Syphilis Symptoms Causes and Treatment

What is Syphilis?

Syphilis (сифилис, مرض الزهري) is a sexually transmitted infectious disease (STD) caused by infection with Treponema pallidum, a pathogenic gram negative bacteria in the genus Treponema. When syphilis is present, symptoms are usually expressed in early stages, early symptoms include a small, painless mouth or genital ulcer (chancre) that persists for 2–6 weeks; However, if left untreated, syphilis can cause headaches, syphilitic alopecia (syphilitic hair loss), syphilitic pharyngitis (sore throat), flu-like symptoms and widespread skin rash. Symptoms tend to show up 10 to 90 days after infection. Like other STIs, syphilis is usually transmitted by direct contact with a sore, through unprotected oral, vaginal, or anal sex with an infected partner and by vertical transmission of Treponema pallidum from an infected mother to her child.

When was Treponema pallidum first discovered?

In 1905, Treponema pallidum (Spirochaeta pallida) was first identified by Schaudinn and Hoffmann in tissue of patients with syphilis. One year later, the Wassermann test, was developed.

Incidence and Prevalence of Syphilis

Since 1992, the global incidence of syphilis decreased dramatically; However, there were 39,920 new syphilis cases reported in the United States in 2012. The disease is very common among people ages 20-24, especially among gay and bisexual men.

Gay men accounted for about 75% of the new cases reported in 2012.

Syphilis infection affects people of all backgrounds, regardless of gender, race or ethnicity, although African Americans and Hispanics report the condition more often than Caucasians. The socioeconomic status, illiteracy and lack of access to healthcare facilities are associated with higher infection rates.

In the United States, cases of congenital syphilis dropped from 360 in 2011 to 322 in 2012.

Epidemiology

Is syphilis caused by a virus or bacteria?

Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum. Syphilis has been known as “the great imitator” as it may mimic the symptoms of many other conditions.

Is syphilis contagious and how?

A person with syphilis is always contagious whenever an open sore or skin rash from syphilis is present, especially during the infection’s primary, secondary, and early latent stages.

How do you get syphilis?

The source of infection:

In most cases, syphilis is caught from other humans (pathogen carriers and sick people).

How can syphilis be transmitted?

Treponema pallidum is usually transmitted from person to person by direct contact between a chancre, also known as a syphilitic sore, and the mucous membranes of the genitals, mouth, or anus, or by broken skin coming into contact with open syphilitic sores, through unprotected vaginal, oral, or anal sex, and by vertical transmission of T. pallidum from an infected mother to her child.

Chancres usually form on or around the external genitals, around the anus, on the lips, in the rectum, mouth, and in the vagina.

How is the body affected by syphilis?

Syphilis infection starts when the causative agent of syphilis penetrates the body through mucous membranes, usually during sexual contact. Treponema pallidum (spirochete Treponema) usually penetrates through the genitals, rectum, or mouth, and then migrates to other parts of the body via the bloodstream.

Can syphilis kill you?

Once your system has been infected, syphilis stays in your body either as an active infection or lays dormant and undetectable for many years before becoming active again. Syphilis can affect multiple organ systems, including the brain, heart, eyes, nerves, and other organs. However, if left untreated, the disease damages your internal organs and can result in death, generally occurring 10–30 years after the initial infection.

Syphilis is usually transmitted from person to person by direct contact with a chancre, especially in patients who are in the primary or secondary stage. However, many of these syphilitic chancres are unrecognized. Thus, transmission may occur from individuals who are unaware of their infection.

Meningovascular syphilis usually occurs 4-12 years after primary infection, whereas cardiovascular syphilis and late neurosyphilis occur 10–30 years after the initial infection. Cardiovascular syphilis is a manifestation of tertiary syphilis, it may lead to syphilitic aortitis, coronary stenosis, aortic aneurism, aortic insufficiency and, rarely, to myocarditis.

What are the stages of syphilis?

Syphilis is classified into four stages: primary, secondary, latent, and tertiary (neurosyphilis). Spirochetes are easily identified from specimens obtained during primary and secondary stages. Primary and secondary stages are the earliest and most contagious stages of syphilis.

Primary syphilis is characterized by one or more small, painless syphilitic chancres in or around the genitals, mouth, or anus.

What is Latent syphilis?

Latent syphilis is an asymptomatic stage that follows secondary syphilis. During this stage of syphilis, syphilitic sores resolve, and patients are asymptomatic. However, during this stage patients have serologic evidence of infection and serologic tests are positive for Treponema pallidum.

Latent syphilis is classified into two stages:

1. Early latent syphilis that occurs within 1 year of infection after secondary syphilis
2. Late latent syphilis that occurs more than 1 year after secondary syphilis.

What is tertiary syphilis?

Tertiary syphilis is the third stage of syphilis, it is characterized by a variety of symptoms depending on the organ system affected. This stage is marked by skin lesions and by involvement of the cardiovascular, skeletal and nervous systems, and for this reason, it is considered the most dangerous form of syphilis.

How long does syphilis stay dormant in the body?

Syphilis can remain dormant in the body for decades, typically during the latent stage. During this time, signs and symptoms of syphilis are not present, but the infection that remains in your body is contagious to intimate partners. The late stage of syphilis or tertiary syphilis can occur anywhere from 1 to 30+ years after initial infection.

What are the long term effects of syphilis?

Without proper treatment the infection may cause lesions in other parts of the body causing serious, long-term complications. However, if left untreated, the pathogens travel through your bloodstream and can eventually spread to the heart, brain, eyes, bones, nervous system, and other internal organs causing severe damage to almost all of the body’s major organs.

How long does it take for a person to get syphilis?

The incubation period for syphilis ranges from 10 to 21 days. However, on rare occasions, the incubation period can last up to 3 months. Syphilis is characterized by a very gradual onset, symptoms usually develop gradually and progresses slowly.

How long does it take to show signs of syphilis and how does syphilis look like?

Symptoms usually appear 10-21 days after direct contact with an infected person. In most cases, the earliest symptoms of syphilis include one or more small, painless syphilitic chancres, inguinal lymphadenopathy or swelling and hardening of lymph nodes in the groin area, swelling and hardening of lymph nodes in the inner thighs, low grade fever, malaise, and headache. Less common symptoms include arthralgia or joint pain, transient body aches, neck ache, pharyngitis (sore throat), aphthous ulcers (canker sores), vague feeling, cervical lymphadenopathy, axillary lymphadenopathy, nausea, and patches of hair loss.

Syphilitic chancres normally appear in or around the genitals, mouth, on the penis, in the vagina or anus.

Is syphilis asymptomatic or symptomatic?

Syphilis is considered a silent killer because initial symptoms are not loudly expressed in early stages that individuals may not even know they have been infected. Moreover, the symptoms of syphilis are generally wide ranging that they may be confused with different conditions. Many symptoms of syphilis mimic the symptoms of other conditions.

Syphilis is characterized by three clinical, symptomatic stages separated by asymptomatic (latency) periods.

Common manifestations include genital sores, skin lesions, aortic disease, meningitis and neurological syndromes.

How long can the first stage of syphilis go undetected?

On average, symptoms tend to show up 10 to 90 days after infection, early symptoms include a small, painless oral or genital ulcer that persists for two to six weeks; However, if left untreated, syphilis can cause headaches, syphilitic hair loss, syphilitic pharyngitis, flu-like symptoms and widespread skin rash. Like other STIs, syphilis is usually transmitted by direct contact with a chancre. This usually occurs during intercourse, including oral sex.

Can you have asymptomatic syphilis?

This asymptomatic stage is divided into the incubation period or the initial period before the symptoms of syphilis appear and the latent period that follows secondary syphilis. The latent period occurs in two phases: early latent syphilis (within 12 months of infection) and late latent syphilis (after 1 year). Late latent syphilis is noncontagious. The pathogens remain inactive in the spleen and the lymph nodes.

What are the symptoms of Syphilis?

What does the start of syphilis look like?

Symptoms of primary syphilis

Symptoms tend to show up 10 to 90 days after infection, early symptoms include regional lymphadenopathy in the infected area and a small, painless chancre on the genitals, mouth, skin, or rectum that heals by itself in 2 – 6 weeks. If left untreated, the bacteria spread throughout the body from the infected area. However, symptoms remain mild as the disease progresses into the second stage.

What are the symptoms of secondary syphilis?

The duration and severity of each phase of the disease is highly variable. In most cases, symptoms vary and may worsen as the disease progresses. Symptoms change from one stage to the next and severity of symptoms may change over time.

The signs and symptoms of Secondary syphilis can be mild or severe and may include:

1. Syphilitic skin rash (skin lesions), usually on the palms of the hands and soles of the feet
2. Syphilitic mucous patches in moist parts of the body such as in or around the mouth, vagina, or penis
3. Condylomata lata, wart-like, mucoid, plaque-like lesions on the genitals or skin folds
4. Low grade fever
5. Malaise
6. Loss of appetite
7. Myalgia (muscle aches)
8. Arthralgia (joint pain)
9. Lymphadenopathy (swollen lymph nodes)
10. Syphilitic alopecia or hair loss that occurs in only 4% of patients with syphilis
11. Diffuse rash on the back and flu-like symptoms
12. Vision problems (ocular syphilis)

If left untreated, vertical transmission can occur at any time during pregnancy, syphilis infection during pregnancy can lead to early congenital syphilis and late congenital syphilis. Syphilis remains the most common congenital infection facing women globally and has enormous outcomes for the mother and her embryo. Despite antibacterial therapy and administration of high doses of penicillin, as many as 14% of pregnant women with untreated early syphilis will have a late intrauterine fetal death (stillbirth), or deliver infants with clinical evidence of congenital syphilis.

What are the symptoms of tertiary syphilis?

The severity of your symptoms gets worse as the disease progresses into the third stage. Tertiary syphilis forms in 30% of untreated patients.

Symptoms of tertiary syphilis are dependent on the organs involved. They vary widely and are difficult to diagnose as they can mimic other conditions. Symptoms of tertiary syphilis include:

Meningovascular syphilis (MVS or meningovascular neurosyphilis) is a rare clinical presentation of secondary or tertiary syphilis characterized by mild, nonsuppurative inflammation of the leptomeninges (the arachnoid mater and pia mater) and primary angiitis of the central nervous system (an intracranial or spinal angiitis). MVS usually occurs 4-12 years after primary infection.

Meningovascular neurosyphilis is a form of neurosyphilis in which the leptomeninges and vascular structures of the brain and spine are involved.

Neurosyphilis is an infection of the brain or spine caused by the spirochete treponema pallidum. Late neurosyphilis occurs 10–20 years after the initial infection and develops in about 25% of untreated patients.

Syphilitic meningitis (meningeal neurosyphilis, or syphilitic aseptic meningitis) is a rare manifestation of syphilis that affects the CNS.

Gummata are soft non-cancerous growths (granulomatous lesions) that contain the bacteria Treponema pallidum, gummas form inside the body or on the skin and may appear as destructive skin and bone lesions or become tumorlike masses. Gummatous tertiary syphilis is a form of granuloma that develops 3–10 years after initial infection. Manifestations of Gummatous tertiary syphilis may include the following:

1. Syphilitic bone lesions, periostitis, gummatous osteitis (syphilitic osteitis), sclerosing osteitis, and osteomyelitis of the skull, femur, scapulae and ribs, etc.
2. Cutaneous gummas are often single granulomas on the arms, back, and face that appear as cutaneous plaques of irregular shape

Syphilitic myelopathy is a form of neurosyphilis characterized by degenerative demyelination of the corticospinal tracts and dorsal columns. Syphilitic myelopathy involves myasthenia (muscle weakness) and paresthesia (abnormal sensations).

Cardiovascular syphilis is an infection caused by the spirochete affecting the heart and blood vessels, it may lead to cardiovascular complications such as syphilitic aortitis, coronary stenosis, aortic aneurism, aortic insufficiency and, to a lesser extent, it may lead to myocarditis. Cardiovascular syphilis occurs 10-30 years after initial infection.

Syphilitic hepatitis is an unusual manifestation of syphilis that is often accompanied by hepatic jaundice.

Complications of tertiary (late) syphilis

What are the complications of syphilis?

During the third stage of syphilis, you may experience meningitis, disorientation to time and place, strokes, numbness, loss of coordination, changes in mood or behavior, cardiovascular issues, memory loss, dementia-like symptoms, and impaired vision or blindness.

How do you know if you have syphilis?

If left untreated, the person may develop painless, rough, red or reddish brown, non itchy rash on the palms and soles. However, rashes can appear on other parts of the body. Other symptoms include fever, lymphadenopathy, or alopecia.

How long does it take for a syphilis rash to go away?

Chancres usually form 10-90 days (average 21 days) after infection. Within 3 to 6 weeks, Chancres heal with or without treatment. If left untreated, the rash of secondary syphilis appears 6-13 weeks after the chancre has healed, and usually heals without treatment within 2 to 6 weeks.

How long do symptoms last for syphilis?

In most cases, ulcers last from 3 to 6 weeks and then will heal with or without treatment; however, without treatment, the infection will persist and progress to advanced stages.

What can happen if syphilis is not treated?

If left untreated, syphilis can lead to severe consequences, it will eventually cause damage to the brain, eyes, nerves, heart, blood vessels, bones, liver and joints. As time passes, the condition worsens and patients may experience difficulty coordinating muscle movements, numbness, paralysis, dementia like symptoms, gradual blindness and even death.

What is the cause of Syphilis?

The disease is very common among people ages 20-24, especially among gay and bisexual men. Gay men accounted for about 75% of the new cases reported in 2012 and the number of reported cases is rising fastest in gay men.

Syphilis infection affects people of all backgrounds, regardless of gender, ethnicity or race, although Latinos and African Americans report the condition more often than Caucasians. The socioeconomic status (SES), illiteracy and lack of access to healthcare facilities are associated with higher infection rates.

Syphilis is a sexually transmitted bacterial disease caused by infection with Treponema pallidum. Syphilis is usually transmitted by direct contact with a sore, when spirochetes get into broken skin or mucus membranes, usually of the genitals, through unprotected vaginal, oral or anal sex with an infected partner, although it also can spread by vertical transmission of Treponema pallidum from an infected mother to her child.

Syphilis occurs worldwide; however, it is more common in urban areas

The late stages of syphilis (secondary syphilis, tertiary syphilis, and congenital syphilis) are not seen as often in the USA as they were in the past because of the availability of:

1. Free, STI clinics that are funded by the government
2. Prenatal screening
3. Screening tests for syphilis
4. Public education about STIs

How to diagnose Syphilis?

How do you test for syphilis?

You can get tested for syphilis whether you get any of the first signs of syphilis or none of them at all. Usually, your physician will take a blood sample to test you for syphilis. Alternatively, if you have an open sore, your doctor may take a fluid sample from the sore with a swab to test it.

What is a serologic test for syphilis?

These tests are designed to detect antibody to T pallidum proteins and anticardiolipin antibodies (ACA) that are produced in most patients with syphilis. The nontreponemal tests are used to detect nonspecific antibodies that react to cardiolipin, whereas treponemal tests are used to confirm a diagnosis of syphilis after a positive nontreponemal test.

Examples of nontreponemal tests include:

1. The rapid plasma reagin (RPR) assay
2. The venereal disease research laboratory (VDRL) assay

Examples of treponemal tests include:

1. FTA-ABS (fluorescent treponemal antibody test)
2. Treponema pallidum hemagglutination assay or TPHA
3. The syphilis IgG test
4. The Bio-Rad BioPlex Syphilis IgG assay, Multiplex flow immunoassay (BioPlex 2200 Syphilis; Bio-Rad Laboratories, Hercules, CA) for the detection of antitreponemal IgG- and IgM-class antibodies.

Exams and Tests

Physical Examination

Tests that may be done include:

1. Echocardiogram, aortic angiogram, and cardiac catheterization to look at the heart and some of the major vessels
2. Examination of chancre fluid
3. Nontreponemal and treponemal blood tests

What is the diagnosis of syphilis?

Syphilis can be diagnosed by testing samples of blood, body fluid, or tissue. Blood tests can confirm the presence of treponemal (antibody to T pallidum proteins) or nontreponemal antibodies (anticardiolipin antibodies) that are produced in most patients with syphilis. The antibodies to treponema pallidum remain in your body for years, so treponemal or nontreponemal tests can be used to diagnose syphilis or to monitor the response to the treatment and to determine a past or current infection.

What is the name of the confirmatory test for syphilis?

In the absence of clinical or historical evidence of treponemal infection, blood tests are carried out to screen for Treponema pallidum (RPR or VDRL), a screening test with a reactive minimal result of 1+ is considered inconclusive. However, if the screening test is positive or reactive (positive RPR or positive VDRL), other, more specific tests must be used to confirm the diagnosis, a reactive screening test must be followed up with specific treponemal tests to confirm a diagnosis of syphilis. FTA-ABS (fluorescent treponemal antibody test) is the best confirmatory test for a serum reactive screening test, as it is the most sensitive test in all stages of syphilis. Alternatively, MHA-TP Spinal tap, and examination of spinal fluid, can be used to confirm a syphilis infection after a reactive screening test.

What does a reactive syphilis test mean?

A reactive or positive test is a test in which antibodies to treponema pallidum are present. An unclear test result is called inconclusive or equivocal. Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) tests are used to used to screen for syphilis. However, other, more specific tests are used to confirm a diagnosis of syphilis such as FTA-ABS, and the Treponema pallidum hemagglutination assay or TPHA (a specific treponemal test for syphilis).

What does a positive RPR blood test mean?

A positive test result means that you may be infected with syphilis infection. If the screening test is positive such as a positive RPR, the next step is to confirm the diagnosis with a treponemal test, such as FTA-ABS. The FTA-ABS test is the most sensitive test in all stages of syphilis, it will help distinguish between syphilis and other conditions or infections.

How long does it take for syphilis to be detected?

Syphilis tests usually turn positive 4-6 weeks after exposure. Symptoms usually show up anywhere from 2-11 weeks after infection.

What is the meaning of Vdrl?

The Venereal Disease Research Laboratory test (VDRL) is a blood test used to screen for syphilis (it has high sensitivity), whereas other, more specific treponemal tests are used to diagnose the disease. VDRL is a nontreponemal test developed by the eponymous lab.

How to treat Syphilis?

Etiotropic treatment

Syphilis can be treated with antibiotics, such as penicillin G benzathine, or doxycycline. Patients who are allergic to penicillin can be treated with tetracycline.

Is syphilis curable or not?

Syphilis is a curable infectious disease with accurate diagnosis and prompt treatment. However, if left untreated for long periods, there may be permanent damage to the brain and heart even after the infection is eliminated.

Can syphilis be cured completely?

Yes, syphilis can be cured with the prompt institution of broad-spectrum antibacterial therapy. However, treatment might not reverse any damage that the infection has already done.

Can secondary syphilis be cured?

Secondary syphilis can be completely cured with early and accurate diagnosis and prompt administration of effective antibacterial agents. a complete cure can be achieved within a few weeks of starting treatment. However, in some cases, it may last up to 1 year. If left untreated, up to one third of individuals with syphilis will develop late complications of syphilis.

Can you treat late stage syphilis?

Yes, all stages of syphilis can be cured with accurate diagnosis and prompt treatment. However, in most cases, organ damages caused by late tertiary syphilis (neurosyphilis) cannot be reversed.

What type of penicillin is used to treat syphilis?

Intravenous Penicillin is drug of choice used to treat syphilis. Alternatively, doxycycline, ceftriaxone, tetracycline, or azithromycin, etc. are commonly used to treat patients who are allergic to penicillin.

If you are allergic to penicillin, your doctor may prescribe an alternative antibiotic for treating early and late latent syphilis, such as doxycycline, tetracycline, ceftriaxone, or azithromycin.

The intensity and duration of therapy depends on the severity of the infection, and factors such as the patient’s overall health status. penicillin is the drug of choice for treating syphilis during pregnancy.

Tetracycline is contraindicated in pregnancy because it is dangerous to the embryo. The use of Erythromycin during pregnancy is not recommended, because it may not prevent congenital syphilis.

Penicillin allergic individuals should be desensitized and treated with a penicillin.

Patients allergic to penicillin should only receive a penicillin via rapid desensitization, and only in cases when an alternative agent cannot be substituted.

Several hours (ten hours) after initiation of antibacterial treatment for the early stages of syphilis, people may experience Jarisch-Herxheimer reaction. This is caused by an immune reaction to endotoxins released by the death of spirochetes within the body. Symptoms and signs of this reaction include: Fever, Chills, Malaise, Headache, Nausea, Rash, Joint and Muscle aches. These symptoms usually disappear within 18-24 hours. Periodic and routine blood tests must be done at 3, 6, 12, and 24 months to make sure that the infection is cleared.

What drug is used to treat syphilis?

Individuals with syphilis are treated with Penicillin; however, penicillin allergic patients will likely be treated with a different antibiotic. Syphilis can be treated with the following antibiotics:

1. Penicillin G benzathine (Bicillin L-A, Benzathine benzylpenicillin) is an antibiotic used to treat bacterial infections, such as syphilis, strep throat, diphtheria, etc.
2. Penicillin G procaine (Procaine benzylpenicillin) is an antibiotic used to treat syphilis.
3. Doxycycline (Doryx, Vibramycin)
4. Erythromycin (E-Mycin, E.E.S.)
5. Tetracycline (Sumycin)
6. Ceftriaxone (Rocephin)
7. Azithromycin (Zithromax)

Can azithromycin be used to treat syphilis?

Adults with syphilis can be effectively treated with a single 1-g dose of azithromycin (Zithromax, Zmax) orally, However, azithromycin must be used with caution due to T. pallidum chromosomal mutations associated with azithromycin, which confer absolute and relative resistance to azithromycin.

How long does it take doxycycline to cure syphilis?

Adults with early syphilis (primary or secondary syphilis) can be effectively treated with Doxycycline (Monodox, Vibramycin, others) at a dosage of 100 mg orally twice per day for 14 days. Alternatively, patients with syphilis can be treated with 2.4 million units IM BPG (Benzathine penicillin G) as a single dose.

Prognosis

Prompt and accurate diagnosis and treatment of syphilis are essential for a good outcome.

Syphilis can be cured with accurate diagnosis and prompt treatment.

If you have syphilis, your sexual partner(s) should be tested and treated even if she or he are asymptomatic. Both you and your partner(s) should receive prompt and effective antibacterial treatment at the same time to prevent reinfection and further spread of the disease. With treatment, syphilis infection should clear up within weeks. However, in some cases it may last for up to 1 year. Abstain from sex when a chancre is present because the disease is highly contagious in the primary and secondary stages. Use condoms until two follow-up tests have indicated that the infection has been cured.

It left untreated, up to 30% of patients will have late complications of syphilis. Tertiary (late) syphilis may cause life-threatening complications and can lead to death if untreated.

How to Prevent Syphilis?

How can you avoid getting syphilis?

1. If you are sexually active, use a new condom every time you have sex. Safe sex can reduce your risk of getting syphilis.
2. All pregnant women should be screened for syphilis as a precaution to prevent congenital syphilis.
3. Avoid having a lot of sexual partners
4. Avoid polyamory and casual sex
5. If you’ve got an STD, inform your partner(s) and abstain from sex until two follow-up tests have indicated that the infection has been cured.
6. Get tested for STDs regularly
7. Avoid recreational drugs
8. Get tested for syphilis before marriage, premarital blood tests are used to check people getting married for syphilis and other STD’s.

Condoms can reduce your risk of getting syphilis only if the condom covers the chancre(s). However, syphilis can be extremely contagious even when there are no visible signs or symptoms of syphilis, especially in the primary and secondary stages.

 

 

 

 

References

 

 

Verified by: Dr.Diab (December 19, 2023)

Citation: Dr.Diab. (December 19, 2023). What is Syphilis? Symptoms Causes and Treatment. Medcoi Journal of Medicine, 44(2). urn:medcoi:article19282.