Syphilis

According to statistics from the CDC (Centers for Diseases Control), syphilis is slowly making a comeback. In recent years, there has been a general increase in syphilis cases among both homosexuals and heterosexuals. In Singapore alone, an average of 1,500 cases had been reported yearly over the last five years, according to Singapore health authorities.

Syphilis is caused by a bacteria referred to as Treponema pallidum. One positive thing is that syphilis is an entirely treatable sexually transmitted disease. But, if left untreated, this disease can potentially result in serious health complications.

So, how is syphilis transmitted?

This sexually transmitted infection is transmitted through direct contact with a syphilis ulcer/sore during vaginal, oral, and anal intercourse. A syphilis ulcer or sore is commonly found around your penis, vagina, anus, lips, or mouth. What’s more, it can be transmitted from an infected untreated mother to the unborn baby, which can sometimes lead to serious complications or even death of the unborn baby. However, you won’t catch syphilis from toilet seats, doorknobs, bathtubs, clothing, or even swimming pools.

So, what are some of the most common syphilis symptoms?

First and foremost, it is worth noting that syphilis develops in stages, implying that symptoms may vary with each stage. These four stages include primary, secondary, latent, and tertiary stages. The primary and secondary stages are very contagious.

Primary syphilis symptoms:

• The infected individual can experience a sore or numerous sores at the site of infections. These sores are commonly found around your genitals, mouth as well as around the anus. Though there may be slight individual differences, these sores are usually round, firm, and unpainful.

• Primary syphilis sores usually appear between ten and ninety days after infection.

• These sores may last between three and six weeks, may heal spontaneously regardless of whether you got treated or not. This means that your syphilis will likely go unnoticed and hence untreated. However, it is important to note that even if your symptoms have subsided, you still need to get treated as this will help prevent your infection from progressing to secondary syphilis.

Secondary syphilis symptoms:

• When your syphilis progresses to the secondary stage, you might experience more systematic symptoms such as skin rash, fever, swollen lymph nodes, weight loss, patchy hair loss, joint and muscle aches, lethargy and headache. The skin rashes may appear on your palms as well as over the bottom of your feet, usually appearing as red or brown spots.

• Secondary syphilis symptoms are usually witnessed three weeks to six months after infection.

• Just like their primary symptom counterparts, secondary syphilis symptoms will eventually subside even without treatment. It is imperative to receive appropriate treatment to prevent the disease from progressing further to latent and latent syphilis stages.

Latent syphilis stage:

• Despite being one of the advanced stages of syphilis, the infected person will not display any visible signs and symptoms.

• This particular stage usually occurs within the first twelve months after infection. It can also occur beyond one year of onset of infection and some may even have an unknown duration of onset of infection.

Tertiary syphilis:

• This phase of syphilis is usually associated with severe health conditions, including heart, brain, nerve system, and eye-related health complications. In severe scenarios, tertiary syphilis can cause significant damage to your internal organs, potentially resulting in death.

• Tertiary syphilis is known to lag behind the time of infection up to one or three decades later.

Neuro-syphilis:

• When untreated syphilis spreads to your brain and the nervous system, it is referred to as neurosyphilis.

• Common neurosyphilis symptoms include profound headache, muscle numbness and paralysis, dementia (memory impairment and mental disorder), and poor coordination movement.

Ocular syphilis:

• When your untreated syphilis spreads to your eyes, it is described as ocular syphilis.

• Common ocular syphilis symptoms include visual disturbances and blindness.

It is important to note both ocular and neurosyphilis can occur at any syphilis phase discussed above.

What’s more, it is crucial to note that you may have syphilis but still feel completely well and healthy without displaying any visible symptoms. This scenario is described as latent syphilis. If you acquired the infection in the past year, it is considered early latent syphilis. On the other hand, this happens more than a year ago, it will be considered late latent syphilis.

Syphilis can affect both your nerves and eyes during any infection stage. This will lead to a range of symptoms such as abnormal body motions, early dementia, and vision problems.

Is it important to get tested for syphilis?

In general, you should get tested for syphilis if:

• You are expectant and are at your first prenatal visit with your obstetrician.

• You are a sexually active individual and had partners who has unknown infection status
• Your partner is tested positive for syphilis
• You are diagnosed to have other Sexually transmitted diseases
• You suspect that you might have syphilis

What can I expect during my first syphilis appointment with my doctor?

Your doctor will first take your medical history, taking into account both your symptoms and sexual history. Followed by a full physical examination.

Your doctor will also conduct some blood tests to screen for syphilis and may also consider screening you for other STIs.

What are some of the available tests for Syphilis?

There are 2 kinds of test.

• Blood test which a blood sample is drawn and sent to the lab. The result normally takes about 5-7 working days
• Rapid syphilis test- MOH approved test kit which gives a result in 20mins !

Speak to your doctor for further information. 

So what are the treatment options for syphilis?

Despite being a potentially dangerous sexually transmitted infection, syphilis is completely curable with the right antibiotics. As stated earlier, untreated syphilis can affect other sensitive areas within your body such as your eyes, brain, and the nervous system. So, even though the right treatment using antibiotics works, this treatment will not be able to reverse any damage that may have occurred as a result of syphilis infection. What this means is that early syphilis screening and treatment are key to the success of your treatment.

Syphilis infection is treated through antibiotics injections. The dosage, as well as the number of injections, usually depends on the current stage of your syphilis. And you are allergic to penicillin, you should consult your doctor, who may consider other viable treatment options.

You will have to undergo routine blood tests for a few months to help monitor the progress of your syphilis. And if in any case, the treatment is unable to eliminate the infection, your doctor may prescribe additional antibiotics to be used over an extended period. You should not engage in any form of sexual encounter during your treatment to reduce the risk of transmitting the disease to others.

How can I avoid contracting syphilis?

It is imperative to note that treated syphilis doesn’t make you immune to future infections. And if you don’t practice safe sex, you can be re-infected. As always, complete abstinence is your best bet toward evading all sorts of sexually transmitted infections.

However, if you are sexually active, you can significantly minimize your risk of acquiring syphilis through:

• The use of barrier contraception such as condoms appropriately each time you have intercourse. However, this only works if the syphilis sores are covered by the condom. If the sores occur in areas not covered by the condom, syphilis may still spread through contact with the infected area.

• Having one faithful sex partner who has been tested and free from syphilis.

Frequently Asked Questions:

What is the first symptom of syphilis?

On most occasions, the first visible symptom of syphilis is a small and painless sore, commonly referred to as chancre, on the skin. Several sores may equally appear. Also, your lymph nodes near your groin area may become enlarged.

Can syphilis be completely cured?

Of course, it is very visible for syphilis to be cured completely using the right medication (antibiotics) from the right healthcare provider. However, as earlier mentioned, treatment may not solve any damage that syphilis might have caused already.

So, why is syphilis extremely dangerous?

Even though syphilis is completely curable, if left untreated, it can potentially cause severe damage to your heart, brain, nervous system, and eyes. In more severe cases, it can result in fatality.

Can I contract syphilis even after treatment?

Let me reiterate that treated syphilis doesn’t render anyone immune to future syphilis infections. This implies that even after you have been successfully cured of your syphilis, you are still susceptible to future infections. This is why you should follow up with your healthcare provider to confirm that you are indeed cleared from syphilis.

Your risk of being re-infected becomes even higher if you continue to engage in unprotected sex because most syphilis patients don’t always exhibit visible symptoms. If you didn’t know, syphilis sores can be hidden in the genitals, under the foreskin, or inside the mouth. So, unless you are certain that your partner has been tested and treated appropriately, you may be at great risk of contracting syphilis from an already infected partner.

How can I minimize my risk of getting syphilis?

Abstinence from sex is the ultimate way to avoid contracting syphilis. However, if you are sexually active, the following guidelines should help reduce your risk of getting the diseases:

• Using latex condoms appropriately each time you are having sex. Condoms prevent from having contact with syphilis sore or sores. However, some syphilis sores may occur in areas not covered by a condom, and having contact with these sores can still make you contract syphilis.

• Being in a long-term, faithful relationship with one partner who has been tested and cleared of syphilis.

How will syphilis affect both my pregnancy and my unborn baby?

If you have syphilis and are pregnant, you can potentially transmit it to your unborn child. Studies have also shown that having syphilis can result in a low birth weight baby. What’s more, it increases the chance of you delivering the baby too early as well as stillbirth. To enhance the safety of your unborn baby, you are strongly advised to get tested for syphilis at least once in the course of your pregnancy. And if you test positive, seek immediate treatment.

An infected baby can be born without showing any visible signs and symptoms of syphilis. But, if not treated, there are increased chances that your baby could develop serious health issues within the first few weeks. Untreated infants may develop health conditions such as deafness, cataracts, seizures, or may even be life threatening.

If you suspect that you might be suffering from syphilis, fret not!Consult your trusted healthcare provider and get the relevant treatment.

However, even after treatment, you will still need to protect yourself to avoid future re-infections.

References

1. Asselin, C., Ekindi, N., Carignan, A., & Richard, P. O. (2019). Gummatous penile syphilis. IDCases, 18, e00589. https://doi.org/10.1016/j.idcr.2019.e00589
2. Syphillis. (1890). The Hospital, 7(177), 314.

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