Syphilis is a sexually transmitted infection caused by type of bacteria named, Treponema pallidum. The number of cases and risk of contracting syphilis is less than the other sexually transmitted infections we have talked about. However, from 2000-2017 there has been a rise in reported cases primarily with men who have sex with men. Out of the total reported cases of syphilis, approximately 88% of the cases were in men. Rates of occurrence in women have also increased with higher incidence in those who abuse drugs.
There are several stages that occur with a syphilis infection. The primary stage occurs when there is a painless genital ulcer present, also called a chancre. This is the most infectious stage. The disease is spread when another person has direct contact with the chancre during sex. It typically takes about 21 days after exposure for a chancre to show up. If left untreated, the disease spreads throughout the body within weeks to months. Once the infection has spread throughout the body this is considered the secondary stage. There are many symptoms that someone could get in this stage including fever, fatigue, headache, weight loss, sore throat, lymph node enlargement, diffuse hair loss, and widespread rash commonly including the palms and soles. The rash can affect the mucosa inside the mouth and also the genital area, the lesions appear as large gray to white raised areas. In the secondary stage you can still get infected if you kiss or touch a person with active lesions on the lips, inside the mouth, breasts or genitals. Other organs can be compromised in the secondary stage such as the liver, GI tract, muscles and bones, kidneys, eyes, and brain.
If syphilis is not treated in early stages some may get the late stage of syphilis that can occur 1 to 30 years after the initial infection. In the late stage or tertiary stage, the heart can be affected leading to heart murmur or heart failure. Though rare, gummas, or nodular lumps and ulcers, can occur on the skin, bones, or internal organs in the late stage. Neurosyphilis, or infection of the brain, can occur at any time during the course of the infection and this can cause severe neurological disease such as paralysis and dementia. Some people who are infected can go into a latent stage in which they have no symptoms at all. If a woman is pregnant the infection can spread to the baby whether they are having symptoms or not. If a baby is infected there is a high incidence of fetal death.
Testing for syphilis is typically done by blood testing. All pregnant women should be screened for syphilis. Women and men who have suspected symptoms of syphilis or who are at high risk for contracting the infection should also be tested. If the test is positive for syphilis the treatment of choice is penicillin, though if you are allergic to penicillin the doctor will choose an alternative antibiotic.