Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum bacteria. It first presents with symptoms such as painless sores on the penis, anus or vulva that disappear spontaneously. These sores then return after several weeks, months or years in their secondary or tertiary forms, and are considered to be more severe.
This infection is transmitted through unprotected sex with an infected person, whether vaginal, oral or anal, but it can also be transmitted by sharing contaminated needles or transmitted from mother to baby during pregnancy or birth.
Syphilis is curable and is treated by a gynecologist, urologist, infectious disease specialist or general practitioner through penicillin injections, which are guided by a doctor and depend on the stage of the disease.
Main symptoms
The symptoms of syphilis will vary depending on the stage of the disease:
1. Primary syphilis
The main symptoms of primary syphilis are:
- Hard, smooth, painless lumps
- Single or multiple wounds that do not bleed
- Painful and swollen lymph nodes close to the site of the lesions
These primary lesions, also called hard chancre, are a sign of the initial stage of the infection. They appear about 10 to 90 days after direct contact with another person's contaminated sore, and disappear spontaneously in about 3 to 6 weeks without leaving any scars.
Syphilis sores generally appear in the genital region, and tend to grow in the labia minora and vaginal wall in women, or around the foreskin of the penis in men.
Syphilis sores can also develop in other areas that have had contact with the bacteria, such as the anus, mouth, tongue, breasts or fingers.
2. Secondary syphilis
The main symptoms of secondary syphilis are:
- Smooth, soft and flat lesions on the skin, called flat condyloma
- Red spots on the skin, mouth, nose, palms and soles of the feet
- Skin peeling or alopecia
- Spots all over the body, but mainly in the genital region
- Headache, muscle aches, joint pain or sore throat
- Low-grade fever, usually below 100.4ºF (or 38ºC)
- General malaise, lack of appetite and weight loss.
Symptoms of secondary syphilis tend to appear about 2 to 8 weeks after primary syphilis sores disappear. At this point, the bacteria have had the opportunity to multiply and spread to other parts of the body through the bloodstream, and can therefore appear on the skin and internal organs.
Secondary syphilis lesions are highly contagious and appear in outbreaks that regress spontaneously. These symptoms have periods of active sores followed by periods of regression, also referred to as latent periods, which is also seen with primary syphilis.
These latent periods can last for a year or more. However, even if symptoms are not present, it does not mean that the disease is cured.
3. Tertiary syphilis
The main symptoms of tertiary syphilis are:
- Larger sores on the skin, mouth and nose
- Intense or constant headaches
- Muscle weakness
- Changes in vision or eye pain
- Hearing loss, dizziness or vertigo
- Mental confusion or memory problems
The symptoms of tertiary syphilis can vary depending on the affected organs, which can include heart, brain, bones, muscles, liver or blood vessels. Tertiary syphilis can appear 10 to 30 years after the initial infection, especially if the disease is left untreated.
Syphilis that affects the central nervous system is also referred to as neurosyphilis, while syphilis that affects the eyes is ocular syphilis, and syphilis that affects the ears is otosyphilis.
4. Congenital syphilis
The main symptoms of congenital syphilis are:
- Round, pale red or pink spots on the skin, including the palms of the hands and soles of the feet
- Yellow skin and eyes
- Restlessness
- Loss of appetite and energy
- Problems with bone and teeth development
- Hearing loss
- Mental disability
Congenital syphilis is characterized by syphilis diagnosed in newborns or infants that is transmitted by an infected pregnant woman to the baby through the placenta during pregnancy or at the time of birth. The disease is typically transmitted by mothers who have syphilis that is left untreated or not treated correctly.
Women infected with syphilis during pregnancy may experience miscarriage, and are at a higher risk for fetal birth defects or death of the baby at birth. In living babies, symptoms can appear within the first few weeks of life and even as late as 2 years after birth.
Online symptoms test
To find out if you have syphilis, please enter your symptoms below:
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This test is only a guidance tool, and does not provide a diagnosis, nor does it replace a consultation with a urologist, gynecologist or infectious disease specialist.
Confirming a diagnosis
Syphilis is diagnosed by a gynecologist, urologist, infectious disease specialist or general practitioner through an assessment of your symptoms, health status and sexual history. The doctor will also examine any sores you may have and order testing.
Tests for syphilis
A syphilis diagnosis is confirmed through tests, such as:
- PCR syphilis test
- Non-treponemal tests, such as a VDRL, which detect antibodies that are produced in response to cell damage caused by the syphilis bacteria
- Treponemal serology, such as FTA-ABS or TPHA, which detect specific antibodies against the syphilis bacteria that the body produces when infected
Depending on the symptoms that the patient presetns with, the doctor may order further testing to assess whether the patient has had complications from this infection. For example, the doctor may order a lumbar puncture to check for the presence of bacteria in the central nervous system, or a chest X-ray or CT scan to assess whether there is an aneurysm in the heart.
The doctor may also order tests to rule out other possible STIs, like HIV.
How it spreads
Syphilis is transmitted through unprotected vaginal, anal or oral sex (without a condom,) when the uninfected person comes into contact with infected discharge from sores present in the genital and/or anal region.
Syphilis can also be transmitted by sharing needles, as the bacteria in the secondary phase of the disease is circulating in the blood and can be transmitted from one person to another through this route.
Another form of transmission is from mother to child during pregnancy or at birth. This can happen when a pregnant woman is infected by not adequately treated for this infection.
Types of syphilis
In addition to being classified according to the stage of infection, syphilis can also be classified according to the region of the body that is affected. The main types of syphilis include:
1. Genital syphilis
Genital syphilis is characterized by the appearance of syphilis sores in the genital region. It can affect the vulva, labia minora, vagina or cervix in women (which is referred to as vaginal syphilis) or the foreskin of the penis in men (which is referred to as penile sypihilis)
This type of syphilis can also affect the anal area.
2. Oral syphilis
Oral syphilis is characterized by syphilis sores that appear in the mouth, tongue or throat. These are caused by unprotected oral sex.
3. Syphilis on the skin
Syphilis on the skin is characterized by the presence of syphilis sores on the skin, which can affect the skin of the genital region or spread to other areas of the body (which is referred to as tertiary syphilis).
4. Syphilis in pregnancy
Syphilis in pregnancy occurs when a pregnant woman is infected and has the potential to spread to the fetus through the placenta. An active infection and affect fetal development and cause malformations in the nose, teeth, jaw, roof of the mouth, as well as deafness, blindness or meningitis.
Syphilis in pregnancy can also lead to other complications such as miscarriage, low birth weight or stillbirth.
This type of syphilis can be detected by the obstetrician during prenatal exams.
5. Ocular syphilis
Ocular syphilis occurs in cases of tertiary syphilis, when the bacteria reaches the eyes.
Symptoms of ocular syphilis are redness or pain in the eyes, floaters, blurred vision, increased sensitivity to light or even blindness.
6. Neurosyphilis
Neurosyphilis is a type of tertiary syphilis that occurs when the bacteria reaches the central nervous system, and affects the brain, meninges or spinal cord.
This type of syphilis can cause symptoms such as severe headache, muscle weakness, paralysis, difficulty concentrating or dementia.
7. Cardiovascular syphilis
Cardiovascular syphilis is another type of tertiary syphilis in which the bacteria has spread to the heart and/or blood vessels. It can lead to an aortic aneurysm or problems with the aortic valves.
8. Otosyphilis
Otosyphilis is a rarer type of tertiary syphilis and occurs when the bacteria affects the auditory and vestibular system. It can cause symptoms such as dizziness, vertigo, ringing in the ears, hearing loss or balance problems.
9. Gummatous syphilis
Gummatous syphilis is also a type of tertiary syphilis that appears when the bacteria infiltrates any organ, especially skin or bones, causing their destruction.
Treatment options
Treatment for syphilis should be carried out as directed by a doctor. It is important to adhere to treatment, even if you are asymptomatic, to ensure that the bacteria is totally eliminated.
Syphilis is typically treated with benzathine-penicillin G, or BPG injections. Second-line treatment, like doxycycline, ceftriaxone or azithromycin, may also be considered.
Treatment time and the number of injections needed may vary depending on the stage of the infection and the symptoms presented.
Is syphilis curable?
Syphilis is curable and can be easily treated with antibiotic injections, but treatment should be started as soon as possible to prevent serious complications in other organs such as the brain, heart and eyes.