Syphilis Disease Treatment

Syphilis is a bacterial sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Unlike some other STIs, syphilis progresses through distinct stages, each with potentially different symptoms. If left untreated, it can cause serious health problems, but the good news is that it's highly curable with antibiotics in its early stages.

Treponema pallidum is a spiral-shaped bacterium that spreads through direct contact with a syphilis sore on the skin or mucous membranes of an infected person. This can happen during vaginal, anal, or oral sex.

In some cases, mothers with syphilis can also pass the infection to their unborn babies, leading to congenital syphilis. This is why prenatal testing for syphilis is crucial to protect the health of both mother and child.

Syphilis progresses through several stages, each characterised by distinct symptoms and clinical manifestations. These stages are as follows:

Primary Syphilis

The primary stage of syphilis begins with the emergence of a small, painless sore known as a chancre. Typically, chancres develop at the site of infection, which is commonly the genitals, anus, mouth, or rectum. However, they can also appear on other parts of the body. These chancres are highly contagious, yet their painless nature often leads individuals to overlook them. Without treatment, chancres will spontaneously heal within a few weeks. Even though the sore disappears, the infection remains in the body and progresses to the next stage if left untreated.

Secondary Syphilis

Secondary syphilis occurs as the infection spreads throughout the body after the primary stage. It manifests with a range of symptoms, including a distinctive skin rash. This rash often appears as reddish-brown sores on the palms of the hands and soles of the feet. Alongside the rash, individuals may experience fever, swollen lymph nodes, sore throat, headaches, fatigue, and muscle aches. These symptoms can come and go over time, and their varied nature can make diagnosis challenging, sometimes leading to misinterpretation as other illnesses.

Latent Syphilis

Latent syphilis is characterised by a dormant period during which no symptoms are present. There are two categories of latent syphilis: early latent (less than one year since primary infection) and late latent (more than one year since primary infection). Despite the absence of symptoms, the infection remains in the body during this stage. If left untreated, latent syphilis can persist for years, increasing the risk of progression to tertiary syphilis and the associated severe complications.

Tertiary Syphilis

Tertiary syphilis represents the most severe stage of the disease, occurring years after the initial infection. During this stage, the infection can lead to profound and potentially life-threatening complications affecting various organs. These complications include cardiovascular problems such as aneurysms, neurological disorders such as dementia and paralysis, blindness, and organ damage. Tertiary syphilis underscores the importance of early detection and treatment to prevent the progression of the disease and mitigate its devastating consequences on health.

Individuals infected with syphilis will progress through all stages, and the timeline of progression can vary from person to person. Early detection and treatment of syphilis are crucial to prevent complications and reduce transmission of the infection.

Syphilis is caused by the bacterium Treponema pallidum, which is primarily transmitted through sexual contact with an infected individual. This bacterium can also be transmitted from an infected mother to her baby during pregnancy or childbirth, leading to congenital syphilis. 

There are several factors that can increase the risk of contracting syphilis:

• Unprotected Sexual Activity: Engaging in unprotected vaginal, anal, or oral sex with an infected individual increases the risk of acquiring syphilis. This risk is particularly high if the sexual partner has an active syphilitic sore (chancre), even if it's not visible.
• Multiple Sexual Partners: Having multiple sexual partners or engaging in sexual activity with individuals who have multiple partners raises the risk of exposure to syphilis and other sexually transmitted infections (STIs).
• High-Risk Sexual Behaviours: Practices such as inconsistent condom use, having sex while under the influence of drugs or alcohol, and engaging in sex work can increase the likelihood of syphilis transmission.
• HIV Infection: Individuals living with HIV have an elevated risk of acquiring syphilis due to biological factors and shared risk behaviours.
• Sexual Contact with High-Prevalence Areas: Having sexual contact with individuals from regions or communities with high syphilis prevalence rates increases the risk of exposure to the infection.
• Congenital Transmission: Pregnant women with untreated syphilis can transmit the infection to their unborn babies, leading to congenital syphilis. Lack of prenatal care or inadequate screening and treatment during pregnancy contribute to this risk.

Syphilis symptoms vary depending on the stage of the infection. There are four main stages: primary, secondary, latent, and tertiary.

Primary Syphilis Symptoms

The chancre appears at the site where the bacteria entered the body, typically within 3 weeks of exposure. Here are some characteristics of a chancre:

• Usually painless, firm, round, and ulcer-like
• Appears on the genitals, rectum, or mouth
• Heals on its own within 6 weeks, even without treatment

Secondary Syphilis Symptoms

Weeks or months after the chancre heals, secondary syphilis symptoms can develop. These symptoms can come and go and may include:

• Rash on the palms of the hands and soles of the feet (often described as a copper-coloured rash)
• Fatigue
• Swollen lymph nodes
• Muscle aches
• Sore throat
• Patchy hair loss
• Headache

Latent Syphilis Symptoms

If left untreated, syphilis enters a latent stage where there are no symptoms. This stage can last for years, even decades.

Tertiary Syphilis Symptoms

In about a third of untreated cases, syphilis progresses to tertiary syphilis. This stage can cause serious damage to internal organs, including the brain, heart, nerves, eyes, and bones. Symptoms can vary depending on the affected organs.

The diagnosis of syphilis typically involves a combination of medical history, physical examination, and laboratory tests. Here's a breakdown of the diagnostic methods commonly used for syphilis:

Medical History and Physical Examination

A healthcare provider will inquire about your medical history, including any symptoms you may be experiencing, and about your sexual activity.

During a physical examination, the healthcare provider may look for signs of syphilis, such as skin rashes, chancres, or enlarged lymph nodes.

Blood Tests

Blood tests are the primary method used to diagnose syphilis. These tests detect antibodies produced by the body in response to the Treponema pallidum bacterium.

Two types of blood tests are typically used for syphilis diagnosis:

• Nontreponemal tests: These types of syphilis blood test (like Venereal Disease Research Laboratory (VDRL) or Rapid Plasma Reagin (RPR)) detect antibodies your body produces in response to an infection, not necessarily syphilis specifically. They are generally quick and inexpensive.
• Treponemal tests: These tests (like Fluorescent Treponemal Antibody Absorption (FTA-ABS) or Treponema pallidum particle agglutination (TP-PA)) directly detect the presence of Treponema pallidum bacteria, the cause of syphilis disease. They are highly specific for syphilis but might not be positive in the very early stages.

Direct Testing of Fluid from Sores

In cases where chancres are present, a healthcare provider may take a sample of fluid from the sore and examine it under a microscope to look for the presence of Treponema pallidum bacteria.

Cerebrospinal Fluid (CSF) Examination

In cases where neurological symptoms are present or there is suspicion of neurosyphilis, a lumbar puncture (spinal tap) may be performed to collect cerebrospinal fluid (CSF) for testing.

CSF examination can help diagnose neurosyphilis by detecting the presence of syphilis antibodies and assessing CSF abnormalities.

Syphilis can be transmitted from an infected pregnant person to their foetus during pregnancy or childbirth. The consequences of syphilis on pregnancy can be severe and include:

• Congenital Syphilis: If a pregnant woman is infected with syphilis, the bacteria can pass through the placenta to the foetus, leading to congenital syphilis. This can result in serious complications for the foetus, including stillbirth, premature birth, low birth weight, birth defects, and neonatal death.
• Miscarriage: Syphilis infection during pregnancy can increase the risk of miscarriage or spontaneous abortion.
• Premature Birth: Pregnant women with syphilis are at an increased risk of delivering prematurely, before the baby has reached full term.
• Neurological Complications: Congenital syphilis can cause severe neurological complications in infants, including developmental delays, seizures, intellectual disabilities, and problems with vision and hearing.
• Other Health Issues: Infants born with congenital syphilis may also experience symptoms such as rash, fever, swollen liver and spleen, jaundice, anaemia, and bone deformities.

It's crucial for pregnant women to undergo regular prenatal screenings for syphilis disease and other sexually transmitted infections to prevent transmission to the foetus.

Syphilis is typically treated with antibiotics. The choice of antibiotic and duration of treatment depend on the stage of syphilis and other factors such as allergies and individual health considerations. The primary antibiotics used for treating syphilis include:

• Penicillin: Penicillin is the preferred and most effective treatment for syphilis. The specific type of penicillin and the duration of treatment vary depending on the stage of the infection. For early-stage, a single injection of penicillin is often sufficient, while for more advanced stages, a longer course of medical treatment for syphilis may be necessary.
• Doxycycline: Doxycycline is an alternative antibiotic for individuals who are allergic to penicillin or for situations where penicillin cannot be used. It is usually taken orally for a prescribed duration.
• Ceftriaxone: Ceftriaxone is another antibiotic that may be used to treat syphilis, especially in cases where penicillin cannot be used. It is often administered via injection.

It's important for individuals diagnosed with syphilis to follow their healthcare provider's recommendations regarding treatment, including completing the full course of antibiotics prescribed, even if symptoms improve before the treatment is finished. This helps ensure that the infection is completely eradicated.

Syphilis is a curable bacterial sexually transmitted infection (STI), but neglecting it can have severe consequences. While early diagnosis and treatment usually prevent lasting damage, untreated syphilis can wreak havoc on your body over years or even decades. Here's a detailed breakdown of the potential complications:

• Organ Damage: Untreated syphilis can invade and damage various organs, including the brain, heart, nerves, eyes, and bones. This damage can be permanent and lead to serious health issues down the line.
• Neurological Complications (Neurosyphilis): In some cases, the bacteria can travel to the nervous system, causing a range of problems like meningitis (inflammation of the brain and spinal cord membranes), stroke, dementia, loss of coordination, seizures, and difficulty with speech or balance.
• Cardiovascular Complications: Syphilis can damage the heart and blood vessels, increasing your risk of developing a potentially life-threatening aortic aneurysm (a bulge in the main artery leaving the heart), heart valve problems, and angina (chest pain).
• Eye Problems: Untreated syphilis can lead to inflammation and other issues in the eye, potentially causing blindness or painful eye conditions.
• Bone and Joint Issues: Syphilis can also affect bones and joints, resulting in persistent bone pain and joint damage.
• Pregnancy Complications (Congenital Syphilis): If a pregnant woman has untreated syphilis STD, it can be passed to the developing baby. This can lead to devastating consequences, like miscarriage, stillbirth, premature birth, low birth weight, and serious health problems for the baby, including blindness, deafness, and intellectual disabilities.

At Max Hospital, our team of specialists can not only diagnose and treat syphilis effectively, but also help manage potential complications arising from delayed diagnosis. We offer comprehensive care, including consultations with specialists like neurologists, cardiologists, and ophthalmologists, if needed, to address any organ damage caused by syphilis.

Preventing syphilis involves a combination of strategies aimed at reducing the risk of acquiring or transmitting the infection. Here are some key preventive measures:

• Safe Sexual Practices: Practising safe sex is one of the most effective ways to prevent syphilis transmission. This includes using condoms correctly and consistently during sexual activity, including vaginal, anal, and oral sex. Condoms can help reduce the risk of syphilis transmission, although they may not provide complete protection if the sores are located outside the condom-protected area.
• Regular Testing and Screening: Individuals who are sexually active, especially those with multiple partners or engaging in high-risk sexual behaviours, should undergo regular testing for sexually transmitted infections, including syphilis. Early detection allows for prompt treatment, reducing the risk of complications and further transmission.
• Partner Notification and Treatment: If someone is diagnosed with syphilis, it's essential to notify their sexual partners so that they can seek testing and treatment if necessary. This helps prevent the spread of the infection within sexual networks.
• Routine Prenatal Screening: Pregnant women should receive routine screening for syphilis as part of prenatal care. Early detection and treatment of syphilis during pregnancy can prevent transmission of the infection to the foetus and reduce the risk of congenital syphilis.
• Avoidance of Risky Behaviours: Avoiding behaviours that increase the risk of syphilis transmission, such as unprotected sex with multiple partners or sharing needles for drug use, can help prevent infection.
• Pre-Exposure Prophylaxis (PrEP): For individuals at high risk of acquiring syphilis, pre-exposure prophylaxis (PrEP) may be recommended. PrEP involves taking medication (usually antibiotics) regularly to reduce the risk of infection.
• Education and Awareness: Educating individuals and communities about syphilis, its transmission routes, and preventive measures can help raise awareness and promote safer sexual practices. This includes providing information about the importance of regular testing, treatment, and partner notification.

Is syphilis an STD or STI?

Syphilis is an STI, which stands for Sexually Transmitted Infection. The older term, syphilis STD (Sexually Transmitted Disease), is still sometimes used, but syphilis STI is more accurate because syphilis doesn't always cause immediate or noticeable illness.

Can syphilis affect fertility or reproductive health?

Yes, untreated syphilis can affect fertility in both men and women. In women, it can increase the risk of miscarriage, stillbirth, and ectopic pregnancy. In men, it can lead to problems with sperm production and motility. Early diagnosis and treatment can help prevent these complications.

Is it possible to transmit syphilis through breastfeeding?

Yes, but it's uncommon. If you have syphilis and are breastfeeding, it's important to talk to your doctor about minimising the risk of transmission to your baby. This might involve avoiding breastfeeding directly from a breast with a sore or pumping and discarding milk from that breast.

Are there any specific dietary or lifestyle recommendations for individuals with syphilis during treatment?

There are no specific dietary restrictions for people with syphilis during treatment. However, maintaining a healthy lifestyle with a balanced diet and getting enough sleep can support your body's healing process.

Can syphilis affect mental health or cognitive function?

In rare cases, untreated syphilis that affects the nervous system (neurosyphilis) can lead to problems with mood, memory, and concentration. Early treatment can help prevent these complications.

Are there any alternative or complementary therapies that can help manage symptoms or support treatment for syphilis?

There are no alternative or complementary therapies that can treat syphilis STI. Antibiotics are the only effective treatment.

What should I do if I suspect I have been exposed to syphilis but do not have symptoms?

If you think you may have been exposed to syphilis, even if you don't have symptoms, it's important to get tested. Early diagnosis and treatment are crucial to prevent complications. Talk to your doctor or visit a sexual health clinic for testing.

Can syphilis be transmitted through non-sexual contact, such as sharing personal items or swimming pools?

No, syphilis is not spread through casual contact. It can only be transmitted through direct contact with a syphilis sore during vaginal, anal, or oral sex. You cannot get syphilis from sharing personal items like towels, toilets, or utensils, or by using swimming pools, hot tubs, or saunas.

Is syphilis more common in certain populations or geographic regions?

Yes, syphilis rates can vary depending on factors like access to healthcare, sexual practices, and socioeconomic status. Certain populations, such as men who have sex with men (MSM) and people with HIV, may be at higher risk.

How does syphilis impact organ transplantation or blood donation?

If you have syphilis, you may need to wait for successful treatment before undergoing organ transplantation or donating blood. Talk to your doctor for specific guidance.

Can syphilis affect the effectiveness of hormonal contraception or other birth control methods?

No, syphilis does not affect the effectiveness of hormonal contraception or other birth control methods like condoms. However, condoms are the only form of contraception that can help prevent the spread of syphilis.

Who treats syphilis?

Syphilis can be diagnosed and treated by various healthcare providers, including primary care doctors, gynaecologists, urologists, and infectious disease specialists.

Why choose Max Hospital for syphilis?

Max Hospital offers comprehensive and confidential care for syphilis. Our team of experienced specialists can diagnose and treat the infection effectively. We provide advanced testing methods and appropriate antibiotic regimens. We understand the importance of discretion and can support you throughout the treatment process.

Reviewed By Dr. Amit Varma, Senior Consultant, Dermatology on 22 May 2024.