What is syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. primary and secondary (P&S) syphilis is the earliest and most transmissible stages of syphilis. Syphilis can cause serious health problems if not adequately treated. The nation is facing an increase in syphilis rates among both men and women in every region of the country, especially in gay and bisexual men.
How common is syphilis?
In 2018, there were 115,045 new diagnoses of syphilis compared to about 38,739 of HIV infection and 583,405 of gonorrhea. Of the syphilis cases, 35,063 were P&S syphilis. The majority of the cases occurred among gay, bisexual, and other men who have sex with men (MSM). MSM accounted for 77.6% of all P&S syphilis cases among males in which sex of sex partner was known and 64.3% of P&S syphilis cases among men or women with information about sex of sex partner. However, in recent years, the rate of P&S syphilis has been increasing among MSM as well as heterosexual men and women.
Syphilis and HIV
In the United States, approximately half of men who have sex with men (MSM) with syphilis were also living with HIV. MSM who are HIV-negative and diagnosed with P&S syphilis are more likely to be infected with HIV in the future. Genital sores caused by syphilis also make it easier to transmit and acquire HIV infection sexually.
Correct and consistent use of latex condoms can reduce the risk of syphilis when the infected area or site of potential exposure is protected. However, a syphilis sore outside of the area covered by a latex condom can still allow transmission.
Because chancres can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Unless a person knows that their sex partners have been tested and treated, they may be at risk of being infected or re-infected by an untreated partner
The best way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Partner-based interventions include partner notification, is a critical component in preventing the spread of syphilis. Sexual partners of infected patients should be considered at risk and provided treatment immediately
The definitive method for diagnosing syphilis is visualizing the Treponema pallidum bacterium via darkfield microscopy. Home self-tests kits are also available but not often reliable. These tests are simple, inexpensive, and are often used for screening.
Who should be tested for syphilis?
Any person with signs or symptoms suggestive of syphilis should be tested for syphilis. Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with syphilis should be tested for syphilis.
Routine testing is recommended for those who
- are pregnant;
- are sexually active men who have sex with men (MSM);
- are living with HIV and are sexually active;
- are taking PrEP for HIV prevention.
Transmission of syphilis can occur during vaginal, anal, or oral sex, by direct contact with a syphilitic sore, known as a chancre. These chancres can appear on or around the external genitals, in the vagina, around the anus, the rectum, or in or around the mouth. Pregnant women with syphilis can transmit the infection to their unborn child.
Signs and Symptoms
Syphilis is known as “The Great Pretender”, as its symptoms mimics many other diseases. Syphilis typically follows stages that can last for weeks, months, or even years Symptoms appearance can range from 10 to 90 days, but the average time between acquisition of syphilis and the first symptom is about 21 days.
The appearance of a single chancre marks the primary (first) stage of syphilis symptoms, but there may be multiple sores. The chancre is usually firm, round, and painless. It appears at the location where syphilis entered the body. These painless chancres can occur in locations that make them difficult to notice (e.g., the vagina or anus). The chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated or not. However, if the infected person does not receive adequate treatment, the infection progresses to the secondary stage.
Symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, fatigue and rash. The skin rashes and/or sores in the mouth, vagina, or anus mark the second stage of symptoms. This stage typically starts with the development of a rash on one or more areas of the body. Rashes can appear when the primary chancre is healing or several weeks after the chancre has healed. The rash usually does not cause itching. The syphilis rash may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may also occur on other parts of the body, sometimes resembling rashes caused by other diseases. The rashes may also be so faint that they are not noticed. Large, raised, gray or white lesions, known as condyloma lata, may develop in warm, moist areas such as the mouth, underarm or groin region. The symptoms of secondary syphilis will go away with or without treatment. However, without treatment, the infection will progress to the latent and possibly tertiary stage of disease.
Latent Stage (Early latent syphilis and Late latent syphilis)
The latent (hidden) stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. Without treatment, the infected person will continue to have syphilis in their body even though there are no signs or symptoms. Early latent syphilis is latent syphilis where infection occurred within the past 12 months. Late latent syphilis is latent syphilis where infection occurred more than 12 months ago. Latent syphilis can last for years.