Syphilis is a sexually transmitted bacterial infection. It threatens good health with fatal consequences if left untreated or improperly treated. Usually the infection starts as painless sores located around the genitals, rectum or mouth. Syphilis spreads among human only through broken skin or mucous membrane in contact with syphilis sores.
After the initial infection, the syphilis bacterium can be dormant in the body for decades before reappearing. This infection is a public health burden in developed and developing countries. It affects many races, gender and ages at various degrees of severity and frequency. Presently syphilis causes deaths in hundreds of thousands globally, largely due to increased rate of promiscuity, rape and prostitution.
This highly contagious infection is treatable in the early stages. Previous successful treatment does not protect someone from re-infection after a contact with syphilis infected sore or chancre. Without treatment, it can lead to permanent disability, neurological disorders, cardiac and congenital defects among other ill health problems. And it causes preventable death finally. It is important to make yourself readily available to expert health care providers. They will test and re-test you, and if need be early treatment with effective antibiotic, Penicillin will be initiated.
WHAT IS SYPHILIS?
Syphilis is a sexually transmitted infection (STI). The first presentation of syphilis is in form of small, painless sore on the genitals, rectum or inside the mouth. This sore is called a chancre which some people may not notice immediately. The four stages of syphilis which present varying signs and symptoms are primary, secondary, latent and tertiary.
CAUSES OF SYPHILIS
The causative bacterium for syphilis is called Treponema pallidum. It most commonly enters the body through contact with an infected person’s sore during sexual activities. Syphilis is mostly contagious during primary and secondary stages, and in the early latent period occasionally.
TRANSMISSION OF SYPHILIS
In rare circumstances, syphilis is transmitted through direct unprotected contact with active lesion or sore during intense kissing. The infection is mainly transmitted through direct contact with syphilitic sore(s) on the skin or mucous membranes of vagina. Anus, rectum, lips or mouth during oral, anal or vaginal sexual intercourse are other routes. An infected mother can transfer syphilis to her unborn baby during pregnancy or newborn during childbirth (congenital syphilis).
People who tested positive for syphilis should notify their recent sexual partners with persuasion to get tested and treated. This is to break further transmission. It should be noted that syphilis bacterium die very fast outside of the body. Therefore, it cannot be transmitted through sharing of toilet, bathtub, clothing, eating utensils, doorknobs, swimming pools or screened donated blood.
STAGES OF SYPHILIS INFECTION
The four stages of syphilis are primary, secondary, latent and tertiary. The first two stages are most infectious. Latent stage is hidden or dormant in the body of the affected person without signs and symptoms. Tertiary syphilis is the most destructive and deadly. The stages are described below.
The primary stage of syphilis is highly infectious. It starts about 3-4 weeks after exposure during sexual activity. And remains in the affected part for 2-6 weeks. It manifests with painless sore(s) called chancre which may appear at the entry port of the causative bacterium. The sore usually appears on or inside the genitals, mouth or rectum. The sore(s) may heal without treatment after six weeks, leaving no scar. However, adequate treatment is needed here.
This stage is marked by mucus membrane ulcers or sores and non-itching skin rash on one or more areas of the body. The ulcers appear within 4-10 weeks of the chancre healing. The characteristic rash may be observed as faint, rough, red or reddish-brown spots. The palms of the hands and the soles of the feet are where they are mainly seen. The signs and symptoms of secondary syphilis can disappear with or without treatment. Notwithstanding, proper treatment is needed to break its progression to other subsequent stages of the infection.
The third stage of syphilis infection starts about a year after secondary stage. Here the bacterium is hidden inside the body of the affected person without clear signs and symptoms. This delicate stage could persist for 11 months to 2 years before tertiary stage sets in. Therefore, earlier appropriate treatment is essential to avoid this stage of syphilis infection. Also, it can recur with severe damaging effects to body organs including the brain.
According to Mayo Clinic, approximately 15-30 percent of untreated or improperly treated patients will enter this last stage. This life-threatening, but non-infectious stage presents many deadly signs and symptoms. It can manifest 2-15 years after the initial infection. This stage should be avoided.
SIGNS AND SYMPTOMS OF STAGES OF SYPHILIS
Syphilis is categorized into four stages which are associated with different overlapping signs and symptoms. The contagious stages include primary, secondary and sometimes, the early latent phase. The tertiary stage of syphilis infection is known for most dangerous signs and symptoms but not contagious. However, in some cases, there may not be obvious signs and symptoms for several years.
The signs and symptoms of primary stage are:
- One or many painless, firm and round sores called chancres at the infection site. They appear on mouth, vagina, rectum, anus or penis) and enlarged lymph nodes near the groin.
- The sores can heal on their own after 3 to 6 weeks. The syphilis is hidden in the body of an infected person who can still spread the disease.
- This stage in known to be easily treatable and curable.
The signs and symptoms of secondary stage, which can disappear or worsen if untreated include:
- Swollen lymph nodes.
- Weight loss.
- Non-itchy rash that may be rough, red or reddish-brown in colour. The rash covers the entire body parts beginning from the trunk.
- Wart-like sores/ulcers on the mouth, anus and genitals.
- Muscle aches, headaches, sore throat and fever.
Usually the above signs and symptoms of secondary stage can last about 2 to 10 weeks after the first sore appears.
This stage can be dormant (hidden) in the body of some people for years. It does not show obvious signs and symptoms. And it has high risk of recurrence. Treatment is still recommended here. The infection may affect the nerves, brain, bones, heart and other vital organs of the body.
Late or tertiary
After a normal period of latency, tertiary stage of syphilis infection can occur 10 to 30 years later. The common signs and symptoms at this stage include:
- Soft tissue swellings (gummas) that can cause soft tissue and bone destruction anywhere in the body.
- Muscle control problems.
- Personality changes.
- Vision problems that may lead to blindness.
- Neurosyphilis which is an infection of the brain or spinal cord resulting to stroke or meningitis.
- Damage to the organs -liver, bones, heart, blood vessels and joints, leading to death finally.
COMPLICATIONS OF SYPHILIS
Without treatment, syphilis can lead to complications in many organs of the body. Treatment prevents future damages but cannot repair or reverse already caused damages. The complications include:
- Small bumps or tumors: The bumps which are called gummas, can form as dead tissue and fiber on all parts of the body. Also affected are bones, liver or any other internal organ during the late stage. Gummas typically disappear with treatment.
- Neurological problems: The nerve disorders caused by syphilis are called neurosyphilis. The infection involves the central nervous system (CNS). The problems can result to major CNS complications like loss of coordination and blindness. Also reported are sudden-lightning-like pains, numbness, bladder incontinence, sexual dysfunction in men (impotence) and mental disorder. These appear within 4 to 25 years after the initial infection.
- Aortic aneurysms: Cardiovascular syphilis typically occurs 10–30 years after the initial infection. This complication most commonly results in aortic aneurysm formation. Also, heart valves can be damaged by syphilis infection.
- HIV infection: Sexually active adults with syphilis genital ulcers or sores are five times more likely to contract Human Immunodeficiency Virus (HIV). Syphilis sores can bleed easily and promote easy entry of HIV into the bloodstream during unprotected sexual behaviours. Also, this makes it easier to transmit HIV.
PEOPLE MOST VULNERABLE TO SYPHILIS INFECTION
Evidences show that these groups of people are most likely exposed to syphilis. They include:
- Fetus during pregnancy or infant during delivery from infected mother.
- People who engage in unprotected sex especially with numerous sexual partners.
- Men who have sexual contact with men.
- People who are sexually active and HIV positive.
INCIDENCE OF SYPHILIS INFECTION
The precise origin of syphilis infection is not clear. There are some documented cases of syphilis infection which makes it a global threat to financial and human resources. It affects more than 1.6 million pregnancies a year, resulting in complications. It is worth mentioning that in 2015, Cuba recorded the first breakthrough in the world. They eradicated mother to child transmission of syphilis infection.
Syphilis infection was widespread in Europe and other nations during the 18th and 19th centuries. It decreased later in the 1980s and 1990s. This is due to the advent of the use of an effective antibiotic, Penicillin. However, since about the 20th century, syphilis infection has been increasing at fluctuating rates. This is happening among different genders in the United States, Canada, Africa, the United Kingdom, Australia and Europe. The increase is primarily attributable to unsafe sexual practices such as rape, sexual promiscuity and prostitution. For instance, in the United States, rate of syphilis infection in 2019 was about six times more in men than in women. This is mostly among men who have sex with men. Within this 20th century, about 12 million cases occur especially in developing countries. The cases with many deaths are mostly among intravenous drug abusers, homosexuals and people with HIV infection.
EFFECTS OF SYPHILIS ON PREGNANCY, FETUS AND NEONATES
Pregnant women can transfer syphilis to their unborn or new babies, resulting to congenital syphilis. Congenital syphilis highly exposes pregnant women, fetus and newborn to breach of expectations, with severe and life-threatening health challenges.
Pregnant women can face the challenges of early fetal death or miscarriage, stillbirth, preterm or premature births. Newborns can experience low birth weight/difficulty gaining weight and saddle nose (loss of Nose Bridge). Observed are fever and small blisters on hands and feet. The blisters later turns to copper-coloured bumpy or flat rash spreading to the face. There may be watery nasal fluid and neonatal deaths within few days after birth. Older infants and young children can manifest infections and Hutchinson teeth or abnormal, peg-shaped teeth. Bone pain, sight and hearing loss, inflamed joints and lower leg bones problems are common. And rashes, scars and gray patches on the genitals, anus and mouth can be observed.
Other general health discomforts of congenital syphilis include anemia, deformities, seizures and inflamed liver or spleen. Undetected congenital syphilis can develop into late stage syphilis in babies. This can result to damages to their brain, bones, teeth, eyes, ears, blood, liver and skin.
DIAGNOSIS AND TREATMENT OF SYPHILIS
The diagnosis of syphilis is challenging because someone can have it without experiencing any signs and symptoms for years. Syphilis can be diagnosed with two different quick blood tests performed by expert health care professionals in standard health facility.
The only recommended and proven treatment at all stages of syphilis infection is the use of the antibiotic, Penicillin. It is administered at the dose(s) and durations that are related to the period/stage of infection. There are no home remedies or over-the-counter drugs that will cure syphilis infection. Expert medical care, advice and monitoring at standard health facility are highly required. Especially for pregnant women and those who may not tolerate Penicillin due to allergic reactions. The goals of treatment are to kill the syphilis bacterium, prevent further damage; and ease pain and discomfort. Syphilis that stays untreated for a long time can cause major permanent damages to important organs of the body.
For good treatment outcome, syphilis sores and sexual contacts must be avoided during the period of treatment. Both sexually active partners should be conclusively treated at the same time. So, carry your sexual partner along so as to avoid preventable health complications from syphilis. Safe sexual activities should resume after expert medical confirmation that both partners are totally cured/free from the infection.
PREVENTION OF SYPHILIS INFECTION
There is no effective vaccine presently for syphilis prevention. Therefore, we must contact with expert health care professionals for regular check on the genitals. Especially when there are experiences of abnormal discharge, sore or rash. Some good preventive measures to decrease the risk of syphilis infection include:
- Abstaining from sex or unprotected sexual intercourse even after a cure from previous syphilis attack.
- Staying mutually faithful to a tested and uninfected husband or wife.
- Avoiding excessive use of alcohol and drugs that could potentially motivate unsafe sexual activities.
- As a result of the deadly effects syphilis has on fetus and neonates, health professionals do recommend that all pregnant women be screened for the infection.
- Make sure that the full course of treatment is religiously completed even if signs and symptoms of syphilis have disappeared.
- Avoid all sexual activities until you and your partner are medically certified safe.
- Ensure you get tested for HIV also.