Alarming Syphilis Symptoms To Watch Out For

Syphilis symptoms appear in Syphilis which is a sexually transmitted disease1 caused byTreponema Pallidum.’ Syphilis spreads by close and direct contact with the infected person and, if not treated, may cause serious health problems.

Transmission of syphilis symptoms2, as the world knows it, does not necessarily require sexual intercourse between two people. But till today, the most common route of transfer of syphilis is having unprotected Vaginal, Anal, or oral sex. The spread of syphilis symptoms also has other factors like:

  • Syphilis can be passed on from mother to unborn child during pregnancy, causing congenital syphilis3.
  • Endemic syphilis symptoms are spread through poor hygiene conditions.
  • Rarely can syphilis be spread through organ donation.
  • Practicing Polygamy, mainly men who have sex with men.
  • Shared injections for transfusion4, snorting, or smoking drugs.
  • HIV-positive5 people (Human immunodeficiency virus) are more susceptible to acquiring syphilis.
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The first sign of syphilis symptoms is a painless sore often called Chancre. These syphilis sores called Chancres initially show their presence on the genitals, rectum, vagina, anus, or mouth. It appears like any other sore on the body. Thus people fail to notice it or do not pay earnest heed to the multiple sores.

1. Syphilis Statistics

According to the syphilis CDC fact sheet(Centers for Disease Control and Prevention), in 2019 total of 129,813 cases of syphilis were reported. These included 38,992 cases of primary syphilis, and secondary syphilis was reported. The cases of syphilis were the lowest in 2000 and 2001 and have been increasing since then, reaching 11.2% in 2018-19, and these are the numbers according to the syphilis CDC fact sheet.

The syphilis CDC fact sheet (Centers for Disease Control) has also reported that primary and secondary syphilis rates have increased in the male population, probably due to MSM.

Syphilis among the male population accounted for 56.7% of all cases in 2019. Cases of syphilis among females are lower than in males but have been increasing in recent years. They reached the highest of 178.6% during 2015-19.

The rate of congenital syphilis has been increasing every year since 2013. In the same year, the reported cases of congenital syphilis marked the first increase in its cases since 2008.

2. Treponema Pallidum

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An agent responsible for the world to go mad over a life-threatening disease is Treponema Pallidum6. Bacterium treponema pallidum is a spirochaete bacterium that does not have any other host apart from humans. The bacterium has various subspecies under it, which are responsible for other diseases as well.

  1. T. p. pallidum causes syphilis.
  2. T. p. endemic causes Bejel or Endemic syphilis.
  3. T. p. pertenue causes yaws.

Syphilis bacteria, bacterium treponema pallidum, has minor metabolic activity because it lacks a tricarboxylic acid cycle. Treponema pallidum is a helically coiled bacteria, making it easier to enter the human body through a mucous membrane. The bacterium is 6-15 micrometer long and 0.1 – 0.2 micrometer wide.

Treponema pallidum enters our body through the lining of genitalia, mouth, throat, or rectum and causes severe symptoms which diagnose syphilis.

3. Syphilis Symptoms

Syphilis is a progressive sexually transmitted infection. The syphilis symptoms develop through stages which allow the health care provider to mention the stage of the disease to the patient. The stage of syphilis lasts for weeks, months, or even years in some patients. The symptoms don’t have to occur in sequence, and the stages might sometimes overlap.

Signs and symptoms of syphilis are often confused with that of other diseases. Therefore syphilis is famously known as ‘the Great Pretender.’ This confuses the person, and they do not visit the hospital thinking this is not something serious and need not be worried about. Healthcare providers also are not able to diagnose this sexually transmitted infection in one go.

1. Primary Syphilis

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The appearance of Chancre characterizes early infection in syphilis. Chances are round, firm, and painless, yet highly infectious. These chancres appear at the site where the bacterium has entered the body. It is usually in the mouth, external genitalia, or rectum.

The painless chancres appear after three weeks of exposure to the bacterium and last for three to six weeks. Most of the infected people appear only with one chancre, but there can be multiple sores. The sores resolve spontaneously, whether the patient is treated with syphilis or not.

Most people fail to identify this sign of early syphilis and, therefore do not receive any treatment. Failure to treat infection in primary syphilis symptoms leads to a secondary stage called secondary syphilis.

2. Secondary stage

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Secondary syphilis starts a few weeks after the chancres of the primary stage have healed or are still recovering. Skin rash is the distinguishing feature of the secondary stage of this sexually transmitted infection. Secondary syphilis symptoms usually start after 2-12 weeks of exposure to the bacterium.

The skin rashes appear initially on the trunk and spread throughout the body, mainly the palms and soles. A typical rash appears as red, brown, or reddish-brown. Skin rash, which appears in a secondary stage, is not itchy. Some rashes occur with a different appearance on other body parts, and they are mistaken for a skin rash of other causes. These skin rash are so faint they do not catch the eye of the infected person.

Lesions of different appearance also occur in secondary syphilis. These skin rash are called ‘Condyloma Lata.’ They appear as large, raised, grey or white lesions and may develop in warm and moist regions of the body like the mouth, underarm, or groin areas.

Other syphilis symptoms occurring in secondary syphilis are

  1. Fever
  2. Weight loss
  3. Sore throat
  4. Swollen lymph nodes
  5. Muscle aches
  6. Patchy hair loss
  7. Headache
  8. Fatigue

The signs and symptoms of secondary syphilis may come and go as long as a year. They resolve upon themselves with or without receiving any syphilis treatment. But if not treated, the infection progresses to latent syphilis or tertiary syphilis.

Syphilis | Clinical Presentation

3. Latent Syphilis

The latent stage is a period where there are no visible signs and symptoms. Even without syphilis symptoms, bacteria still reside inside the human host and transmit the disease to others. Living in the host, the bacteria starts damaging the internal organs.

If the infected person does not take any primary and secondary syphilis treatment, the disease progresses to latent stage syphilis. The latent stage of syphilis lasts for years; it stays for as short as one year or as long as 5 to 20 years.

Latent-stage syphilis falls under two categories-

  1. Early latent syphilis- Latent stage syphilis falls under early latent syphilis when the syphilis infection occurs within 12 months.
  2. Late latent syphilis- Late latent syphilis is where syphilis infection occurred more than 12 months ago.

Latent stage syphilis has gone unnoticed for many years. Many times woman who has contracted syphilis doesn’t identify her infection until she gives birth to a child with syphilis. Babies born in such a condition are called congenital syphilis.

Signs and symptoms in this stage might never return, or the patient may develop tertiary syphilis.

4. Tertiary Syphilis

After the primary and secondary stages of syphilis come late-stage syphilis called Tertiary syphilis.

The tertiary stage occurs when the patient does not receive any treatment after contracting syphilis. Approximately 15-30 percent of people with untreated syphilis progress to tertiary syphilis. After the initial infection, it takes years or decades together for tertiary syphilis symptoms to develop.

Some other symptoms of the tertiary stage include-

  1. Blindness
  2. Deafness
  3. Affects Heart and blood vessels- Cardiovascular syphilis
  4. Affects Spinal cord, brain, and nervous system – neurosyphilis.
  5. Mental illness
  6. Memory loss
  7. Destruction of bones and soft tissues
  8. Heart disease
  9. Affects the liver and joints.
  10. May sometimes lead to death in fatal conditions.

5. Neurosyphilis

At any given stage of syphilis, T. Pallidum invades the Cerebrospinal fluid. This attack causes neurological manifestations in the patient. Testing of CSF and examination of cranial nerves should be done as soon as the patient presents with defects in the nervous system.

Along with infection of the nervous system, infection of Ocular symptoms (Ocular syphilis) or infection ear (Otosyphilis) can also occur. Otosyphilis can lead to permanent hearing loss in the patient. Otosyphilis or Ocular syphilis may be the initial syphilis symptoms presented by a patient.

4. Congenital Syphilis

Sometimes syphilis passes from infected pregnant women to their babies. Untreated syphilis in pregnant women is transmitted to their newborn babies through the placenta or at delivery time. Babies born to such mothers suffer from congenital syphilis.

Pregnant women should regularly be screened for sexually transmitted diseases or sexually transmitted infections on their every ante-natal visit starting from their first antenatal visit. Their second test will be done in their third trimester (at 28 weeks of gestation) or at the time of their delivery.

Pregnant women who are mainly tested for syphilis symptoms are-

  1. Women who are living in high prevalence areas of syphilis.
  2. Women who are living in areas of high morbidity area of syphilis.
  3. Positive blood tests for syphilis symptoms in their first ante-natal test.
  4. Sexually active women.
  5. Women with multiple sex partners.
  6. Women with excess drug use (heroin or meth)
  7. Pregnant women with less or no ante-natal care
  8. Pregnant women living in low socio-economic conditions.

Congenital syphilis is asymptomatic and does not show any syphilis symptoms. But sometimes rash or syphilis sore as it is called can be on the palms of their hands and soles of newborns’ feet. Late signs of congenital syphilis are sore throat, teeth deformities, saddle nose, or deafness. Congenital syphilis is fatal in about 40 %-50 % of cases. Depending on how long the mother is infected with syphilis bacteria, there is a high risk of stillbirth or giving birth to a newborn who dies shortly after birth.

Pregnant women who deliver stillborn after 20 weeks of gestation should be tested for syphilis symptoms. If babies are alive after delivery, they should immediately be treated for congenital syphilis, or they may develop severe complications like seizures, and developmental disorders.

Congenital syphilis affects multiple organs like liver swelling, brain, anemia, jaundice, etc.

However, pregnant infected women undergo miscarriages, abortions, or the pain of the death of their newborn after birth.

5. HIV Infection and Syphilis

People suffering from syphilis symptoms are more likely to develop HIV infection in the coming years and as the disease progresses. According to recent reports, it has been observed that people who are suffering from primary-stage and secondary-stage syphilis are also suffering from HIV infection in later years.

HIV & AIDS - signs, symptoms, transmission, causes & pathology

Mainly people who are sexually active and Men who have sex with other men are more prone to developing HIV infection and syphilis. Men who have sex with men, if they tested negative with HIV initially and positive for syphilis, are reported to have tested positive for HIV in later stages. Syphilis sores on the body of the patient make it easier for the person to acquire HIV.

Patients with HIV may develop different symptoms of syphilis, unlike patients who have only syphilis.

Syphilis or any other sexually transmitted infections or sexually transmitted diseases indicate the quality of surroundings. It also shows the area and the population at higher risk and needs to be taken care of.

6. Test for Syphilis

Any person observing any signs and symptoms should get themselves tested for syphilis. Even if there are no visible signs and symptoms, one should get tested for syphilis. No apparent signs and symptoms are occurring in primary syphilis or initial infection. Symptoms occurring in the secondary stage of syphilis resemble other infections. Therefore they should get tested irrespective of the presence or absence of symptoms or stage of syphilis.

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Persons having oral vaginal or anal sex partners or indirect contact should primarily get tested for syphilis.

The persons that are highly at risk are:

  • have had unprotected sexual contact with a person who tested positive for syphilis
  • In pregnant women
  • anal, vaginal, or oral sex
  • sex worker
  • sexually active prisoners
  • have or had unprotected sexual contact with several multiple people
  • having a partner who had sexual contact with numerous persons.
  • Men who have sex with men.
  • have a history of HIV infection

7. VDRL Test

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VDRL test stands for Venereal disease research laboratory7, and it is used as a blood test for conforming syphilis. even though it is an indirect test used for coordinating antibodies for syphilis

The disease is caused by a syphilis bacteria known as Treponema pallidum. It infects the person’s body entering through wounds, usually of genitalia.

As given by the Centers for Disease Control and Prevention, the VDRL test confirms the antibodies in the person positive for syphilis, and the antibodies are produced in response to the antigens. If antibodies are present in the person’s body, the blood test detects it as positive for syphilis.

The signs and symptoms of syphilis aren’t necessary for this test to be accurate and diagnose syphilis diagnosed.

Reverse sequencing is done to detect persons with previously treated syphilis and untreated syphilis. As sexually transmitted syphilis makes way for HIV, the person is tested even for HIV and sometimes for other sexually transmitted infections.

To confirm neurosyphilis, cerebrospinal fluid is examined through lumbar puncture

8. Treatment for Syphilis

Treatment for Early Infection

Early treatment for primary and secondary syphilis is intramuscular benzathine benzylpenicillin – 2.4 million units.

For people who are allergic to penicillin, doxycycline and tetracycline are the choices to treat syphilis. Patients are advised to avoid sex until the treatment is complete. The same drugs will cure syphilis in pregnant women.

Treatment for Late Infection

For patients suffering from late latent syphilis symptoms of late-stage syphilis symptoms, large doses of 7.2 million intravenous penicillin G are administered at weekly intervals.

For complications like neurosyphilis, Otosyphilis, and ocular syphilis, treatment is acquired crystalline penicillin G 18-24 million units per day continuously for 10-14 days.

Treating syphilis will stop the further progress of the disease but will not reverse the damage already done.

Even after treatment is completed, necessary follow-up should be done to prevent recurrence of the disease. Frequent blood tests, strict abstinence from sex with new partners should be followed. Regular tests for HIV infection should be mandatory.

One of the reactions for the treatment is the Jarisch-Herxheimer reaction. This might start within one hour of the treatment and could last for 24 hours. During this period patient experiences fever, headache, muscle pains

9. Disease Control and Prevention

According to Disease Control and prevention (CDC), the correct use of latex condoms will decrease the risk of syphilis. The potential site for the transmission of syphilis into the body should be protected; therefore, proper use of condoms should be encouraged.

Apart from using latex condoms, the surest way to prevent syphilis is to restrain themselves from having sex.

Prevention of congenital syphilis can be done when regular checkups of pregnant women are thoroughly followed. Every antenatal visit of pregnant women should be monitored.

Closing Thoughts

As soon as signs and symptoms are visible, the patient is supposed to rush to the hospital. Their history and complaints should be thoroughly mentioned to the doctors to provide medical advice, and immediate treatment can begin. This will prevent further damage and disabilities.

Even diseases like syphilis can be eliminated from society only if proper preventive measures are followed. Notification and immediate treatment of infected people also play a crucial role in managing syphilis incidence globally.

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  1. Allan-Blitz, Lao-Tzu, et al. “A position statement on Mpox as a sexually transmitted disease.” Clinical Infectious Diseases 76.8 (2023): 1508-1512. ↩︎
  2. Trovato, Emanuele, et al. “Syphilis diagnosis and treatment: state of the art.” Dermatology (2021): 1-11. ↩︎
  3. Gilmour, Leeyan S., and Tony Walls. “Congenital syphilis: a review of global epidemiology.” Clinical Microbiology Reviews 36.2 (2023): e00126-22. ↩︎
  4. McCullough, Jeffrey. Transfusion medicine. John Wiley & Sons, 2021. ↩︎
  5. Karmen-Tuohy, Savannah, et al. “Outcomes among HIV-positive patients hospitalized with COVID-19.” JAIDS Journal of Acquired Immune Deficiency Syndromes 85.1 (2020): 6-10. ↩︎
  6. World Health Organization. “WHO guidelines for the treatment of Treponema pallidum (syphilis).” (2016). ↩︎
  7. Diggory, Paul. “Role of the Venereal Disease Research Laboratory test in the detection of syphilis.” Sexually Transmitted Infections 59.1 (1983): 8-10. ↩︎

Last Updated on by Sanjana


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