Syphilis: causes, symptoms, prevention and treatment

Syphilis

Syphilis is a sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum. It starts with the appearance of a painless ulceration in the penis, vagina or anus. If left untreated, syphilis can cause serious health problems, affecting the heart and brain.

Syphilis was a major cause of disability and death, but it is much less common since the discovery of antibiotics in 1945. The disease is uncommon in the US but the number of people infected has increased significantly since 2007, which suggests that people do not protect themselves adequately during sex. According to the CDC, this rise in the rate of reported cases of syphilis has been attributed to increased cases among men, gay men, bisexual, and other men who have sex with men (MSM).

CDC Syphilis | Treponema pallidum
Credit: CDC

Causes of Syphilis

Syphilis can be transmitted through oral, genital, or anal sex with an infected partner. More rarely, it can be spread through the exchange of needles or through a skin lesion. Finally, it can be passed from mother to child during pregnancy.

Possible complications

Untreated syphilis can be very destructive and lead to many complications such as internal or external damage, serious cardiovascular and mental health problems. It can, in some cases, lead to death.

Having syphilis also increases your chances of getting HIV.

When to consult a doctor?

If you’ve had unprotected risky sex, or if you notice ulcers, redness, or pimples on your genitals, see your doctor for the appropriate screening tests.

Symptoms of Syphilis

Syphilis has 3 stages as well as a latency period. The primary, secondary and early latent stages of syphilis are considered infectious. Each stage has different symptoms.

  • Primary stage

Symptoms first appear 3 to 90 days after infection, but usually 3 weeks.

At first, the infection takes on the appearance of a red pimple; The bacteria then multiply and eventually create a painless ulcer (s) at the site of infection, usually in the genital, anal or throat area. This ulcer is called a syphilitic chancre. It may be visible on the penis, but easily hidden in the vagina or anus, especially as it is painless. Most people who are infected develop only one chancre, but some develop more than one;

Eventually the sore heals on its own within 1 to 2 months. If it has not been treated, however, this does not mean that the infection is cured.

  • Secondary stage

When untreated, syphilis progresses. 2 to 10 weeks after the onset of ulcers, the following symptoms occur:

  • Fever, fatigue, headache and muscle pain;
  • Hair loss (alopecia);
  • Redness and rash on the mucous membranes and skin, including on the palms of the hands and soles of the feet;
  • Inflammation of the lymph nodes;
  • Inflammation of the uvea (uveitis), the blood supply to the eye, or the retina (retinitis).

These symptoms may go away on their own, but that does not mean the infection is cured. They can also appear and reappear intermittently, for months or even years.

  • Latency period

After about 2 years, the syphilis goes into a latent state, when no symptoms appear. However, the infection can still develop. This period can last from 1 year to 30 years.

  • Tertiary stage

If left untreated, 15-30% of people infected with syphilis will suffer from very serious symptoms which in some cases can even lead to death:

  • Cardiovascular syphilis (inflammation of the aorta, aneurysm or aortic stenosis, etc.);
  • Neurological syphilis (stroke, meningitis, deafness, visual disturbances, headache, dizziness, change in personality, dementia, etc.);
  • Congenital syphilis. Treponema is transmitted from the infected mother through the placenta and will lead to spontaneous abortions, neonatal death. Most affected newborns will not have any symptoms at birth, but they will appear within 3 to 4 months;
  • Gum (gingiva): destruction of tissue in any organ.

People at risk of syphilis

  • Men who have sex with other men;
  • People who have unprotected sex;
  • People who have multiple sexual partners;
  • People with HIV or other STIs;
  • People who inject drugs and their partners.

Prevention of syphilis

Prevention aims to reduce the incidence of syphilis by preventing the transmission of the bacteria.

Basic preventive measures

Using condoms correctly helps prevent the transmission of syphilis during anal or vaginal sex. Condoms or dental dams can also be used as a means of protection during oral sex.

Screening measures

  • Systematic screening for syphilis at the 1st pregnancy visit:
  • Given the resurgence of syphilis in the United States and Europe, systematic screening is essential for all pregnant women.
  • Screening after unprotected sex

Getting tested helps prevent the infection from being passed on to new partners. In the event of a positive result, tell anyone you have had sex with who may have been exposed. This person will need to be tested and treated, if necessary.

Syphilis can be detected with a blood test.

Medical treatments of syphilis

Syphilis is treated with antibiotics, usually penicillin, by intramuscular injection. If you are allergic to penicillin, other antibiotics are available.

If the infection has lasted for less than 1 year, a single dose may be sufficient. Further blood tests will be done after treatment to check if the antibiotics had worked. People who are immunosuppressed, especially those with HIV may need longer treatment.

In conclusion

The number of people infected with syphilis has been increasing for more than 10 years, which means that those at risk, especially gay males, do not protect themselves adequately when having sex. In addition, syphilitic chancre is an easy entry point for HIV, and the risk of contracting this disease (AIDS) becomes 2 to 5 times greater. We also know that people with HIV, who also have syphilis, transmit the virus more easily to another person.

If you are at risk, feel free to get tested for syphilis, especially as this disease is usually very easy to treat with just one injection.