Syphilis Preventing the Silent but Serious STD

Causes of Syphilis

Syphilis is highly contagious STD/STI that is caused by the bacterium Treponema pallidum.  The STD/STI is commonly transmitted through sexual contact—vaginal, anal, or oral—by coming into direct contact with the sores of an infected person.  The bacteria can enter the bloodstream through minor cuts or abrasions in the skin.  However, syphilis is not spread through sharing toilets, clothing, or cooking utensils.

Stages of Syphilis Infection

Syphilis progresses through several distinct stages, each characterized by specific clinical signs and symptoms. The first two stages are highly contagious but easily treatable, while later stages can lead to severe, life-threatening complications.

Primary Syphilis:

The initial sign of infection is usually a small, painless sore known as a chancre, which can appear on the genitals, rectum, or inside the mouth.  This sore often goes unnoticed because it typically does not cause discomfort. 

Secondary Syphilis:

Four to ten weeks after the primary stage, or sometimes while still in that stage, individuals may develop a non-itchy rash that often appears on various parts of the body, particularly on the palms of the hands and soles of the feet. Additional sores may emerge in the mouth, vagina, or anus.  Other symptoms may include:

．Headaches

．Fever

．Swollen lymph nodes

．Muscle aches

．Fatigue

．Weight loss

These symptoms, however, may resolve on their own, regardless of whether treatment is received, but this does not signify that the infection has cleared.  Proper medical intervention is still required to prevent further progression.

Latent Syphilis:

After secondary syphilis symptoms disappear, the bacteria remain dormant in the body for years, not replicating.  During this latent period, no symptoms are present.  However, the bacteria can advance to the tertiary stage if left untreated. It is also important to note that the infection may still be contagious even without the patient exhibiting any symptoms.

Some individuals may experience a relapse of secondary syphilis during the latent stage, meaning the symptoms of secondary syphilis can reappear.  Relapses can occur multiple times.

Tertiary Syphilis:

If syphilis is not treated, it may advance to tertiary syphilis, a severe complication that can manifest 20 to 40 years after the initial infection. At this stage, syphilis is no longer contagious, but it can inflict significant damage on various tissues and organs, including the brain, nerves, heart, and blood vessels, potentially leading to fatal outcomes. Without appropriate treatment, the bacteria can cause serious complications such as:

．Dementia

．Paralysis

．Meningitis

．Numbness

．Vision problems

．Heart disease

．Ischemic stroke

Risk Factors for Syphilis

Anyone who is sexually active can contract syphilis, but certain factors can increase the risk:

．Unprotected sex: Engaging in any form of sex (vaginal, anal, or oral) without a condom increases the risk of syphilis through skin-to-skin contact.

．Multiple partners: Having sex with multiple partners increases exposure to the bacteria.

．HIV/AIDS: Those with HIV are more susceptible to syphilis, and vice versa.

．Anal Sex:  Due to the delicacy of rectal tissues, individuals who engage in anal sex may have an increased risk of contracting sexually transmitted STIs or STDs.

Complications of Syphilis

As previously mentioned, tertiary syphilis is the most dangerous stage, causing extensive damage and potentially leading to death:

．Gummatous syphilis: Large sores or tumors of dead tissue, affecting skin, bones, and internal organs.

．Neurosyphilis: When the bacteria affect the brain and nervous system, causing dementia, numbness, vision problems, and paralysis. This can occur at any stage.

．Cardiovascular syphilis: Bacteria affecting the heart and blood vessels, leading to inflammation (aortitis) and aneurysms, as well as other heart diseases.

Pregnancy and Syphilis

Pregnant women with syphilis face heightened risks, including miscarriage, stillbirth, or premature birth.  The infection can be transmitted to the baby either through the placenta or during delivery.

Most infants born with congenital syphilis appear asymptomatic (showing no symptoms) at birth;  however, some may exhibit signs akin to secondary syphilis, such as rashes on the palms and soles, as well as organ infections.  If left untreated, congenital syphilis can progress to late-stage complications, potentially leading to corneal inflammation (a type of infection of the eye), hearing loss, a saddle nose deformity, and even death.

For these reasons, it is strongly recommended that pregnant individuals undergo syphilis testing to ensure the health and safety of both mother and child. 

Screening and Diagnosis of Syphilis

Syphilis screening generally involves two types of tests: nontreponemal and treponemal.

．Nontreponemal tests are used to detect general markers of infection. If a nontreponemal test returns positive, it indicates that the patient has contracted an infection.

Venereal disease research laboratory test (VDRL test)

Rapid plasma reagin (RPR) test

．Treponemal tests are then conducted to identify the specific type of disease. These tests provide further confirmation and help determine the exact infection the patient is facing.

Enzyme immunoassay (EIA) test

Treponema pallidum haemagglutination (TPHA) test

Treponema pallidum particle agglutination (TPPA) assay

Fluorescent treponemal antibody absorption (FTA-ABS) test

This two-step approach ensures accurate diagnosis and appropriate treatment.

Treatment of Syphilis

If a patient tests positive for syphilis, the most effective treatment is an injection of penicillin, which effectively eliminates the bacteria in the primary, secondary, and early latent stages. For individuals who are allergic to penicillin, alternative antibiotics such as tetracyclines or cephalosporins can be used.

In cases of late latent and tertiary syphilis, longer courses of penicillin are required. However, it’s important to note that any organ damage caused by syphilis prior to treatment cannot be reversed.

Pregnant women diagnosed with syphilis should receive penicillin, and if they are allergic, desensitization is necessary to enable its safe use. Even with treatment, the baby may still be at risk for congenital syphilis, so further testing for newborns is strongly recommended.

Important Notes:

Even after treatment, reinfection is possible, so periodic blood tests are needed to ensure effectiveness. Avoid sexual contact until all sores have healed, treatment is completed, and as advised by your doctor. Notify your partner about your condition and recommend they get tested and treated if necessary.

Syphilis Testing in Hong Kong

If you suspect you have syphilis or other kinds STDs, it is highly recommended to get tested.  For more information on syphilis tests, VDRL tests, and other STD tests in Hong Kong, refer to our STD testing guide.