Syphilis – symptoms, treatment and consequences

Syphilis is a chronic infectious disease primarily transmitted through sexual contact, caused by the bacterium Treponema pallidum. Although effective treatments are available today, syphilis remains a significant health concern due to its deceptive course and the serious consequences of untreated infection. In this article, we will discuss the symptoms of syphilis at various stages, treatment methods, and the potential risks of neglecting therapy.

What is syphilis?

Syphilis is a systemic disease that progresses in stages. After the bacterium enters the body (usually through sexual contact), the disease develops gradually, from skin lesions to severe damage to internal organs and the nervous system. The infection can remain latent for a long time, which means many people are unaware they are infected and therefore do not seek treatment.

Modes of transmission

The most common way syphilis is transmitted is through sexual contact – vaginal, anal, or oral – with an infected person. It can also be transmitted through contact with a lesion or sore, or more rarely through blood (e.g., shared needles) or from an infected mother to her baby during pregnancy (congenital syphilis).

Symptoms of syphilis – stages of the disease

Syphilis develops in four main stages:

1. Primary syphilis

The first symptoms typically appear 10–90 days after infection (on average, around 3 weeks). The hallmark sign is a painless sore (chancre) with firm edges, usually at the site of bacterial entry – most commonly the genitals, anus, or mouth. The sore heals on its own within 3–6 weeks, which may falsely suggest that the infection has resolved.

2. Secondary syphilis

This stage occurs a few weeks or months after the primary sore heals. The bacteria spread throughout the body. Symptoms may include:

• a spotty or wart-like rash (especially on the palms of the hands and soles of the feet),
  
• flu-like symptoms (fever, headache, fatigue),
  
• swollen lymph nodes,
  
• mucosal lesions (e.g., flat warts in the genital area).
  

These symptoms may also resolve on their own, but the infection continues to progress silently.

3. Latent syphilis

This is a symptom-free phase that can last for years. Although there are no visible signs, the bacteria remain in the body and can damage internal organs. Latent syphilis can only be detected through blood tests.

4. Tertiary syphilis (late-stage)

Approximately 30% of untreated individuals progress to this stage 10–30 years after the initial infection. It can cause serious, irreversible damage to:

• the cardiovascular system (e.g., aortic aneurysms, heart inflammation),
  
• the nervous system (neurosyphilis – neurological symptoms, cognitive impairment),
  
• skin and bones (syphilitic gummas – tumor-like inflammatory lesions).
  

At this advanced stage, the disease can become life-threatening.

Congenital syphilis

Syphilis can be transmitted from an infected mother to her baby during pregnancy. Fetal infection may result in miscarriage, premature birth, low birth weight, or serious birth defects, such as:

• deafness,
  
• bone deformities,
  
• blindness,
  
• developmental delays.
  

In many countries, including Poland, all pregnant women are required to undergo syphilis screening to ensure early diagnosis and treatment, thereby preventing transmission to the baby.

Diagnosis

Diagnosis of syphilis is based on medical history, physical examination, and blood tests, such as:

• non-treponemal tests (e.g., VDRL, RPR) – used to detect antibodies and monitor treatment,
  
• treponemal tests (e.g., FTA-ABS, TPHA) – confirm the presence of Treponema pallidum.
  

In suspected cases of neurosyphilis, a lumbar puncture (spinal fluid analysis) may be needed.

Treatment of syphilis

Syphilis is curable with antibiotics. The standard treatment is benzathine penicillin G, administered intramuscularly. For those allergic to penicillin, alternative antibiotics such as doxycycline or azithromycin may be used, though with slightly lower efficacy.

Dosage and duration depend on the stage of the disease:

• in early syphilis, a single injection is usually sufficient,
  
• in late-stage or latent syphilis, treatment may last several weeks.
  

Sexual partners should also be treated, and patients must abstain from sexual activity until treatment is completed.

Consequences of untreated syphilis

If left untreated, syphilis can lead to:

• severe cardiovascular and neurological damage,
  
• mental health disorders (e.g., dementia, psychosis),
  
• blindness, paralysis, hearing loss,
  
• infertility,
  
• increased risk of HIV infection,
  
• transmission to partners and unborn children.
  

In extreme cases, untreated syphilis can be fatal.

Prevention

Key preventive measures include:

• consistent condom use during sexual activity,
  
• regular STI testing,
  
• avoiding sexual contact with people who have visible lesions,
  
• routine screening during pregnancy.
  

Summary

Syphilis is a serious but fully treatable disease if diagnosed early. Unfortunately, many individuals are unaware of their infection, leading to potentially life-threatening consequences. Education, awareness, and routine testing are essential in combating the disease effectively.

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