter the tertiary stage. This is a complication of the previous stages. At the end of this stage, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.


At the end of the tertiary stage syphilis starts damaging internal organs like kidneys, heart, liver, eyes, and brain. Neuroshyphilis is the stage when syphilis damages the brain and nervous system. This is the most critical and lethal stage of the infection. At this stage treatment become harder. Individuals with asymptomatic neurosyphilis or meningeal neurosyphilis usually return to normal health. People with meningovascular syphilis, general paresis, or tabes dorsalis usually do not return to normal health, although they may get much better. Individuals who receive treatment many years after they have been infected have a worse prognosis. There are many types of Neurosyphilis, for example;

  1. Asymptomatic neurosyphilis means that neurosyphilis is present, but the individual reports no symptoms and does not feel sick. Individuals with asymptomatic neurosyphilis or meningeal neurosyphilis usually return to normal health.
  2. Meningeal syphilis can occur between the first few weeks to the first few years of getting syphilis. Individuals with meningeal syphilis can have headaches, stiff necks, nausea, and vomiting. Sometimes there can also be loss of vision or hearing.
  3. Meningovascular syphilis causes the same symptoms as meningeal syphilis but affected individuals also have strokes. This form of neurosyphilis can occur within the first few months to several years after infection.
  4. General paresis can occur between three to 30 years after getting syphilis. People with general paresis can have personality or mood changes.
  5. Tabes dorsalis is characterized by pains in the limbs or abdomen, failure of muscle coordination, and bladder disturbances. Other signs include vision loss, loss of reflexes and loss of sense of vibration, poor gait, and impaired balance. Tabes dorsalis can occur anywhere from five to 50 years after the initial syphilis infection.

Congenital Syphilis Syphilis, its symptoms, causes, and treatment

An infected pregnant woman can infect her baby 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 signs in infected babies are teeth deformities, saddle nose deformities, and deafness. Babies with syphilis may have chances of death before or just after their birth.

Complications of Syphilis

There are several complications associated with Syphilis. Syphilis can cause the following medical conditions if not treated timely.

  1. Damage to Organs: Untreated Syphilis can cause damage to the organs. The secondary stage syphilis can cause renal and liver disorders. In the late latent stage or tertiary stage, it can extend to the nervous system, and damage the meninges, brain and nervous system. Syphilis, when affects the meninges, can cause meningitis, which is a life-taking condition. Treatment at this stage becomes more complicated.
  2. Meningitis: Meningitis is a deadly neurological condition caused by the inflammation and swelling of the meninges. Meninges are the membranes that cover the brain and spinal cord. Syphilis infection can proceed to the head and can affect the meninges, thus causing severe inflammation and pain in the meninges.
  3. Neurological Disorders: Syphilis can cause a number of complications associated with the nervous system, including:
    • Intense Headache
    • Stroke
    • Meningitis
    • Deafness
    • Damage to eyes and causing visual problems, including blindness
    • Dementia and Loss of Cognition
    • Insensibility to pain and temperature
    • Sexual dysfunction and loss of libido in men
    • Bladder incontinence
  4. Heart and Cardiovascular Problems: Syphilis can cause heart problems if left untreated. In its later stages, syphilis can affect the cardiovascular system and lead to serious complications such as heart valve damage, bulging and swelling of the aorta, aneurysms, and aortitis. However, prompt treatment with antibiotics can cure the infection and prevent these complications.
  5. Risk of having HIV infection: There is no direct link between syphilis and HIV infection. However, having syphilis can increase the risk of acquiring HIV infection because it weakens the immune system and creates sores that can facilitate the spread of HIV. Therefore, it is important to practice safe sex and get tested regularly to prevent both infections.
  6. Pregnancy and Child Birth Complications: It is a serious and potentially life-threatening condition that, if left untreated, can cause serious health problems, including complications during pregnancy and childbirth.Pregnancy complications related to syphilis include:
    1. Stillbirth: This is when a baby is born dead, typically after 20 weeks of pregnancy.
    2. Premature delivery: This is when a baby is born before 37 weeks of pregnancy.
    3. Low birth weight: This is when a baby is born weighing less than 5 pounds 8 ounces.
    4. Congenital syphilis: This is when a baby is born with syphilis because the mother passed the infection to her baby during pregnancy.
    5. Congenital deformities: This is when a baby is born with physical abnormalities due to syphilis.

    Childbirth complications related to syphilis include:

    1. Increased risk of spontaneous abortion: This is when a pregnancy ends on its own before 20 weeks.
    2. Increased risk of maternal death: This is when a mother dies during or after pregnancy due to syphilis.
    3. Increased risk of postpartum bleeding: This is when a mother experiences excessive bleeding after delivery.

    In conclusion, it is important to get tested for syphilis and to receive treatment early to avoid these serious pregnancy and childbirth complications.

  7. Development of Gummas on Skin: Gummas are nodular lesions that occur in syphilis and are typically found in the skin, bones, and internal organs and are characterized by their rubbery consistency and soft, spongy texture. Gummas may be accompanied by other symptoms of syphilis, such as rashes, fever, joint pain, and loss of vision or hearing. Treatment of gummas typically involves antibiotics to eliminate the underlying infection and prevent further damage.

Causes of Syphilis

Syphilis is caused by the bacterium Treponema pallidum. It is primarily spread through sexual contact, but it can also be transmitted from an infected mother to her baby during pregnancy or childbirth. The bacteria can not normally enter the body, it can only enter through minor cuts or abrasions in the skin or mucous membranes. Syphilis in its all stages is not contagious. It can only transmit during its primary and secondary stages, and very less in the early latent period.

It can also be passed from mothers to their babies in the womb and during pregnancy or childbirth.

Less commonly, syphilis may spread through direct contact with an active lesion, such as during kissing, using the same toilet,  bathtub, or from doorknobs, swimming pools or hot tubs, clothing or eating in common utensils.

Syphilis does not recur if treated once, however, you can again get infected if you are contacted with someone’s sore/lesion, or rash. The recurrence is conditioned only with re-exposure to the bacteria.

Risk Factors of Syphilis

There are many factors and activities that can increase the risk of having an infection of Syphilis. They are as follows:

  1. Unprotected sexual activity: Engaging in unprotected sex, either vaginal, oral, or anal, increases the risk of contracting syphilis.
  2. Multiple sexual partners: Having multiple sexual partners increases the risk of contracting syphilis as it increases the chances of exposure to the bacterium.
  3. History of sexually transmitted infections: People who have a history of other sexually transmitted infections are more likely to get syphilis.
  4. Substance abuse: Substance abuse, such as alcohol and drug abuse, increases the risk of engaging in risky sexual behaviors.
  5. Men who have sex with men: Men who have sex with men are at a higher risk of contracting syphilis due to the prevalence of the disease in their community.
  6. Lack of access to healthcare: People who lack access to healthcare or who do not seek medical attention for STIs are at a higher risk of getting syphilis.
  7. Poor hygiene: Poor personal hygiene and poor sexual hygiene increase the risk of syphilis transmission.
  8. Unscreened blood transfusions: People who have received blood transfusions from unscreened donors may be at risk of contracting syphilis.
  9. Pregnancy: Pregnant women are at a higher risk of contracting syphilis as the bacterium can be transmitted from mother to child during pregnancy or delivery.
  10. HIV infection: People who are infected with HIV are at a higher risk of contracting syphilis due to their weakened immune system.

How to prevent Syphilis?

Avoiding the above-mentioned risk factors can reduce the risk of having the infection. Following measures should be taken in order to prevent Syphilis;

  1. Practice safe sex: Use a condom every time you have sex to reduce the risk of transmission.
  2. Limit your sexual partners: The more partners you have, the greater the risk of exposure to the Syphilis bacteria.
  3. Get tested regularly: Regular testing for Syphilis can help you to identify any infection and get it treated before it spreads to others.
  4. Get treated early: If you do have Syphilis, it is important to get treated as soon as possible to avoid further damage to your health.
  5. Avoid sharing needles: Sharing needles with someone who has Syphilis can increase your risk of contracting the disease.

Remember, the most effective way to prevent Syphilis is to practice safe sex, get tested regularly, and get treated if necessary.

Diagnosis of Syphilis

In the early stages, Syphilis can be diagnosed by examining the sores and rashes, and other symptoms. However, it becomes very difficult to diagnose the condition in its latent and tertiary stages. Moreover, congenital syphilis is also harder to detect. It is, therefore, necessary to conduct some laboratory tests to detect the infection.

  1. Blood tests: Blood tests, such as the RPR (Rapid Plasma Reagin) test or the FTA-ABS (Fluorescent Treponemal Antibody Absorption) test, can be used to confirm the diagnosis of syphilis.
  2. Darkfield microscopy: This test involves examining a sample of fluid from a syphilis sore under a special microscope to detect the presence of the bacterium that causes syphilis.
  3. Biopsy: In some cases, a biopsy of the syphilis sore may be taken for further testing and confirmation of the diagnosis.
  4. Cerebrospinal fluid test. If you suspect having nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a lumbar puncture.

It’s important to note that the early stages of syphilis may not show any symptoms and may only be detected through blood tests.

Treatment of Syphilis

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 may suggest another antibiotic or recommend penicillin desensitization.

The recommended treatment for primary, secondary or early-stage latent syphilis — which refers to an infection within the last year — is a single injection of penicillin. 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 be tested for congenital syphilis and if infected, 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 a headache. This reaction usually doesn’t last more than one day.