Syphilis

What is syphilis?

Syphilis is a sexually transmitted infection caused by a type of bacteria called Treponema pallidum. In its earliest stage, syphilis produces an open sore (ulcer) that leaks fluid filled with syphilis bacteria. Syphilis can be transmitted by contact with this ulcer or other infectious sores that form later in the disease, usually during vaginal, oral, or anal sex. If untreated, syphilis moves through a series of stages that affect different parts of the body, although the stages can overlap:

Primary syphilis — In this first stage, syphilis causes a painless ulcer called a chancre, usually in the genital area where syphilis bacteria enter the body. This stage begins 10 to 90 days (average three weeks) after a person has been exposed to someone with syphilis. The sore goes away without treatment in about four to eight weeks.
Secondary syphilis — In this stage, syphilis bacteria spread throughout the body. This usually causes a rash over most of the body along with fever, aches and pains, and other symptoms. This stage begins six to eight weeks after a person is exposed to syphilis, and it lasts up to one year.
Latent syphilis — This stage begins when the secondary stage ends. Although there are no symptoms, the person remains infected. This stage can last for many years, even for the rest of a person's life. About one-third of cases of latent syphilis progress to tertiary syphilis.
Tertiary syphilis — In this stage, syphilis bacteria can cause severe damage to many different internal organs, including the brain and spinal cord. It usually begins within 10 years of infection and can end in death.

Pregnant women with syphilis can pass the bacteria to their babies, causing a condition known as congenital syphilis. Congenital syphilis causes a variety of skin and organ problems in infants, and it can be deadly. Pregnant women with syphilis also have about a 40% chance of having a baby that is stillborn.

If you are infected with syphilis, it may be easier for you to become infected with HIV. If you already have HIV, a syphilis infection may make you more likely to spread HIV to others.

Symptoms of syphilis

The symptoms of syphilis vary depending on the stage of the illness:

Primary syphilis

Usually, a single ulcer (chancre) appears at the site where the bacteria entered the body. The genitals are the most common location for chancres to develop, but these ulcers also can form around the mouth or anus. The chancre is firm and painless, and it oozes fluid that contains syphilis bacteria. Sometimes, lymph nodes near the ulcer become enlarged, but remain painless. The chancre of primary syphilis usually heals after one to five weeks, although the person remains infected.

Secondary syphilis

Typical symptoms of secondary syphilis are:

a rash, which may look like rough "copper penny" spots or fine red dots on the palms of the hands and soles of the feet
a skin rash on the arms, legs, and trunk — The rash can take a variety of forms, such as small blotches or indented circles; small blisters filled with pus; thick gray or pink patches
white patches inside the mouth and other mucous membranes.

Without treatment, rash symptoms usually go away after two to six weeks.

Other symptoms can include:

enlarged lymph nodes (swollen glands)
fever
headaches
muscle aches
sore throat
poor appetite
weight loss
feeling extremely tired.

Without treatment, these other symptoms generally last about one year.

Latent stage

This stage does not cause any symptoms.

Tertiary syphilis

In this stage, syphilis causes symptoms related to severe organ damage. These symptoms can include:

destructive tumors, called gummas, in the mouth, nose, tongue, bones, skin, liver, or other organs
chest pain or breathing difficulties related to heart valve damage or damage to the wall of the aorta (the major blood vessel bringing blood from the heart to the rest of the body)
joint pain
paralysis, coordination problems, loss of sensation, blindness, deterioration of intellectual function, personality changes, and impotence due to nerve or brain damage.

Diagnosing syphilis

If your doctor suspects that you have syphilis, he or she will look for any of the typical symptoms of the infection, especially for a chancre in the genital area. Your doctor can diagnose syphilis by taking a sample of fluid from a suspicious ulcer and having that fluid examined under a microscope for the presence of syphilis bacteria.

Your doctor also may order blood tests to check for certain antibodies that are present in people with syphilis. However, in some cases, people without syphilis test positive for these antibodies. A positive test may have to be confirmed with a second blood test.

Because of the high risk of HIV infection in people with syphilis, public-health officials recommend that all people infected with syphilis should be tested for HIV infection.

Expected duration of syphilis

Unless treated, syphilis is a lifelong illness.

Preventing syphilis

A person who has symptoms of primary or secondary syphilis can pass a syphilis infection to his or her sex partner. During sexual intercourse, the bacteria can pass from sores to the uninfected sexual partner through tiny breaks in the skin. To prevent this from happening, a person infected with syphilis (and his or her sexual partners) should abstain from sexual activity until after the completion of treatment for the infection. Every pregnant woman should have a blood test for syphilis to prevent passing the infection to her baby.

Treating syphilis

People with primary syphilis can usually be cured with a single injection of a long-acting penicillin. People in later stages require longer treatment with penicillin. Other antibiotics, including doxycycline, azithromycin or ceftriaxone may be effective for people who are allergic to penicillin. All sex partners of people with syphilis should be treated as well. Babies born with congenital syphilis should be treated with a course of penicillin.

When to call a professional

Contact your doctor if you develop any of the symptoms of syphilis, especially if you are pregnant. If you have a sex partner who is diagnosed with syphilis, contact your doctor immediately so that you can be treated for syphilis.

Prognosis

With proper antibiotic treatment, early syphilis infection can be cured without causing permanent damage. Although later stages of syphilis also respond to antibiotics, treatment will not repair any organ damage caused by the disease. Without treatment, about one-third of patients with latent syphilis develop tertiary syphilis, and these patients risk severe organ damage and death.