Understanding Syphilis: Key Facts, Overview, and More

Key Facts

Syphilis is a significant public health concern, with the World Health Organization (WHO) estimating that 8 million adults worldwide between the ages of 15 and 49 acquired syphilis in 2022. Alarmingly, most infections are asymptomatic or go unrecognized, allowing the infection to spread unknowingly. Particularly vulnerable groups, such as gay men and other men who have sex with men, are disproportionately affected by this infection.

In pregnancy, untreated syphilis can lead to severe adverse birth outcomes, affecting 50−80% of cases. This highlights the urgency for testing and treatment to prevent complications that can arise both for mothers and infants.

Overview

Syphilis is a preventable and curable bacterial sexually transmitted infection (STI). If left untreated, it can lead to serious health issues. The bacteria responsible for syphilis, Treponema pallidum, can be transmitted through oral, vaginal, and anal sex. Additionally, pregnant women can pass the infection to their babies, leading to conditions such as congenital syphilis.

Many individuals infected with syphilis have no noticeable symptoms, making regular testing crucial for early detection and prevention. The use of condoms is an effective way to reduce transmission risk.

Symptoms

Lack of Symptoms

One of the biggest challenges with syphilis is that many people don’t notice any symptoms. This asymptomatic phase can be particularly misleading, as untreated syphilis can persist for years. The disease progresses through several stages:

Primary Syphilis

• Duration: Typically lasts about 21 days.
• Signs: A round, painless sore (chancre) appears, often on the genitals or anus.
• Note: Many may not notice this sore; it often heals within 3–10 days, progressing to the next stage if untreated.

Secondary Syphilis

In this stage, visible symptoms appear:

• Rash: A non-itchy rash usually develops on the palms of the hands and soles of the feet.
• Lesions: White or grayish lesions may occur in warm, moist areas, such as the labia or anus—these can spread the infection.
• Duration: Symptoms may resolve without treatment but indicate that the infection is still present.

Latent Syphilis

Symptoms often fade in this stage, which can last for years. However, without treatment, it can eventually progress to:

Tertiary Syphilis

This final stage occurs after years of infection and can lead to severe health issues, affecting multiple organs such as the brain, heart, and liver.

Congenital Syphilis

Infants born to mothers with untreated syphilis may experience a range of issues, including:

• Rashes
• Organ inflammation
• Anemia
• Bone and joint problems
• Neurological conditions like blindness and deafness

Prevention

Preventing syphilis is entirely possible and straightforward:

• Condom Use: Using condoms consistently and correctly is the best defense against syphilis and other STIs. However, transmission can still occur in areas not covered by a condom.

• Regular Testing: High-risk individuals should get tested at least annually. Pregnant women should be tested during their first prenatal visit to ensure early treatment if necessary.

• Partner Notification: Those diagnosed with syphilis should inform their sexual partners to prevent new infections.

Diagnosis

Diagnostic efforts for syphilis rely on a combination of clinical history, physical examinations, and laboratory testing. As many symptoms are subtle or unnoticeable, comprehensive testing is essential.

Laboratory tests include:

• Direct Detection: Identifying the T. pallidum bacterium through a microscope.

• Blood Tests: Both indirect and rapid tests can provide insights into a syphilis infection, facilitating immediate treatment when necessary.

Identifying asymptomatic cases early through testing is crucial to minimize transmission and prevent pregnancy complications.

Congenital Syphilis

Currently, there are no specific tests for congenital syphilis. However, all live or stillborn infants born to mothers with syphilis should be thoroughly examined for signs of congenital syphilis. Clinical evaluations at birth, along with follow-up tests, can guide appropriate treatment.

Treatment

The good news is that syphilis is both treatable and curable. Those who suspect they may have the infection should consult a healthcare provider promptly.

Treatment Options

• Early Stage: It is typically treated with a benzathine penicillin (BPG) injection, the primary treatment recommended by WHO for both general and maternal cases.

• Second-Line Treatments: Alternatives like doxycycline, ceftriaxone, or azithromycin may be employed for specific therapeutic needs.

BPG treatment may require multiple doses for later stages of syphilis. It is the only treatment that effectively prevents transmission from mother to child.

Scope of the Problem

The global burden of syphilis remains high, with 8 million newly acquired cases reported by WHO in 2022. In particular, syphilis rates are surging among men who have sex with men.

Congenital Syphilis

In 2022, WHO estimated 700,000 cases of congenital syphilis, leading to devastating outcomes like stillbirths and neonatal deaths. Many infants suffer long-term health consequences due to maternal syphilis.

At-Risk Populations

Certain demographics are particularly vulnerable. Estimates suggest 7.5% of gay men and other men who have sex with men have syphilis, compared to only 0.5% in the general male population.

Transmission

Transmission of syphilis primarily occurs through:

• Sexual Contact: Oral, anal, or vaginal sex involving contact with infectious lesions.

• Pregnancy: The bacterium can pass through the placenta from mother to child, especially during the early stages of infection.

Possible Complications

HIV Infection

The presence of syphilis can significantly increase the likelihood of acquiring HIV, nearly doubling the risk. Other STIs, such as gonorrhea and chlamydia, are also more likely.

Severe Disease Outcomes

Untreated tertiary syphilis can have dire long-term consequences, affecting critical organs and potentially leading to death.

Neurological and Ocular Complications

Conditions like neurosyphilis, ocular syphilis, and otosyphilis can develop at any stage of the infection:

• Neurosyphilis: May cause severe headaches, muscular problems, and cognitive decline.

• Ocular Syphilis: Can lead to symptoms ranging from eye pain to blindness.

• Otosyphilis: Impacts hearing and balance.

Congenital Syphilis

Maternal syphilis significantly impacts pregnancy, leading to potentially devastating outcomes for the child.

WHO Response

The WHO has initiated global efforts to eliminate congenital syphilis as part of a broader strategy against mother-to-child transmission of multiple infections, including HIV. Key initiatives include:

• Developing comprehensive guidelines for syphilis testing and treatment.

• Advocating for the use of dual tests for HIV and syphilis.

• Supporting initiatives to ethically communicate diagnosis to partners.

WHO also aims to ensure that communities have access to high-quality diagnostic tests while working to alleviate penicillin shortages globally.

By recognizing the complexities surrounding syphilis and its implications for public health, we can work towards its prevention and effective treatment, thereby protecting both individual and community well-being.