Definition

Syphilis, also known as the great imitator, is a bacterial infection that usually spreads through sexual contact. This disease is called the great imitator because syphilitic sores often resemble those of other diseases, making diagnosis challenging for healthcare professionals.

If untreated, syphilis can cause severe damage to body organs. There are several stages of syphilis, each with different types of sores and symptoms.

Syphilis is prevalent in many countries and continues to affect millions worldwide, especially in developing countries where access to healthcare is limited. According to the CDC, there were about 88,000 reported cases of syphilis in 2016. Men aged 20-29 are commonly found to suffer from primary and secondary-stage syphilis.

Causes

Syphilis is caused by the bacterium Treponema pallidum. It is most commonly transmitted through contact with syphilitic sores during sexual intercourse, including vaginal, oral, or anal sex. The bacteria can enter the body through cuts or abrasions in the skin and mucous membranes. It can also be transmitted from a mother to her fetus during pregnancy or childbirth.

Although rare, syphilis can also spread through:

• Skin-to-skin contact
• Blood transfusions
• Shared needles

Syphilis is not transmitted through shared use of items such as toilets, clothing, eating utensils, door handles, swimming pools, or bathtubs.

Risk factor

Engaging in unprotected sex or having multiple sexual partners plays a significant role in the transmission of syphilis. Factors that increase the risk of contracting syphilis include:

• Having unprotected sex, such as without using a condom.
• Having multiple sexual partners.
• Being a man who has sex with men.
• Having an HIV infection.

Symptoms

Syphilis progresses through several stages, each with different symptoms. It's important to note that sometimes the infection can be asymptomatic. The phases of the disease can overlap. Here are the symptoms based on the stage of the disease:

Primary Syphilis This stage is also known as a chancre or ulcer durum. During the first stage of syphilis infection, you might notice one or more sores on your body. These sores are typically round, firm, and painless, although not always. You might not even realize you have a sore because it is painless.
Since individuals with HIV often have a lower immune response, those infected with both HIV and syphilis generally have multiple sores and may experience lymph node swelling.
Sores appear about 10-90 days after exposure to the infection and occur at the site where the bacteria entered the body, such as:

• Penis
• Vagina
• Rectum
• Lips or inside the mouth

After the initial infection, the syphilis bacteria can remain dormant in the body long before becoming active again.

Secondary Syphilis A few weeks after the healing of primary syphilis sores, secondary syphilis begins to appear, typically 2-8 weeks later. Symptoms of secondary syphilis include:

• Skin rashes on the palms of the hands, soles of the feet, and body, which feel rough, are non-itchy and are red or reddish-brown.
• Hair loss and bald patches.
• Swollen lymph nodes.
• Weight loss.
• Headaches.
• Muscle aches.
• Fatigue.
• Fever.

Secondary syphilis can become latent or progress to tertiary syphilis. Skin sores in secondary syphilis are highly contagious due to the presence of numerous bacteria. Symptoms can disappear within a few weeks or recur over years.

Latent Syphilis If untreated, secondary syphilis will progress to the latent (hidden) stage. Latent syphilis can last for one year or more. Typically, there are no clear signs or symptoms in patients whose syphilis has become latent. However, the disease can still progress to the next stage.

Tertiary Syphilis Untreated syphilis can advance to tertiary syphilis. At this stage, syphilis can affect various organs, such as the heart, blood vessels, brain, and nervous system. Tertiary syphilis is severe and can occur 10-30 years after the initial untreated infection. Organ damage at this stage can be fatal.

Neurosyphilis Untreated syphilis can also spread to the brain and nervous system. Neurosyphilis can occur at various stages of syphilis. Signs and symptoms of neurosyphilis include:

• Headaches.
• Muscle weakness and/or movement disorders.
• Difficulty concentrating.
• Personality changes.
• Dementia (memory and decision-making impairments).

Congenital Syphilis Babies born to women with syphilis can become infected through the placenta or during delivery. An infected fetus may be born prematurely or stillborn. Most newborns with congenital syphilis show no symptoms, although some may have a rash on the palms and soles. Severe symptoms in infants include deafness, dental deformities, or a saddle nose.

Diagnosis

 Syphilis can be diagnosed by examining samples taken from:

• Blood: Blood tests can confirm the presence of antibodies produced by the body to fight the syphilis infection. Antibodies against the bacteria that cause syphilis can remain in the body for years, so this test can differentiate between a current or past infection.
• Cerebrospinal Fluid: If a patient is suspected of having nervous system complications due to syphilis, a doctor may recommend a cerebrospinal fluid sample taken from the spinal cord.

Management

Management of syphilis depends on the stage of the disease. However, since bacteria cause syphilis, treatment usually involves antibiotics to kill the bacteria. You should inform your doctor if you have any allergies to certain antibiotics. For pregnant women receiving treatment for syphilis, their babies will also be examined after birth to check for congenital syphilis. Babies with congenital syphilis will be treated with specific antibiotics.

Complications

Without therapy, syphilis can cause severe damage to organs such as the heart or brain. These complications can be life-threatening. For HIV-infected individuals also suffering from syphilis, the untreated condition can rapidly worsen the HIV infection. Pregnant women with syphilis may experience pregnancy complications if not treated promptly.

Prevention

There is no vaccine for syphilis. To help prevent the spread of syphilis, the following measures can be taken:

• Avoid sexual contact or have only one sexual partner: The only sure way to avoid syphilis is to abstain from sexual activity. The second best option is to have sexual contact with only one uninfected partner.
• Use latex condoms: Condoms can reduce the risk of contracting syphilis, but only if they cover the syphilis sores.
• Avoid illicit drug use: Misuse of alcohol or other drugs that impair thinking can increase the risk of engaging in unsafe sexual behavior, so it is best to avoid them.

If you have syphilis, your current and past sexual partners from the last year should be informed so they can also be tested.

Since a person can be infected with syphilis without knowing it, and syphilis can have fatal effects on the fetus, all pregnant women should be tested for syphilis.

When to see a doctor?

Contact a doctor if you or your child experiences sores or rashes. Regular check-ups are essential so appropriate treatment can be administered promptly if infected.

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