Jyoti Kinghorn 
In syphilitic lymphadenitis, patients experience swollen lymph nodes and fatigue.
Lymphadenitis is a medical condition in which one or more lymph nodes are enlarged. This is usually due to an infection from a pathogen such as a virus or bacteria. In the case of syphilitic lymphadenitis, lymph nodes get swollen because of infection with Treponema pallidum, the bacterium that causes syphilis.
The syphilis infection can start at another site, usually the genital, anal, or oral area, and spread to the lymph nodes present in the groin or neck.
Transmission and prevalence of syphilis
Syphilis is a sexually transmitted infection (STI) contracted by having unprotected anal, vaginal, or oral sex with someone who has syphilis.
Syphilis can be passed by a pregnant woman to her fetus. Babies can also get syphilis from coming in contact with syphilitic sores on the mother’s vagina during vaginal birth. This kind of syphilis is called congenital syphilis.
Syphilis is readily cured by antibiotics, usually penicillin. With the increasingly common use of penicillin after the Second World War, syphilis had been almost eradicated from the U.S. However, cases of syphilis started reappearing in the 90s and are currently as high as they were in the 1950s. In 2022, as many as 203,500 cases of syphilis and 3,755 cases of congenital syphilis were reported to the CDC.
Among all STIs including chlamydia and gonorrhea, the CDC is most concerned about the syphilis numbers skyrocketing. They say on their website that “The most alarming concerns center around the syphilis and congenital syphilis epidemics, signaling an urgent need for swift innovation and collaboration from all STI prevention partners”.
There are several reasons for this heightened concern even though the number of syphilis cases is a fraction of the number of cases of other STIs, particularly chlamydia. Firstly, syphilis is treatable in most of its stages by a single antibiotic injection so there should be no reason for it to be so widespread. Secondly, the disease in advanced stages can cause irreparable damage to major organ systems such as the heart. Thirdly, the disease has a horrific impact on newborns, with 40% of those with congenital syphilis dying in their first 28 days, and others suffering from a number of health and developmental problems.
Different stages have different symptoms
Syphilis infection has four stages- primary, secondary, latent, and tertiary.
Primary syphilis is characterized by a small painless ulcer called a chancre that forms at the inoculation site (where the syphilis bacteria entered the body). Chancres usually appear in genital and anal areas, though they can also appear in the mouth or throat after oral sex with someone infected. Usually, a single chancre is formed, though multiple chancres are also reported. Usually, multiple chancres are present when there is a coinfection of syphilis with another STI such as HIV or herpes. Painless, swollen, and rubbery lymph nodes are other symptoms of primary syphilis.
Secondary syphilis is characterized by a rash that spreads all over the body, including the palms of the hands and the soles of the feet, swollen lymph glands, headache, fever, muscle ache, fatigue, patchy loss of hair, and unintentional weight loss.
Latent syphilis is characterized by the lack of clinical symptoms.
Tertiary syphilis is characterized by damage to the heart and brain and tumor-like syphilis presentations. Blindness and deafness from syphilis can occur in this stage
Secondary syphilis- swollen lymph nodes, fatigue, and more
Syphilitic lymphadenitis occurs due to direct infection of the lymph nodes by Treponema pallidum and can develop at any stage of syphilis. However, it is more widespread in the body during the secondary stage when multiple lymph nodes may be affected.
The swollen lymph nodes can be tender and painful and are often accompanied by fever and fatigue. The most common location is the groin area and less frequently in the neck area. The swellings can look like inflammatory pseudotumors, which is why they can be sometimes mistaken for head cancer, neck cancer, and lymphoma.
Swollen lymph nodes are also observed in children with congenital syphilis.
Syphilis risk factors
Because syphilis can cause serious and irreversible harm, testing and treatment should not be delayed. If any symptoms of syphilis are observed, individuals should get tested immediately.
Risk factors for syphilis include engaging in unprotected oral, anal, or vaginal sex with partners of unknown STI status. Males who have sex with males are particularly vulnerable to the infection. People with HIV should get tested more often because having STIs such as HIV increases the risk of getting syphilis infection.
Pregnant individuals should get prompt prenatal care that includes testing for syphilis and other STIs.
Early testing and treatment prevent permanent harm
Many people are embarrassed or uncomfortable discussing their sex lives with their physicians. Not being honest can lead the doctors to originally form the wrong diagnosis or not order the right tests which can delay treatment and compromise health. Always be honest about any symptoms especially around the genital areas with your doctor, even if they feel unrelated to other symptoms you may be feeling such as fever or fatigue.
You can also test yourself periodically by buying at-home testing kits.
The CDC also provides links to locations that may do free STI testing or provide testing at a reduced cost. Find a location near you here: https://gettested.cdc.gov/
If you test positive, antibiotic treatment with penicillin is the standard treatment and cure.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
