Is Syphilis Treatable? Causes, Symptoms, Treatment and Prevention

Duly Care
Jun 18
9 min read

Syphilis is one of the oldest and most misunderstood sexually transmitted infections (STIs). It remains a significant public health concern globally. Its potential for severe long-term consequences makes early detection and treatment critical. Syphilis is caused by Treponema pallidum, a bacterium that spreads primarily through sexual contact. Despite its alarming reputation, syphilis is curable when treated appropriately.

This blog aims to provide a comprehensive understanding of syphilis, exploring its causes, symptoms, testing, treatment options, prevention strategies, and the long-term effects of untreated infection.

Key Takeaways

Syphilis is caused by the bacterium Treponema pallidum. It is a curable sexually transmitted infection that can lead to severe health issues if left untreated.
Timely detection through accessible blood tests like Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR) is crucial for early treatment and preventing complications like organ damage or neurosyphilis.
Practicing safe sex, including consistent condom use, limiting partners, and regular STI screenings, significantly reduces the risk of infection.
Early and appropriate treatment, usually with antibiotics like penicillin, ensures a full recovery and prevents long-term consequences.

What is Syphilis?

Syphilis is a sexually transmitted bacterial infection caused by the microorganism Treponema pallidum. It is characterised by its progressive stages, each with distinct symptoms, ranging from painless sores to severe systemic complications if left untreated.

Though syphilis primarily spreads through sexual contact, it can also be transmitted from a pregnant individual to their unborn child during pregnancy, a condition known as congenital syphilis. This form of transmission can result in devastating consequences for the child, including stillbirth or severe developmental issues.

Syphilis is often referred to as a "great imitator" because its symptoms can mimic those of many other diseases, making diagnosis challenging without specific testing. Despite its historical reputation as a debilitating and untreatable condition, syphilis is entirely curable when identified early and treated appropriately.

Historical Context and Stigma

Syphilis has a long history of stigma and misconceptions. Historical evidence suggests that the disease may have emerged in Europe in the late 15th century, though its exact origins remain unclear.

Throughout history, societal attitudes toward syphilis have often been shaped by misinformation, leading to delayed diagnosis and treatment for many affected individuals. The persistence of stigma around STIs continues to create barriers to care today.

How is Syphilis caused?

The cause of syphilis lies in its transmission through direct contact with syphilitic sores, or chancres, during vaginal, anal, or oral sex. These chancres, which appear at the infection site, are highly infectious. Additionally, the bacteria can pass from a pregnant individual to their fetus via the placenta, leading to congenital syphilis.

Risk Factors for Syphilis

Certain behaviours and conditions increase the risk of contracting syphilis:

Partner's STI History: A partner with untreated syphilis or another STI may act as a source of infection.
Unprotected Sex: Engaging in sexual activity without using condoms or dental dams significantly heightens the risk.
Multiple Sexual Partners: Having multiple partners increases exposure to potentially infected individuals.
Limited Access to Testing and Treatment: Inadequate access to healthcare can delay diagnosis and treatment, increasing transmission rates.

Understanding how syphilis is transmitted and recognising the factors that contribute to its spread are crucial for reducing its prevalence and protecting individual and public health.

Symptoms of Syphilis: Recognising the Signs at Every Stage

Syphilis is a progressive disease with symptoms that vary depending on its stage. Knowing these symptoms is essential for early detection and treatment, as the disease can lead to severe complications if left untreated.

Primary Stage: The First Warning Sign

The primary stage of syphilis begins with the appearance of a painless sore known as a chancre. This sore typically develops at the site where the bacteria entered the body, such as the genitals, mouth, or rectum, and emerges within 3 to 6 weeks of exposure.

Key Characteristics of a Chancre:

Often single and firm, though multiple sores can occur.
Usually painless, making it easy to overlook, especially in less visible areas like the cervix, vagina, or rectum.
Heals on its own in a few weeks, even without treatment.

While the chancre may disappear, the infection persists and progresses to the next stage if untreated.

Secondary Stage: Symptoms Spreading Across the Body

If syphilis is not treated during the primary stage, it advances to the secondary stage, which can present a wide range of symptoms:

Skin Rashes:

Often appear on the palms of the hands or soles of the feet, but they can occur anywhere on the body.
These rashes may or may not itch, making them easy to dismiss as minor skin issues.

Flu-like Symptoms:

Mild fever, sore throat, and swollen lymph nodes.
Fatigue or a general sense of unwellness, resembling common viral infections.

Mucous Membrane Lesions:

Small sores can form in moist areas, such as the mouth, genitals, or anus.

Patchy Hair Loss:

Loss of hair, eyebrows, or eyelashes in a distinct, uneven pattern.

These symptoms may come and go over weeks or months. Without treatment, syphilis moves into a latent phase.

Latent Stage: The Silent Phase

During the latent stage, syphilis becomes asymptomatic. While the bacteria remain active in the body, no noticeable symptoms occur.

The latent phase can last for years, depending on whether the infection is treated. Although this stage is symptom-free, untreated syphilis can progress to its most severe form - tertiary syphilis.

Tertiary Stage: Advanced Complications

When syphilis goes untreated, it can silently progress through its stages, leading to devastating health outcomes that may be irreversible. Early intervention is critical to prevent complications, which can significantly impact both physical and mental health.

Neurological Complications

One of the most serious consequences of untreated syphilis is neurosyphilis, where the bacteria invade the nervous system. Symptoms can include:

Chronic headaches and changes in mental status.
Vision problems, including potential blindness.
Cognitive decline, memory issues, and even dementia-like symptoms.
Loss of coordination, leading to difficulty walking or performing basic tasks.

Cardiovascular Damage

In its tertiary stage, syphilis can severely affect the cardiovascular system. This may result in:

Aortic aneurysms, or dangerous bulging of the aorta, which can rupture and be fatal.
Damage to heart valves, leading to life-threatening conditions such as heart failure.

Congenital Syphilis

When untreated in pregnant individuals, syphilis can pass to the unborn child, causing congenital syphilis. The consequences include:

Stillbirth or miscarriage.
Severe birth defects affecting the baby’s bones, teeth, and organs.
Lifelong health issues such as developmental delays, hearing loss, or deformities.

Organ Damage

Syphilis can impact various organs, causing chronic pain, dysfunction, or death in extreme cases.

General Health Impact

Untreated syphilis can also weaken the immune system, making individuals more susceptible to other infections, including HIV. Over time, the systemic damage caused by syphilis affects multiple organs, reducing quality of life and life expectancy.

Recognising syphilis at any stage is vital, as it is entirely treatable with the right medical intervention. Early diagnosis not only prevents complications but also curbs the spread of this infection to others.

Testing for Syphilis

Timely testing is crucial for diagnosing syphilis, as early detection enables effective treatment and prevents the infection from advancing. Medical professionals use various diagnostic methods to identify syphilis, each designed to detect specific markers of the infection.

Common Diagnostic Methods

VDRL (Venereal Disease Research Laboratory) Test:

This is a blood test designed to detect antibodies produced by the body in response to Treponema pallidum infection. It serves as an effective initial screening tool, particularly during routine health checkups or for monitoring syphilis progression during treatment.

RPR (Rapid Plasma Reagin) Test:

Similar to the VDRL test, the RPR test detects syphilis-related antibodies. It is widely available and provides faster results, making it ideal for clinics, emergency care settings, or high-volume testing environments where quick diagnosis is crucial.

FTA-ABS (Fluorescent Treponemal Antibody Absorption Test):

This confirmatory test detects antibodies specific to Treponema pallidum. It is often performed following a positive VDRL or RPR test to ensure diagnostic accuracy, especially in latent or long-term infections.

Dark-Field Microscopy:

When an active sore or chancre is present, a sample from the lesion can be analysed directly under a microscope to detect the actual syphilis bacteria. This method is highly effective for identifying early-stage infections.

Treponemal Tests (TPHA or EIA):

Treponemal tests, such as the Treponema pallidum Hemagglutination Assay (TPHA) or Enzyme Immunoassay (EIA), are specialized for identifying antibodies specific to the syphilis bacterium.

Who Should Get Tested?

Testing is strongly recommended for:

Sexually active individuals, particularly those with multiple partners or inconsistent use of condoms.
Individuals with a known exposure to an STI.
Pregnant individuals, to prevent the risk of congenital syphilis in their babies.
People with symptoms such as unexplained sores, rashes, or flu-like conditions after sexual activity.

Routine testing ensures that syphilis, even in its early and often asymptomatic stages, is detected and treated before complications arise.

How to Treat Syphilis

Syphilis is completely curable when treated promptly and appropriately. Early intervention eradicates the infection and prevents its progression to more severe stages.

Standard Treatments

Antibiotics – The Gold Standard:

Penicillin remains the most effective treatment for syphilis.

Early-stage Syphilis: A single injection of Benzathine penicillin G is usually sufficient.
Advanced or Late-Stage Syphilis: Multiple doses may be required over several weeks.

This treatment is safe, cost-effective, and well-tolerated by most individuals.

Alternatives for Penicillin Allergies:

For those allergic to penicillin, options include doxycycline (an oral antibiotic, typically taken for two weeks) and azithromycin (another effective alternative in specific cases).

In severe penicillin allergies, desensitisation procedures can enable safe penicillin use.

Treatment Considerations

Complete the Course: Finishing the prescribed course of antibiotics is crucial to ensure full recovery and avoid reinfection or antibiotic resistance.
Follow-Up Testing: Regular testing after treatment confirms the infection has been eradicated and monitors for possible reinfection.
Abstinence During Treatment: Avoid sexual contact until the infection has cleared to prevent spreading syphilis to partners.

Early and effective treatment ensures syphilis does not progress to its latent or tertiary stages, significantly reducing the risk of severe complications. With timely medical intervention, syphilis remains a fully curable infection.

Prevention of Syphilis

Prevention is the best defence against syphilis. By adopting safe practices and staying informed, individuals can protect themselves and their partners from infection.

Safe Sex Practices

Use Barrier Methods: Consistent and correct use of barrier methods like condoms, diaphragms or dental dams during vaginal, anal, and oral sex significantly reduces the risk of syphilis transmission.
Mutual Monogamy: Limiting sexual activity to one uninfected partner minimises exposure.
Communication: Open discussions about sexual health and STI history with partners can help reduce risks.

Routine Screenings

Regular testing for sexually transmitted infections is critical, especially for:

Those with multiple sexual partners.
Individuals engaging in unprotected sex.
Pregnant individuals, to prevent congenital syphilis.

Early detection through routine screenings not only protects personal health but also prevents the spreading of syphilis to others.

Education and Awareness

Knowledge empowers prevention. Understanding the risks associated with unprotected sex, recognising the symptoms of syphilis, and knowing when to seek medical care can make a significant difference.

By prioritising prevention and early intervention, syphilis can be effectively controlled, safeguarding both individual and public health.

Conclusion

Syphilis is a serious yet entirely preventable and treatable infection when diagnosed early. Its progression through various stages highlights the importance of timely medical intervention and awareness. If left untreated, syphilis can cause life-altering complications, affecting the nervous system, cardiovascular health, and even unborn children through congenital transmission.

By practising safe sex, staying informed about symptoms, and undergoing regular STI screenings, individuals can protect themselves and their partners. Education and open communication play a pivotal role in breaking the stigma around sexually transmitted infections.

Frequently Asked Questions

Can syphilis be transmitted through kissing?
Syphilis can spread through kissing if there are syphilitic sores in or around the mouth. However, this mode of transmission is less common than through sexual contact.
Is there a vaccine for syphilis?
No, there is currently no vaccine for syphilis. Preventative measures like safe sex and regular testing are the best ways to protect yourself.
What does a positive VDRL test mean?
A positive VDRL test indicates the presence of antibodies to syphilis, suggesting a current or past infection. Additional confirmatory tests may be needed to verify the diagnosis.
How long does syphilis last without treatment?
Syphilis can persist for years if untreated, progressing from latent to tertiary stages, which can result in severe health complications.

Important

This blog, including its text, images, and infographics, is for educational purposes only and not a substitute for professional medical advice. For personalized advice, always consult a doctor.

References

US Centers for Disease Control and Prevention. Syphilis - CDC Fact Sheet. 2024. https://stacks.cdc.gov/view/cdc/133600
World Health Organization. Sexually Transmitted Infections. 2023. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
UK National Health Services. Syphilis. 2023. https://www.nhs.uk/conditions/syphilis/
Mayo Clinic. Syphilis- Symptoms and Causes. 2024. https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc-20351756
Morbidity and mortality weekly report. Recommendations and reports. Sexually transmitted diseases treatment guidelines, 2015. 2015. https://pubmed.ncbi.nlm.nih.gov/26042815/