Syphilis belongs to the category of sexually transmitted diseases. It can be transmitted through contact with the genitals, mouth, or rectum, as well as through contact with sores or rashes during the early stages of the infection.

Syphilis is highly contagious and can affect anyone who has sexual contact with an infected person. The patient should seek medical help promptly, as the disease is extremely dangerous. It should be noted that the bacteria responsible for syphilis can remain inactive in the body for decades before becoming active again.

What is syphilis?

Syphilis is a bacterial infection usually transmitted through sexual contact — that is, through contact of the skin or mucous membrane with the sores caused by the disease. This, of course, does not mean that there are no other ways of transmission, as it can also happen from the mother to the unborn child.

The bacterium that causes syphilis is called Treponema pallidum. The disease begins as a painless sore, usually located on the genitals, rectum, or mouth. Early-stage syphilis can be cured, sometimes with a single dose of penicillin. However, if left untreated, syphilis can seriously damage various vital organs such as the brain, heart, etc., and can become life-threatening to the patient.

What are the stages and symptoms of syphilis?

Syphilis evolves in various stages, each characterised by different symptoms:

  • Primary syphilis: The first stage usually begins with the appearance of a painless sore (chancre) at the site of infection. The chancre may appear on the genitals, perianally, and also on the oral mucosa. This sore may go unnoticed, but it is highly contagious. Typically, the chancre appears 14–21 days after the suspected contact, accompanied by enlargement of nearby lymph nodes. Very often, because the syphilitic chancre is painless, it goes unnoticed, as it has the property of healing 6–8 weeks after its appearance. This, of course, does not mean that the syphilis has been cured.
  • Secondary syphilis: This stage begins a few weeks after the syphilitic chancre heals. Typically, a rash appears, which initially develops on the trunk but gradually covers the entire body, including the palms, soles, etc. The rash does not cause itching or any other local symptoms. Some patients also report fever, fatigue, and swollen lymph nodes. If at this stage syphilis remains untreated, then the infection moves to a latent phase, where symptoms cease to exist.
  • Latent syphilis: In this stage, there are no visible symptoms, but the bacteria remain in the body. Latent syphilis can last for years, and during this period, the infection can cause severe damage to internal organs, including the heart and brain.
  • Tertiary syphilis: This stage occurs 3–5 years after infection, with about 16% of patients developing symptoms. If syphilis reaches this advanced stage, it can lead to serious health complications such as cardiovascular problems, neurological problems, and organ damage (brain, heart, liver, bones). These complications can become life-threatening.

How is syphilis diagnosed?

An accurate diagnosis of syphilis is vital for prompt treatment. Syphilis is diagnosed in the laboratory by:

  • Blood test: The most common test is a blood test, which detects specific antibodies against Treponema pallidum, primarily during the early stages of the infection or the presence of the bacterium itself.
  • Microscopy: This test involves taking a fluid sample (smear) from the first-stage chancre and direct microscopy.
  • Cerebrospinal fluid examination: This test is performed when there is suspicion that the patient is in the tertiary stage of syphilis.

The importance of early diagnosis

Early diagnosis and treatment of syphilis is vital. If the disease is diagnosed in its early stages, it is completely curable. For this reason, if a patient has even the slightest suspicion, it is important to visit a specialised dermatologist–venereologist promptly.

What does syphilis treatment include?

When diagnosed and managed in its early stages, syphilis is easily cured.

The preferred treatment in all stages is penicillin. This particular antibiotic provides a complete cure of the infection. The dosage of the medication varies according to the stage of syphilis.

If the patient has an allergy to penicillin, then the doctor will recommend other antibiotics or proceed with the penicillin desensitisation procedure, which will allow the patient to safely receive the antibiotic. If syphilis is in its early stages, then the patient only needs to take a single dose of penicillin. In the case of advanced disease, additional doses may be required.

The same treatment also applies to pregnant women. It should be noted that even if a pregnant patient receives treatment for syphilis during pregnancy, the infant after birth must be tested for congenital syphilis and, if infected, receive antibiotic treatment.

Are there side effects?

Apart from the case where the patient may have an allergic reaction to penicillin, syphilis treatment may have some other side effects. The most common is the Jarisch–Herxheimer reaction, which, if it occurs, will happen on the first day of treatment. The main symptoms of this reaction are headache, nausea, fever, and chills. But this is not something serious, and the symptoms only last about a day.

The importance of regular monitoring by a dermatologist

Regular check-ups with a dermatologist are essential for individuals at risk of syphilis or for those with a history of infection. Dermatologists can perform the necessary tests, monitor your overall health, and provide guidance on prevention strategies.

It should also be understood by everyone that the treatment of syphilis does not provide lifelong protection, as future contact with the responsible bacterium will cause the disease to recur with the same symptoms.

Conclusions

Syphilis is a serious sexually transmitted infection that can lead to severe health consequences if left untreated. Seeking early diagnosis and treatment from a specialised dermatologist is essential for proper management and prevention of complications.

If you have concerns about syphilis or any other skin condition, do not hesitate to schedule an appointment.