Syphilis

How is it contracted?

You can catch it by having unprotected oral, vaginal, and/or anal sex with someone who has syphilis. In pregnant women, it can be transmitted to the baby through the placenta.  

What are the symptoms?

Syphilis manifests in different stages.

In the first stage, a chancre (an ulcerated lesion that is painless and thus can go unnoticed) appears in the area of first contact with the bacterium, such as the mouth, penis, vulva/vagina, or anus/rectum.

If not treated, it will progress to the second stage, known as secondary syphilis. At this stage, skin lesions are the most common sign, with erythematous lesions that affect the palms of the hands and the soles of the feet. However, it can cause many other symptoms, such as fatigue, sore throat, and even eye problems. 

If left untreated, the infection can enter a latent period that can last for years, in which there are no symptoms and the only way to diagnose it is by doing a blood test. 

The latent stage of syphilis has two phases: the early stage, during the first year, and the late stage, which occurs after a year of being infected. Long-term, 20 to 40 years later, a certain percentage of patients will exhibit neurological symptoms (cognitive impairment or neuropathic pain in the lower extremities) or heart issues (aneurysm). However, if these patients receive treatment with the right antibiotics, the syphilis infection can be cured at any stage. Nowadays, it is very rare for this disease to reach late stages.

In pregnant women, it can be transmitted to the foetus, which can trigger a miscarriage or a serious disease like congenital syphilis in the newborn. Thus, every pregnant woman should be screened for syphilis and treated if the test comes up positive. 

How is it diagnosed?

The diagnosis is often done with a blood test, which looks for the antibodies generated in response to the infection. If there is a lesion, direct tests can be carried out on it to detect the presence of the bacteria.

How is it treated?

The treatment of choice is still the intramuscular injection of penicillin. The number of injections required can vary depending on the stage of the disease, ranging from a single injection to three (one per week). If there are symptoms, the patient may run a fever during the first 24 hours following the injection. 

The treatment is considered a definitive cure, but follow-up blood tests should be done periodically to confirm that the infection is gone. 

Even though antibodies can be detected in the blood after treatment, if the individual comes into contact with T. pallidum again, they can be reinfected and experience a new bout of the disease.

Should I notify my sexual partners? 

If you are diagnosed with syphilis, you need to notify the people you have had sexual contact with in the past months. The number of months will depend on the stage the disease is in when it is diagnosed. If it is diagnosed during the first stage, you should contact the people you have had sexual relations with in the past 3 months. If this diagnosis occurs during the second stage, this time frame needs to be extended to 6 months.