Sexually Transmitted Diseases: Syphilis

By Cristiano Antonino Last updated Jan 10, 2024

The World Health Organisation (WHO) states that syphilis is the third most widespread sexually transmitted disease, after chlamydia and gonorrhoea

Contrary to what the sexual mores of the late 20th century might lead one to think, syphilis does not have recent roots: several centuries ago, several doctors and scholars knew it as ‘morbo gallico’ or ‘mal français’, because it was brought to Italy by the Gauls of Charles VIII during his descent to Naples in 1495, the year of the first epidemic of which we have certain knowledge.

Others claim it was Christopher Columbus who brought it to European territory after his travels to the unknown lands of the Americas.

Syphilis is caused by the action of a particular bacterium called Treponema Pallidum

Once it makes its way into the human organism, passing through genital mucous membranes or wounds in the skin, it quickly reaches the blood system and lymph nodes, routes of spread throughout the body.

From this point, the presence of the bacterium in secretions and body fluids makes the subject infectious.

Transmission via the sexual route, through skin contact or transplacentally during gestation and childbirth is particularly frequent.

Once a disfiguring, frightening and difficult-to-treat disease, the situation has changed since the mid-20th century thanks to the discovery of penicillin, still considered the main ally in treating the disease.

Syphilis presents itself with different manifestations and stages.

Let’s take a look at the main symptoms that enable us to recognise it, the causes that give rise to it, but also how it is diagnosed and what treatments are effective.

What syphilis is and why it is important to treat it

Syphilis is an infectious disease that is usually transmitted sexually, either through vaginal intercourse or through anal and oral intercourse.

In the infected person or healthy carrier, the aetiological agent (Treponema pallidum) is spread throughout the body, including body fluids and secretions.

The person is highly infected and can easily infect anyone who comes into intimate contact with them.

The bacterium enters the body through direct contact of the abraded skin or intact mucous membranes with the skin lesions that the disease generates on the sick person’s body or their body fluids.

A particular route of transmission is between mother and child during pregnancy or later.

The mother can transmit it to her child during pregnancy, birth or breast-feeding, when the unborn child comes into contact with the mother’s infected fluids or mucous membranes.

We speak of congenital or prenatal syphilis if the infection is acquired transplacentally, connatal syphilis when the child is infected during passage through the birth canal, and acquired syphilis when the child contracts it after birth.

The route by which the bacterium spreads rapidly is through the lymph nodes.

The process usually takes place within a few weeks and, at its conclusion, Treponema Pallidum is also detectable in the blood system and in various organs.

Initially, the subject is asymptomatic, then syphilis follows a course involving several stages, each of which presents symptoms of varying severity.

Today, this disease is considered curable and easily diagnosed thanks to increasingly advanced instrumentation and the availability of various antibiotic therapies.

It is a disorder that should not be underestimated as it can open the way to much more serious problems, especially immunodepressions.

The main causes of syphilis

To date, the main cause of syphilis transmission remains sexual transmission.

Doctors have in fact observed that the main ‘gateways’ for Treponema Pallidum are the genital mucous membranes and all those anatomical points where the skin, for various reasons, can be injured.

After the infection phase, the incubation period of the disease can vary between 2 weeks and 3 months, during which the syphilis carrier is still infected.

A few days after actual contagion, the bacterium reaches the lymph nodes and, from there, the entire body, making contact with infected secretions (semen and vaginal fluids) extremely contagious.

In addition to sexual transmission (vaginal, anal and oral), syphilis can be spread via the skin, with direct contact of the mucous membranes or infected lesions by body areas with a skin lesion, or via the transplacental route, i.e. from mother to foetus through infected blood.

Contagion can also occur at birth (connatal syphilis), when the baby comes into contact with the birth canal and the mother’s genital mucous membranes.

In contrast, indirect transmission of Treponema pallidum is almost nil because the bacterium does not survive for long in the external environment.

Syphilis: Symptoms with which it presents itself

Syphilis is a disease whose manifestations and symptoms are often nuanced.

In fact, the primary lesion is often so small, painless and hidden (especially in the female gender) that it cannot often be seen with the naked eye unless one looks for it carefully.

Three stages of the disease can be recognised.

The basic symptom of primary syphilis is the presence of a single indolent papule at the site of inoculation of the bacterium. The lesion evolves with edge erosion and locoregional lymphadenopathy with large, hard-elastic, indolent and mobile lymph nodes.

Multiple maculo-papular or pustular lesions may appear on the skin, usually in the palmar-plantar region; they are small, but may merge to create more extensive skin lesions (this is the particular case of syphilitic dermatitis). Associated with this phase are flu-like symptoms such as fever and sore throat, but also gastrointestinal pain, nausea, vomiting and loss of appetite, as well as bone pain. This phase may be followed by a latency period that can last for years (latent syphilis).

When syphilis reaches the stage of tertiary syphilis, more serious problems may appear and early consultation with the doctor is essential. The infection can give rise to migraine and meningitis, neurological syndromes, otitis resulting in labyrinthitis, dizziness and balance problems, visual problems and aortic disease. Ocular syphilis, in particular, can affect any part of the eye although it most frequently presents as uveitis (inflammation of the uvea, the ocular membrane located near the cornea).

As with other diseases, the course of syphilis is accelerated and more severe if the subject is already suffering from other problems, such as sexually transmitted diseases or immunosuppression-inducing diseases such as HIV.

There are several stages in which syphilis presents itself, each with its own symptoms

The stages are sequential with each other: as soon as the symptoms of the previous stage disappear, one moves on to the next stage.

Primary syphilis arises after an incubation period of between 2 and 12 weeks and manifests itself as a single lesion (syphiloma) or as multiple skin lesions where the virus has entered. The papules are usually round and dark red in colour, hard to the touch but not necessarily painful. This lesion, containing bacteria and therefore infectious, heals within a month, but the infection does not disappear. Clinical studies have shown that the areas most at risk for the formation of syphilomas are glans and foreskin for men, cervix, vulva and vagina for women, and rectal area and oral cavity for both, if syphilis is contracted anally or orally.

A week after the lesion appears, another very common symptom of the disease appears: the enlargement of the lymph nodes. This is the moment when Treponema Pallidum has reached the blood and lymphatic system and is ready to spread throughout the body.

The symptoms of the first stage disappear in 4-6 weeks, even without treatment. This is a stage in which syphilis is difficult to detect, because the lesions may be painless, small and hidden. However, the disease is present and is still infectious.

Secondary stage syphilis. It appears when the symptoms of the first stage disappear and give way to new ones. It is recognised by the presence of pinkish or greyish-white patches on the skin called ‘syphilitic roseola’. They usually appear first on the trunk and palm-plantar area and then on the limbs, almost always sparing the face. They are asymptomatic and rarely itch. These spots are accompanied by inflammation of the lymph nodes, which are swollen and painful, and other flu-like symptoms. Again, as with the first stage, symptoms tend to disappear on their own, but the disease continues to progress to a latent, chronic stage.

Patients with secondary syphilis manifest:

1 in 2 lymphadenopathy with fixed, non-painful nodules, usually generalised;
1 in 10 lesions in other organs or apparatuses (eyes, bones, joints, meninges, kidneys, liver, spleen);
3 in 10 an attenuated form of meningitis, with typical symptoms: nuchal rigidity, headache, but also cranial nerve paralysis, deafness and papilledema

When syphilis becomes latent, one has entered a chronic stage of living with the disease. The problem may remain asymptomatic for several years, but it is necessary to intervene with appropriate treatment to prevent it from evolving into tertiary syphilis, the form with the most significant symptoms. This stage can only be identified by carrying out appropriate serological tests that show the presence of antibodies; the stage is defined as early if it develops within a year of infection or late if it appears later.

Tertiary syphilis is the most serious, with cutaneous manifestations to which are added lesions that mainly affect the cardiovascular and nervous systems. If left untreated, it can lead to the death of the individual or degenerative diseases such as dementia and paralysis.

In particular, one can speak of:

benign gummy tertiary syphilis: it develops within 3-10 years of infection and affects bone, skin and viscera with the formation of ‘gums’, soft inflamed masses localised but capable of infiltrating the organ/tissue (they heal slowly but leave scars);
benign tertiary syphilis of the bones: causes inflammatory and destructive lesions accompanied by dull, incessant pain, more intense at night;
cardiovascular syphilis: presents itself 10-25 years after infection as aortic valve insufficiency, narrowing of the coronary arteries or aneurysmal dilatation of the ascending aorta. Typical symptoms are difficulty breathing and coughing due to compression of the trachea, hoarseness due to compression of the laryngeal nerve and pain of the axillary skeleton;
neurosyphilis.

Neurosyphilis, in turn, can be:

asymptomatic: more common in individuals with secondary syphilis, it is an attenuated form of meningitis that – in the absence of treatment – may become symptomatic in 5% of cases;
meningovascular: usually occurs 5-10 years after infection, and is caused by inflammation of the large and medium-sized arteries of the brain or spinal cord. Typical symptoms are headaches, dizziness, neck stiffness, behavioural changes, apathy, memory deficits, blurred vision and insomnia, weakness of the arm and scapular girdle muscles, progressive weakening of the lower limbs, urinary and/or faecal incontinence;
parenchymatous: usually occurs 15-20 years after contracting the infection, but rarely before the patient is 50-60 years old. Similar to dementia, it presents with memory loss, poor judgement, fatigue, lethargy, seizures, mouth and tongue tremors. The patient becomes increasingly less self-sufficient and emotionally unstable;
dorsal tabe: 20-30 years after contracting syphilis, the person may experience progressive degeneration of the posterior cords and nerve roots. Often the primary symptom is intense, stabbing pain in the back and legs, followed by erectile dysfunction, urinary incontinence and recurrent infections.

Syphilis: how to reach a diagnosis

As already mentioned, syphilis is often a difficult disease to diagnose, as the lesions are often small and hidden and the other associated symptoms resemble a common flu.

This is why, when it is suspected that one has contracted it (perhaps after coming into contact with an infected person), the doctor prescribes more in-depth tests that, through an analysis of blood values, make it possible to detect the possible presence of the disease.

The first diagnostic step involves studying the liquids secreted by infected lesions, looking for the direct presence of the bacterium.

Subsequent investigations involve taking a blood sample to investigate the presence of antibodies.

We recognise treponemal and nontreponemal tests.

Treponemal tests are used to investigate the presence of specific antibodies against Treponema Pallidum.

Nontreponemal tests look for non-specific antibodies, produced in response to substances released as a result of cell damage induced by the bacterium, and are useful for assessing response to treatment.

They are also called reaginic tests because they see the reaction of other tissues to the disease.

For a complete diagnosis, specialists opt to perform both types of tests in order to have a more detailed view of the presence of the disease and its stage.

Syphilis: effective treatments

The treatment of syphilis is antibiotic, either oral or parenteral.

The most commonly used method involves the use of penicillin via direct injections, with the dosage varying according to the stage of the disease and its symptoms.

Penicillin therapy is also preferred during gestation periods as it is safe for the unborn child.

At the end of treatment, patients are required to undergo regular (every 3-6-12 months) reagin tests to observe the course and recovery from the disease.

Good hygiene rules must be associated with the therapy.

First of all, it is necessary for the infected person to abstain from intimate relations until the lesions have completely healed.

It is also essential that sexual partners undergo all tests as they may have been infected or be healthy carriers.

Negative serological tests do not require treatment, contrary to what would happen if the results were positive.

It is good to remember that recovery from the disease does not confer permanent immunity and therefore it is possible that the disease will recur.

Prevention and the effects of syphilis on daily life

Fundamental to syphilis prevention is the use of condoms, especially with casual or new partners whose health status is unknown.

If one suspects having come into contact with an infected person or notices suspicious symptoms, it is essential to seek medical attention immediately to prevent the disease from progressing.

In the early stages, in fact, although the individual is more infected and contagious, syphilis is easily managed and eradicated.

During treatment and throughout the course of the infection, it is a good rule to abstain from sexual intercourse.

Even once cured of the disease, it is necessary to maintain the right precautions for oneself and others because cure does not imply immunity from a new infection.

Unfortunately, as with other sexually transmitted diseases, there is no vaccine, but it is important to continue to follow these hygiene rules for proper prevention.

Syphilis remains a notifiable disease in many countries, from Canada to the USA and in the European Union.

For this reason, health professionals are required to notify public health authorities in the event of a diagnosis.

What Is Syphilis

HPV (Human Papillomavirus): Symptoms, Diagnosis And Treatment Of The Papilloma Virus

What Is The Papilloma Virus And How Can It Be Treated?

Human Papilloma Virus: What Are The Characteristics?

What Is Papilloma Virus And How Does It Occur In Men?

Papilloma Virus (HPV): Symptoms, Causes, Diagnosis And Treatment

Pap Test, Or Pap Smear: What It Is And When To Do It

Rocketing Vaccine Cost Warning

The Vaccine Against HPV Lowers The Risk Of Relapse In Positive Women

HPV Vaccine: Why Vaccinating Against The Papilloma Virus Is Important For Both Sexes