Jyoti Kinghorn 
Syphilis is a sexually transmitted infection (STI) caused by the corkscrew-shaped bacterium Treponema pallidum. Syphilis causes a variety of symptoms ranging from sores in the early stages to blindness, deafness, heart problems, and mental disorders in later stages. Treatment with antibiotics can completely cure syphilis, but cannot undo the damage the infection has already done to the body. Early detection and treatment can protect individuals from the more serious long-term effects.
Syphilis is not very common, with estimates of 177,000 cases in the U.S. in 2021. However, the cases have been rising over the last two decades and skyrocketing over the past 3-4 years.
Syphilis transmission
Syphilis is transmitted when someone comes in contact with a syphilitic sore or skin rash. Syphilitic sores and rashes usually appear on the genitals, the anus, or in or around the mouth. Syphilis is spread by sexual contact (even if it does not involve penetration or ejaculation). Syphilis can also spread by kissing someone on the mouth who has a syphilitic sore on their lips or mouth.
Syphilis does not spread through coming in contact with shared items such as toilet seats, doorknobs, or shared clothing. You also cannot get syphilis from sharing the same swimming pool, hot tub, or bathtub with someone who has syphilis. This is because the bacterium Treponema pallidum requires a host to stay alive, and cannot stay alive on other surfaces.
While anyone can get syphilis, current data suggests that men who have sex with men (MSM), and those with HIV are more susceptible. Susceptible individuals and anyone who considers themselves to be at increased risk of syphilis can protect themselves by getting tested regularly. Condoms can prevent transmission if the syphilitic sores are on the penis
Syphilis symptoms and stages
Stage 1 (primary syphilis)
Within 3 weeks of coming in contact with someone with Syphilis, a syphilitic sore called a chancre can develop. This sore is often firm and round but can sometimes have the appearance of a wet ulcer. It is often painless because of which it may not be noticed or be mistaken for a pimple or another skin condition.
Someone may have a single or multiple sores. The sores can show up later for some people and can take up to 3 months to appear. In the primary stage, syphilis is contagious. Anyone who comes in contact with a syphilitic sore is at risk of getting infected.
The sores last for 3-6 weeks and will go away on their own even without treatment, sometimes leaving a scar. However, untreated syphilis will still be active in the body as the infection progresses to stage 2.
Stage 2 (secondary syphilis)
The symptoms of untreated syphilis move to the secondary stage about 2-12 weeks after the appearance of the syphilitic sore.
Symptoms in this stage include:
- A rash or sores that start around the vagina, anus, or the mouth. The rash can spread all over the body, including the palms of the hand and the soles of the feet. The rash can be rough to touch and look red or reddish-brown. On dark skin, it can appear as lighter-pigmented areas on the skin. The rash is usually not itchy, and sometimes can be so faint that it is not particularly noticeable.
- Swollen lymph nodes
- Headache
- Fever
- Muscle ache
- Fatigue
- Unintentional weight loss
- Loss of hair in patches
Without treatment, the symptoms eventually subside within 2 months. However, syphilis is still very much active in the body. People are still contagious in the secondary stage.
Latent stage
Untreated syphilis infection can move into a latent or hidden stage. The infection is still present in your body but there will not be any external symptoms except the possible occasional flare-up of symptoms. This stage can last years. Latent syphilis is not contagious sexually but can be vertically transmitted by a pregnant person to their fetus.
Tertiary stage
About 10-30 years after the initial infection, untreated syphilis can start doing serious damage to many organ systems. It can cause blindness, deafness, damage to the heart and brain, and can result in death.
Particular risks for pregnant people and their babies
A pregnant person with untreated syphilis can pass the infection to their fetus, resulting in premature birth, low birth weight, and increased risk of stillbirth. Congenital syphilis (syphilis contracted by the fetus in the womb) can result in death in about 40% of the affected babies usually in their first 28 days after birth. Others can suffer from severe jaundice, anemia, bone damage, cataracts, blindness, or deafness. Babies can also get infected from syphilitic sores around the vagina during birth.
If you are pregnant or planning to be pregnant and suspect you may have syphilis, contact your doctor right away. Treatment within the first 26 weeks of pregnancy has the best outcomes for the babies.
The importance of early treatment
Syphilis can be treated by a course of antibiotics prescribed by your doctor. Based on the intensity of your symptoms, test results, and medical history, the physician will prescribe the right dose to remove the infection from your body. Follow-up tests may be conducted to ensure that you are syphilis-free.
Early testing and treatment of syphilis can help reduce the spread of the infection through the body.
Testing locations
The CDC links locations on its website that may provide confidential testing and treatment for syphilis and other STIs, sometimes at reduced prices or free of charge.
To find a testing location near you, visit https://gettested.cdc.gov/.
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.
