Syphilis
Syphilis: Overview, Stages, Symptoms, Diagnosis, and Treatment
What is Syphilis?
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It is primarily spread through direct contact with syphilitic sores during vaginal, anal, or oral sex, but can also be transmitted from mother to child during pregnancy or childbirth1234. Without treatment, syphilis can progress through several stages, potentially causing severe damage to the heart, brain, and other organs, and can be life-threatening124.
Stages and Symptoms
Syphilis develops in stages, each with distinct symptoms, though stages may overlap and symptoms can go unnoticed.
Primary Syphilis
- Onset: About 3 weeks after exposure (range: 3–90 days)154.
- Symptoms: A single painless sore (chancre) at the infection site (genitals, anus, mouth, or other areas). Sometimes multiple sores appear. The sore heals on its own in 3–6 weeks, but the infection remains if untreated154.
Secondary Syphilis
- Onset: Weeks to months after the chancre heals154.
- Symptoms:
- Non-itchy skin rash, often on the trunk, palms, and soles154.
- Wart-like sores in the mouth or genital area (condylomata lata)54.
- Flu-like symptoms: fever, sore throat, muscle aches, fatigue, swollen lymph nodes, weight loss, patchy hair loss154.
- Symptoms may resolve without treatment, but infection persists.
Latent Syphilis
- Onset: Follows secondary stage if untreated.
- Symptoms: None (asymptomatic). Can last for years. The infection remains in the body and can progress to tertiary syphilis124.
Tertiary Syphilis
- Onset: Years to decades after initial infection in untreated cases.
- Symptoms: Severe complications affecting the heart, brain, nerves, blood vessels, liver, bones, and joints. Can be life-threatening124.
Congenital Syphilis
- Passed from mother to baby during pregnancy or birth.
- Can cause miscarriage, stillbirth, prematurity, or severe complications in infants (rashes, bone/joint problems, neurological issues, developmental delays, blindness, deafness, seizures)34.
Diagnosis
- Blood tests: Most common method; detects antibodies to T. pallidum (e.g., Anti-TP, RPR, TPPA, TPHA)64.
- Direct detection: Microscopic examination of fluid from sores.
- Rapid tests: Provide results in minutes for immediate treatment4.
- Pregnancy screening: Essential to prevent congenital syphilis734.
Treatment
- First-line treatment: Penicillin injection (benzathine penicillin G) is highly effective at all stages1674.
- Early syphilis: Single dose.
- Late/unknown duration: Three weekly doses.
- Alternatives: For penicillin-allergic patients, other antibiotics may be used, but penicillin is preferred, especially in pregnancy64.
- Follow-up: Regular testing to ensure cure and prevent reinfection.
Prevention
- Safe sex: Consistent and correct condom use reduces risk, but does not eliminate it, as sores may be outside condom coverage34.
- Monogamy: Having a mutually monogamous relationship with a tested, uninfected partner lowers risk3.
- Screening: Regular testing for high-risk individuals and all pregnant women734.
- Prompt treatment: Early detection and treatment prevent complications and transmission74.
Key Points
- Syphilis is a curable bacterial STI with potentially severe complications if untreated.
- Symptoms vary by stage and may be absent for long periods.
- Diagnosis relies on blood tests and clinical evaluation.
- Penicillin is the treatment of choice.
- Prevention includes safe sex practices, regular screening, and early treatment.
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References:
1 Mayo Clinic
2 MedPark Hospital
5 Yale Medicine
6 PSK Clinic BKK
7 PubMed Central
3 CDC
4 World Health Organization
