Syphilis is one of the most commonly transmitted infections through sexual intercourse and remains to afflict millions despite it being a treatable condition.1
Read ahead to find out more about the causes of syphilis, its different stages, how syphilis can get transmitted, risk factors, symptoms of syphilis, treatment options currently available, effects of untreated syphilis, and how to effectively prevent it.
What is Syphilis?
Syphilis refers to the constellation of signs and symptoms seen in an individual infected with Treponema pallidum, a bacterial pathogen. Since treponemes spread from one individual to another through some form of sexual activity, the primary lesions are usually localized to the genitals. But, once they've successfully evaded your defense system and invaded your body, they can lay dormant in any part of your body and continue to multiply, leading to the development of characteristic symptoms of syphilis.
Most signs of syphilis in both men and women are inconspicuous, at least in the early stages, so you could potentially be spreading the infection to your sexual partners without ever being aware of it.
What are the Symptoms of Syphilis?
Before listing down the symptoms of syphilis, it's pertinent to discuss the different stages of syphilis since they largely dictate the signs and symptoms seen. There are four different distinct stages that have been described in the course of syphilis. They are:
Primary syphilis
The primary stage of syphilis is seen between 2 and 12 weeks of exposure. The classical genital lesion is termed a syphilitic chancre and is described as a single, non-tender, painless ulcer that usually does not bleed on touch. Syphilitic chancre, or a hard sore over the glans penis, is one of the most common signs of syphilis in men. Similarly, the presence of a chancre over the vulvar region is one of the classical signs of syphilis in women.
In addition to such lesions, lymph nodes near the genital region may also be enlarged and feel rubbery to touch. When treated at this stage with appropriate antibiotics, the primary stage of syphilis is said to be completely curable.
Secondary syphilis
In the secondary stage of syphilis, there are newer symmetric lesions that appear over the palms and soles. In addition to skin lesions, there may also be other constitutional symptoms of syphilis, like fever, body pain, weight loss, frequent headaches, and swelling of the lymph nodes across the body. Due to the presence of such non-specific symptoms, the secondary stage of syphilis is also termed "the great imitator" and is frequently confused with other similar dermatological conditions like lichen planus and psoriasis.
Latent syphilis
The third stage in syphilis is called latent syphilis since there are no apparent clinical symptoms seen in this stage. However, this stage should not be confused with recovery since the patient continues to harbor the disease-causing bacteria in their body, which continue to multiply indefinitely. This latent stage of syphilis with no symptoms can last for years, if not decades, before moving on to the final stage.
Tertiary syphilis
The last stage in the course of syphilis, tertiary syphilis, is the most grave of the four since it could potentially be life-threatening. The symptoms of syphilis in this stage are attributed to the spread of the bacteria into vital organs of the body, like the brain and heart, via blood. Characteristic features include:
- Aortic aneurysm - localised dilatation of the aortic wall of the heart, potentially causing death.
- General paresis of the insane - a constellation of symptoms seen in cases of advanced cases of neurosyphilis that is known to include personality changes, delusional behaviors, and permanent lapses in memory. 2
- Tabes dorsalis- a clinical condition caused by the damage of neurons in sensory regions of the neural tracts, causing difficulties in maintaining balance and abnormalities in vision. 3
What are the causes of syphilis?
What are the different ways in which syphilis can be caused, and how is syphilis transmitted? As discussed earlier, unsafe sexual practices continue to be one of the major causes of syphilis. So, the individuals who are at the most risk of developing the symptoms of syphilis are:
- Having multiple sexual partners
- Engaging in sexual intercourse (vaginal, oral, or anal) without using any form of barrier contraceptives like a condom, diaphragm, etc.
- Having already contracted other sexually transmitted infections (STIs) like AIDS, gonorrhoea, herpes, or chlamydia
It's important to remember that penetration or ejaculation is not necessarily a prerequisite for the transmission of Treponema pallidum. You could potentially end up developing the symptoms of syphilis even if your body comes in contact with the genital lesion of an infected person. It is also theoretically possible for syphilis to spread via kissing since the bacteria can spread through broken skin as well.
Yet another worrisome cause of syphilis is congenital syphilis, which occurs when a pregnant woman passes the infection to her offspring. While the incidence rates of congenital syphilis seem to have gone down with time, thanks to regular testing of antenatal women for sexually transmitted infections, it still continues to remain a troubling sign of syphilis in women.
The presentation of congenital syphilis varies greatly depending on the age of onset. Early congenital syphilis is seen when the age of onset is less than 2 years. The signature signs and symptoms of early congenital syphilis are:
- Pemphigus syphiliticus - blistering skin lesions seen over the palms and soles
- Snuffles - a runny nose that is pervasive in nature
- Bony abnormalities - bony pain, swelling of limbs, causing difficulty in movement
Late congenital syphilis, on the other hand, is seen when the age of onset is more than 2 years. The characteristic signs and symptoms of late congenital syphilis include:
- Hutchinson's teeth - notched central incisors
- Mulberry molars - irregularities in the surface of molars
- Hearing loss - due to weakening of the nerves involved in the transmission of sound
- Saber shins - characteristic bowing of the tibia bone
- Clutton's joints - swelling of both knees
- Saddle nose deformity - visible external bony deformity of the nose 4
How is Syphilis Diagnosed?
Since the causative pathogen is a bacterium, the diagnosis of syphilis is fairly straightforward. You may be asked to donate a blood sample or a cerebrospinal fluid sample in certain circumstances. The various diagnostic tests for syphilis that are being commonly used include:
- Blood Tests for Syphilis: This is the most commonly used diagnostic test for syphilis and is also the most convenient for both the patient and the diagnostician. They may use a series of antigenic tests, collectively referred to as treponemal tests. In cases of congenital syphilis, the blood tests for syphilis vary slightly, with the samples having to be obtained from both the mother and the baby.
- Dark Field Microscopy: Since Treponema pallidum, the causative bacteria of syphilis, is too small to be seen under a conventional microscope, special microscopes called dark field microscopes are used to visualize them.
- Cerebrospinal Fluid Tests: These tests are performed when a doctor suspects that a patient might be showing symptoms of neurosyphilis, a relatively advanced stage of syphilis wherein the bacteria infect nerve cells. In such cases, blood tests for syphilis will not suffice, and the bacteria will have to be demonstrated in cerebrospinal fluid present in the deeper cavities of the brain. The cerebrospinal fluid samples needed to perform these tests are typically obtained through lumbar puncture, an invasive technique where a needle is inserted into the deeper recesses of the body. Owing to the risks involved with such a procedure, this diagnostic test for syphilis is reserved for extenuating circumstances only.
What are the Treatment Options for Syphilis?
It is fairly easy to treat early cases, namely the primary and secondary stages of syphilis since treponemes respond well to penicillins, a broad category of antibiotics that function by inhibiting the synthesis of cell walls in bacteria. In cases of reported allergy to penicillin, the alternative antibiotics prescribed for the treatment of syphilis are doxycycline and third-generation cephalosporins like ceftriaxone.
While penicillins are considered to be one of the safest treatment options for syphilis, some patients with syphilis, when treated, reported the development of flu-like symptoms like fever, chills, nausea, and vomiting. This was then attributed to a non-allergic reaction called the Jarisch-Herxheimer reaction. 5
If you're facing any such symptoms while being on treatment for syphilis, it is highly recommended to contact your treating physician immediately. However, such reactions are usually self-resolving and do not last for more than a day or two.
Cases of tertiary syphilis, like that causing deterioration of brain function, do not respond to conventional antibiotics used for the treatment of syphilis. They do, however, respond well to certain intravenous formulations of penicillin. However, it is important to note that while such treatments for syphilis can allay certain symptoms of advanced syphilis, like neuropathic pain, they cannot reverse other neuropsychiatric symptoms like personality changes.
What are the Methods of Prevention of Syphilis?
While the only sure-shot way to completely avoid the risk of contracting the symptoms of syphilis is to refrain from having sex, there are various methods you can employ to reduce the risk. Some of these include:
- Use barrier contraceptives like a condom or a diaphragm while engaging in sexual intercourse to lessen your chances of coming in contact with infected lesions around the genital region or other parts of the body.
- Use a dental dam while performing oral sex to completely avoid coming in contact with syphilitic sores on a partner's genitals. These sores are pathognomonic signs of syphilis in both men and women.
- Refrain from sharing sexual toys and ensure that they're being cleaned after being used.
- Keep getting yourself regularly tested for syphilis and other sexually transmitted infections.
- Being open with your partners about your mutual sexual history.
- Abstain from sexual intercourse until you are completely cured if you're infected since there are always chances of recurrence.
- Let your sexual partners (from the past 2 years at least) know if you tested positive for syphilis or any other STI so that they can get tested and adequately treated if need be.
Syphilis in Modern Times
Syphilis is one of the oldest diseases known to mankind, and one would presume that given the improvement in treatment protocols for syphilis, it may have been eradicated by now. But, contrary to that thought, incidence rates of symptoms of syphilis seem to be on the rise, with some epidemiologists calling it a modern epidemic. The same trend is seen with congenital syphilis, too, with the incidence rates seeming to be on the rising trend. 6
While there are varying explanations for this phenomenon, health experts opine that this is a worrying indicator of the contrasting disparities in medical infrastructure in different parts of the country. The lasting devastation left behind by the COVID-19 pandemic can still be felt in such third-world countries wherein STI prevention resources like condoms still remain to be seen as a luxury.
Conclusion
Despite syphilis being a highly infectious disease with the potential to cause long-lasting damage to vital organs of the body like the heart and the brain, it is important to remember that it is treatable. It is completely curable if the right antibiotics meant for the treatment of syphilis are administered early in the course of the disease. Since the major route of transmission of syphilis is through sexual intercourse, it's advisable to keep getting yourself tested regularly. It's always prudent to err on the side of caution and use a barrier contraceptive like a condom, diaphragm, or a dental dam to protect yourself from the risk of contracting an STI. If you experience any of the warning symptoms of syphilis that were listed above in this article, make sure to contact your physician immediately.
Sources
Ref Links:
