Syphilis Unveiled: CDC Comprehensive Fact Sheet

Syphilis is a sexually transmitted disease or STD which occur due to bacterium Treponema pallidum. Taking antibiotics may treat this infection but leaving it untreated may lead to serious health problems like blindness. Chances are it can permanently cause damage to your brain, bones, eyes muscles and heart. In order to lessen the risk of spreading this infection, you should always wear a condom at the time of having sexual intercourse.

How people can get syphilis

Syphilis usually spreads from one person to the other due to direct contact with a syphilitic sore, called a chancre. Now, chancres can occur in, around or on the anus, lips, mouth, penis, rectum, and vagina. Syphilis can transmit at the time of oral, vaginal oranal sex. Pregnant women who have syphilis might pass on the infection to their unborn child.

How soon symptoms can appear after the infection

The average timing between acquisition of syphilis and the start of the first symptom is 21 days. But this may range from 10 to 90 days.

Signs and symptoms in adults

Many people refer syphilis as “The Great Pretender”, as the symptoms appear like other diseases. But syphilis goes through the progression of stages that lasts for several weeks, months, or years.

Primary Stage

This is a single chancre which marks the beginning of the primary or first stage of syphilis though there are multiple sores. The chancre is usually round, firm, and painless appearing at the location where syphilis enters your body. These painless chancres happen in the locations which make them difficult to notice (e.g., the anus or vagina). The chancre usually lasts for 3 to 6 weeks and heals despite whether a person gets the treatment. But the infection will progress to the secondary stage when the person with syphilis does not obtain the treatment.

Secondary Stage

Skin rashes or mucous membrane lesions which are sores in the anus, mouth, or vagina mark the second stage of symptoms. This stage usually starts with the development of a rash on one or more body parts. Rashes which occur during the secondary stage:

• They usually does not lead to itching.
• They may appear when the primary chancre is healing or several weeks after the chancre heals completely.
• They may be so faint they are difficult to notice.
• They may appear as red, rough or reddish-brown spots on the palm of hands and bottoms of feet. But rashes with different appearance might be there on other body parts. Sometimes they look like rashes caused from other diseases.

Condylomalata are large and raised, white or graylesions. They might develop in warm, moist areas like the underarm, mouth or groin area.

Apart from rashes, signs and symptoms of secondary syphilis are the following:

• Sore throat
• Weight loss
• Fever
• Fatigue
• Muscle aches
• Swollen lymph nodes
• Headaches
• Patchy hair loss

The symptoms of secondary syphilis usually go away with or without treatment. But the infection will progress further to the latent without treatment and probably move to tertiary stage of disease.

Latent Stage

The latent or hidden stage of syphilis is the rime when there aren’t visible signs or symptoms of syphilis. Syphilis stays in your body without treatment even though there aren’t any signs or symptoms. Early latent syphilis is whenthe infection happens in the past 12 months. So, late latent syphilis is where infection occurs in more than 12 months. Latent syphilis of unknown duration is when there is not sufficient evidence to confirm initial infection was within the previous 12 months. Latent syphilis may last for many years.

Tertiary Syphilis

Tertiary syphilis develops in thesubset of untreated infections of syphilis. It can appear 10–30 years after a person gets the infection and can be deadly. Tertiary syphilis may affect different organ systems which include the following:

• Nerves
• Joints
• Brain
• Blood vessels
• Bones
• Eyes
• Liver
• Heart

Symptoms of tertiary syphilis will differ as per the organ system being affected.

Neurosyphilis, Ocular Syphilis, and Otosyphilis

During any stage of the infection, syphilis may invade the:

• Nervous system or neurosyphilis
• Visual system or ocular syphilis
• Auditory and/or vestibular system or otosyphilis.

These infections may lead to various symptoms.

Signs and symptoms of neurosyphilisare:

• Trouble with movements in the muscle
• Numbness
• Muscle weakness or paralysis
• Severe headache
• Changes in mental status and dementia such as memory loss, thinking and making decisions).

Signs and symptoms of ocular syphilis might include the following:

• Light sensitivity
• Redness or eye pain
• Changes in vision or blindness
• Floating spots in the field of vision

Signs and symptoms of otosyphilisconsist of:

• Hearing loss;
• Dizziness or vertigo
• Buzzing, roaring, ringing or hissing in the ears
• Balance difficulties

The healthcare providers need to know aboutneurosyphilis, ocular syphilis, and otosyphilis, as well as how to diagnose and manage these infections.

How to diagnose syphilis

The healthcare expert will find syphilis by testing samples of:

• Blood: These tests may confirm the presence of proteins known as antibodies. The immune system prepares them to fight against infections. The antibodies to bacteria causing syphilis remains in the body for many years. So, the blood tests can help to know about the present or past infection.
• Fluid from a sore: The laboratory studies about this fluid under a microscope to detect that syphilis has caused the sore.
• Fluid surrounding the brain and spinal cord: Another name for this is cerebrospinal fluid. If your healthcare team thinks you are having nervous system problems from syphilis, then they may suggest testing for this fluid. A needle can be used to take cerebrospinal fluid sample from between two of the bones in the back. This procedure is what you call a lumbar puncture.

How to treat syphilis

Syphilis is easy to treat when found and treated in its early stages. The preferred treatment at all stages is penicillin. This antibiotic medicine can kill bacteria causing syphilis. When you are allergic to penicillin, the healthcare provider may suggest taking another antibiotic. He may even suggest a method that safely helps your body getting used to penicillin over time.

You need to take a single shot of penicillin for treating primary, secondary or early-stage latent syphilis. If you have had syphilis for more than one year, then you may need to take additional doses.

Penicillin is the only suggested treatment for pregnant women having syphilis. Those who are allergic to penicillin can follow a process that allows them to take this medicine. The procedure is what you call penicillin desensitization. It is done by an allergist or an immunologist and involves taking smaller amounts of penicillin in every 15 to 20 minutes to over 4 hours.

Even when you are tested and treated for syphilis at the time of pregnancy, your newborn need to be tested for congenital syphilis. An infected baby with the syphilis bacterium obtains antibiotic treatment. The first day you obtain the treatment, you may get a Jarisch-Herxheimer reaction. Symptoms include nausea, chills, fever headache and achy pain. Most often, this reaction will not last for more than one day.

Treatment follow-up

After you get treated for syphilis, the healthcare provider will ask you to:

• Getting tested for HIV.
• Conduct routine blood tests and examinations to ensure the penicillin treatment is working. These follow-up tests you need will depend on the stage of syphilis you have.
• Tell your sex partners so they can get tested and treated if needed.
• Do not enjoy sexual contact with new partners till the treatment is over. Blood tests will denote that the infection has cured and any sores have gone completely.

Who need to conduct syphilis testing?

Individuals who have signs or symptoms of syphilis should conduct syphilis testing. Anyone who has anal, oral or vaginal sex with their partner and receives a syphilis diagnosis should undergo this testing.

Some people should get the testing for syphilis even when they do not have any symptoms or know of a sex partner who already has syphilis. Anyone who remains sexually active need to discuss about their risk factors with a healthcare provider. They should ask their healthcare provider about testing for syphilis or other STDs.

Besides, the healthcare providers need to routinely perform syphilis testing in women who

• Are pregnant
• Are staying with HIV
• Remain sexually active
• Are taking PrEP for HIV prevention.

Can syphilis recur?

After getting the most appropriate treatment, it is important to assess clinical and serologic response to the treatment. Even following successful treatment, reinfection can be possible. People who suffer from reinfection or treatment failure will possibly:

• have signs or symptoms that may persist or recur
• have a constant fourfold increase in nontreponemal test titer.

Asymptomatic chancres may be there in the mouth, rectum or vagina. So, it may not be obvious that a sex partner suffers from syphilis.

How syphilis affects a pregnant woman and her baby

When a pregnant woman suffers from syphilis, the infection might pass on to their unborn baby. All pregnant people need to obtain testing for syphilis during their first prenatal visit. Some people will have to test again in the third trimester and at the time of delivery. This includes people who stay in areas having higher rates of syphilis or are at greater risk for getting syphilis at the time of pregnancy.

Risk factors for syphilis at the time of pregnancy:

• having sex with more than one partner
• late entry to prenatal care or no prenatal care
• sex together with transactional sex or drug use
• imprisonment of pregnant person or their partner
• use of heroin or methamphetamine
• unstable housing

You need to evaluate the risk for reinfection by discussing about ongoing risk behavior and treatment of sex partners. Any woman who delivers a stillborn infant after 20 weeks’ gestation should undergo testing for syphilis. Based on how long a pregnant woman has had syphilis, they may be at high risk of having a stillbirth. The baby could even die shortly after birth. When pregnant women do not treat syphilis, this leads to infant death in nearly 40 percent of cases.

A baby born and alive with syphilis might not get any signs or symptoms of the disease. But when the treatment is not immediate, the baby develop serious problems within a few weeks. Babies who don’t obtain the treatment might get developmental delays, seizures, or die. Babies who are born with it and test positive at the time of pregnancy should go for congenital syphilis screening and a thorough examination.

The healthcare providers should use penicillin therapy only for treating syphilis and preventing the spread of it to the baby. The treatment with penicillin is extremely effective in preventing the transmission of this disease to the baby. Pregnant women who are allergic to penicillin should consult with a specialist for desensitization to penicillin.

How someone may prevent syphilis transmission

Condoms, when used in the right way every time someone enjoys sex can lessen the risk of giving or getting syphilis infection. Condoms provide protection when the condom covers infected area or site of possible exposure. But the spread of syphilis may occur with lesions which are not covered by a condom.

The only way you can completely prevent the spread of syphilis is by not having anal, oral orvaginal sex. Another option is to remain in a mutually monogamous relationship with a partner for a long-term who does not have syphilis.

When to consult with a doctor

If you have been in contact with syphilis, then it is necessary to visit a doctor. The signs and symptoms of syphilis may be difficult or almost impossible to detect without conducting a blood test.

Talk to a doctor if you:

• notice it can be syphilis sores
• are told by a sexual partner they have syphilis
• are sexually active but never have had an STI test

You need to know that pregnant women should receive a syphilis test in their prenatal appointments, as part of standard care.

If you have skin rashes or ulcers on your genitals or mouth, then make sure you get in touch with a healthcare provider. They can test you for syphilis and begin the treatment when you have this infection. Thus, the sooner you get treatment, the less likely you will have long-term complications.