Syphilis is a sexually transmitted disease that affects both men and women. The most common locations for the chancre to appear are in the penis, vagina, anus, and even in the oral cavity. There is not much difference in men and women as far as symptoms, diagnosis, and treatments are concerned. However, there is a difference in the number of men and women being affected by syphilis.
According to recent statistics, men are about 5-6 times at higher risk of acquiring syphilis than women. The major reason behind it is the increasing number of men who have sex with men. Another important factor that should be considered is when women acquire syphilis. They are at high risk of passing the infection to the fetus if they are pregnant or planning get pregnant.
Nowadays, congenital syphilis has become a major problem in the United States since many children who are born from untreated mothers with syphilis are either stillborn or born with a life-threatening medical condition.
The initial signs of syphilis are small and painless sores. These sores or "chancres" are formed on any part of the body. Since these chancres are painless, they may go unnoticed by most people during the initial stages of syphilis.
Diagnosing syphilis can be quite challenging. A person may have contracted the infection years ago, but will not be aware of it for a very long time. However, it is still best to diagnose the condition in the earlier stages and get it treated on time. If the condition remains untreated for years, there will be damage to the essential organs of the body such as the heart and brain.
Syphilis is a condition that can only be transferred from one person to another through direct contact with the sores. It cannot be spread by sharing someone’s clothes, personal belongings, and not even by sharing a toilet with someone.
Syphilis in Men
A chancre is an ulcer that can be round, flat, and reddish-brown in color. It often occurs in the penis, but not always, in the primary stage of syphilis. The infectious fluid from the chancre may spread through sexual intercourse. Sometimes, a chancre can be found in the anus, which spreads through anal sex, particularly, when men have sex with men. Men are at a higher risk of getting syphilis compared to women. For this reason, people should be more careful and cautious before having sexual intercourse.
Syphilis in Women
In women, a chancre develops in the outer or inner wall of the genitals, mostly in the vagina. Sometimes, symptoms go unnoticed because the chancre is localized in the inner wall of the vagina. These chancres are usually painless and odorless. When a chancre is localized in the vagina, syphilis spreads through vaginal sex. When sores are in the rectum, then it spreads through anal sex. It can also spread through non-sexual contact. Women have become comparatively stable as far as syphilis statistics are concerned. Women should also take precautions before having sex.
Syphilis is caused by the bacterium called as Treponema pallidum. Syphilis is known as a great imitator because its symptoms are also common to many other diseases. There are different stages of syphilis depending on its severity.
This stage shows signs of the disease a few weeks after getting infected by the bacteria. It starts with a painless, small sore or an ulcer-like substance called as "chancre". There can be multiple sores in this stage as well. Moreover, these sores are highly infectious. They usually appear in the area of infection. They can be found inside the oral cavity or in your genital areas. These sores are sexually transmitted. It can also be transferred through oral sex.
At this stage, you may find rashes or sores on your skin. They are usually seen in the palm of your hand and soles of the feet. These symptoms are often associated with other health conditions as well. The rashes are usually found near the vagina or the mouth. As these symptoms are very common, some of the other symptoms of secondary syphilis are swollen lymph glands, fatigue, fever, weight loss, and aching joints.
This stage has no symptoms. Basically, at this stage, all the primary and secondary symptoms disappear. Therefore, it is also known as the "hidden stage". Although there are no symptoms, the infection is still present. This stage may be present for an extended period of time.
It is the final stage of syphilis. You would reach this stage only if the previous stages went untreated. This stage takes years to develop and is seen in fewer people. However, this stage is life-threatening, as the disease can cause the following:
- Weak bones
- Mental illness
- Loss of memory
- Brain and spinal cord damage
- Severe heart damage
HIV and Syphilis
People who are infected with the syphilis bacteria have higher chances of getting HIV. The symptoms of syphilis tend to be different for those who are already HIV-positive than those who are not.
Causes of Syphilis
Apart from being transferred through sexual intercourse, syphilis can also be transferred from the mother to her baby in the womb during pregnancy. This condition is termed as "congenital syphilis".
In the case of congenital syphilis, there is a possibility of a stillbirth or low birth weight, and if not treated promptly, the baby can suffer from other complications such as:
In some cases, the baby may also die due to syphilis infection.
Risk Factors of Syphilis
The people who are more at the risk of getting infected with syphilis include:
- Individuals who have unprotected anal, vaginal, or oral sex
- Men having sex with other men
- People who are HIV-positive
- Those who have sex with multiple partners
Symptoms of Syphilis
The severity of syphilis is based on its different stages. The symptoms may also vary in each stage. However, there are cases where the person may not experience any signs or symptoms for many years. The most infectious stages are the primary and secondary stages, and at times, the early phase of the latent stage. Below are the symptoms according to each stage:
- Formation of small, firm, round, and painless sores
- An incubation period of around three weeks from contacting the bacteria.
- In men, the chancres are normally formed in the genital area but not always on the penis.
- In women, the chancres are formed on the outer area of the genitals or within the vagina. A chancre that is formed inside the vagina or on the cervix may go undetected.
- There may be swelling of the lymph glands near the chancres.
- The chancres can also be formed on any part of the body apart from the genitals.
- The sores or chancres will disappear after 3-6 weeks, but you must take the necessary treatments to avoid the infection to progress to the next stages.
In secondary syphilis, there will be a formation of rashes that do no cause itchiness but gradually spread to the different parts of the body including the palms and soles. The rashes are rough in texture and red or brown in color. In people with a darker complexion, the chancres may be lighter than their skin color. Other symptoms include:
The symptoms of this stage may disappear in few weeks but it may reoccur after some time. If syphilis is not treated at this stage, it will advance to the later stages.
In this stage, all the primary and secondary symptoms disappear. This phase may last for many years without having any symptoms. Thus, it is also known as the "hidden stage". Although the infected individuals are asymptomatic, the infection may move to the tertiary stage, which is the final stage of the disease. At times, the symptoms may not reoccur at all.
If syphilis is left untreated, around 15-30 percent of infected individuals will progress to the last stage of the disease. A person progresses to the tertiary stage after 10-30 years of contracting the infection.
Some of the symptoms include blindness, deafness, weak bones, mental illness, loss of memory, brain and spinal cord damage, as well as severe damage to the heart, blood vessels, liver, etc. This stage can also lead to death because of organ damage.
The infection can also spread from the mother to the baby in the womb through the placenta, and at times, during the process of giving birth. Mostly, babies who are born with syphilis have no symptoms. However, some newborns may have the following symptoms:
- Deformed teeth
- Developmental delays
- Saddle nose
In this stage, Treponema pallidum, the causative agent of syphilis, have continuously developed for years. The tertiary stage manifests lesions that affect different body tissues such as the skin, bones, heart, arteries, and nerves. These damaged areas are called as “gummas”, which are quite destructive.
However, these days, tertiary syphilis is less frequently seen due to the early detection of the disease and prompt treatments.
Congenital syphilis can occur when a mother who has syphilis passes the infection to her baby during pregnancy. It is a multisystem infection that is transmitted through the placenta. The risk of transplacental infection is around 60-80 percent. The likelihood of disease transmission is usually during the second half of pregnancy. In infected newborns, the manifestations of the disease are categorized as early congenital and late congenital. Early congenital syphilis manifests at birth up to 2 years of age. Late congenital syphilis, on the other hand, manifests at the age of 2 and up.
Neurosyphilis and Ocular Syphilis
Syphilis can damage the nervous system at any stage of the infection, which can lead to different symptoms such as headaches, changes in behavior, muscle coordination problems, paralysis, sensory issues, and dementia. The damage caused by the infection to the nervous system is termed as neurosyphilis.
Similarly, ocular syphilis can also develop at any stage of the infection. It can affect any eye structure. However, it commonly affects the back part of the eye, the uveal tract, retina, and vitreous humor. Some of the symptoms of ocular syphilis are changes in vision, reduction in visual acuity, and permanent blindness. Health care providers should be aware of this condition so that they can suggest screening the patients who are more at risk of developing syphilis for any visual complaints.
Management of Partners
When a partner has syphilis at any stage, the other partner should undergo diagnostic tests, and even if the diagnostic tests are negative, presumptive treatment must be done. If the diagnosis is done after 90 days, and if the test results are negative, treatment is not needed anymore. The rate of syphilis among African-Americans are high, so presumptive treatment should be given. Partners who are in a long-term relationship and are diagnosed with syphilis in the latent stage should get serologically tested. The people who are at risk, especially the partners of patients who are recently diagnosed with syphilis, should be privately notified about the condition.
Prevention is always better than cure. Therefore, taking precautions during sexual intercourse and taking action during the early stages of infection are the best ways to fight syphilis.
Tests and Diagnosis for Syphilis
In diagnosing syphilis, the doctor will ask the patient to undergo the following tests:
1) Blood test: This test is done to check for any past or current infection. The antibodies against the disease are usually present in the blood for several years.
2) Body fluid: In the first two stages of syphilis, the doctor can collect a sample from the chancres and send it to the laboratory for more specific tests.
3) Cerebral spinal fluid: There may be a need for a spinal tap if the doctor suspects that the infection is harming the nervous system.
When to test for syphilis?
In the primary stage, the symptoms may go unnoticed because there may only be mild symptoms to none. Moreover, the symptoms of the secondary stage are similar to many other ailments. Therefore, it is best for a person to get tested for syphilis in the following cases:
- Had unsafe sex with someone who may be infected with syphilis
- If you are pregnant
- If you are a sex worker
- If you have been in prison
- Having unsafe sex with multiple partners
- Man having sex with another man
If a person tests positive in the syphilis test, it is very important to complete the course of treatment. One must not stop the course in between even if there is a reduction in the symptoms. One must also avoid any form of sexual activity until the doctor suggests that it is already safe to have sex. It is also recommended to get an HIV test done.
Treatments for Syphilis
It is best to treat syphilis with penicillin since prolonged exposure to the infection can cause fatal complications. Normally, for those infected with syphilis, the doctor will prescribe a single or multiple doses of penicillin based on the symptoms and the stage of infection.
If a patient is allergic to penicillin, the doctor will prescribe an alternative medication. However, in the tertiary stage and in the case of neurosyphilis, a patient who is allergic to penicillin will be desensitized to proceed with the treatment and medication. Similarly, pregnant women who are also allergic to the drug will be desensitized.
Patients may experience fever, chills, nausea, body aches, and headaches on the first day. This phenomenon is known as the Jarisch-Herxheimer reaction. Hence, patients must not stop their treatment if they experience these symptoms. Syphilis patients must complete the entire course of medication and then get a blood test done to check if their infection has been cured.
The best way to avoid contracting syphilis is to practice safe sex. The use of a condom reduces the risk of transmitting the bacteria. However, it does not eliminate it. The condom should cover the affected area or the possible infected parts. There are chances that the bacteria could be on the parts that are not covered by the condom, so syphilis can be easily transmitted. In such cases, it is advisable not to have sex until you consult a doctor for medical advice.
Men who have sex with other men should go for a checkup on a regular basis. Such people are more vulnerable to having syphilis. Moreover, pregnant women should visit their doctor for a checkup at the initial stage of pregnancy. If the mother is found to have syphilis, then treatment can begin soon, and the fetus would not be harmed. In such cases, it is better for both the father and mother to undergo treatment.
Knowing about syphilis is really important to remove the stigma surrounding it. People need to be more open with their sexual diseases because they can end up having a life-threatening disease later on.