Syphilis: Signs, Symptoms, and How to Avoid it
Updated: Nov 15
New cases of syphilis are sexually transmitted.
Syphilis is an infectious disease caused by the T. pallidum, first discovered in 1905. Worldwide in 2016, there were 19.9 million adolescents and adults aged 15 to 49 years infected with syphilis, and additional 6.3 million new cases.
How do you get infected?
Transmission of T. pallidum usually occurs via direct contact with an infectious lesion during sex. In addition, T. pallidum readily crosses the placenta, thereby resulting in fetal infection. The acquisition of syphilis through transfused blood is very rare because all donors are screened and T. pallidum cannot survive longer than 24 to 48 hours under blood bank storage conditions.
Sexual transmission requires exposure to open lesions with organisms present. These lesions are very infectious, with an efficiency of transmission estimated at approximately 30 percent.
T. pallidum can initiate infection wherever inoculation occurs. Thus, contact of infected secretions with almost any tissue can lead to a primary syphilis lesion at that site, and syphilis can be spread by kissing or touching a person who has active lesions on the lips, oral cavity,, breasts, or genitals. As an example, the transmission of syphilis has been identified in men who have sex with men (MSM) who have reported oral sex as their only risk factor for acquisition.
Syphilis is also associated with the transmission and acquisition of other sexually transmitted infections (eg, HIV).
How do you know you have syphilis?
Syphilis has many forms of presentation but these three stages, the early, secondary, and late syphilis, are of more importance.
Early syphilis: Primary syphilis is the first stage of infection. Symptoms start 2 to 3 weeks after the person becomes infected. At that time, the person usually gets a raised red bump on the spot where the infection first entered the body. This bump is usually painless. Eventually, it turns into a small sore (or ulcer) with a raised edge.
The sores caused by syphilis usually form on the penis or around the vagina or anus. But they can also form in places that are hard to see, such as the back of the throat or inside the vagina or rectum.
Sores caused by primary syphilis usually heal on their own within a few weeks. Since they usually don't hurt, many people don't get treatment for them.
Secondary syphilis: Secondary syphilis is the second stage of infection. It starts weeks or a few months after primary syphilis and happens in about 25 percent of people who don't get treatment for their primary syphilis.
People with secondary syphilis may develop symptoms including fever, headache, malaise, nausea, sore throat, muscle aches, and weight loss. Additionally, the patient develops swollen lymph nodes in the neck, armpit, and groin area; a widespread rash; hair loss (Baldness); headaches; and liver problems; to mention a few. Similar to Early syphilis, the manifestations of secondary syphilis typically resolve spontaneously, even in the absence of therapy, except in the case of severe cutaneous ulcerations, but secondary syphilis may recur after 5 years.
Late syphilis: Approximately 25 to 40 percent of patients with untreated syphilis can develop the late disease. The manifestations appear at any time from 1 to 30 years after primary infection. The manifestations of late syphilis are highly variable. The most common manifestations include:
Nodular problems in a variety of organs, usually skin and bones
Brain and spinal cord involvement lead to weakness of the legs or deformity of the back.
Some individuals are the carrier of syphilis when they are in the period when they are infected with T. pallidum but have no symptoms. That emphasizes why prevention and treatment are very crucial even in the absence of concerning symptoms.
On the BYON8 app, confidential consultation with a medical doctor is available 24/7 from the comfort of your bed/couch. Reach out for any questions.
Guidelines for the management of symptomatic sexually transmitted infections: https://www.who.int/publications/i/item/9789240024168