Syphilis is a highly infectious disease that is mostly spread through sexual activity, including anal and oral sex. Infected persons often do not know they have the disease and readily spread it to their sexual partners. 

If not treated, it can cause severe complications such as heart failure, brain damage, pathological fractures and stillbirth in pregnant women. Syphilis is divided into four stages. There are different signs and symptoms associated with each stage.


Globally, the prevalence of syphilis varies by region. It remains common in many developing countries and some areas of North America, Asia, and Europe, especially Eastern Europe. The highest rates are in South and Southeast Asia, followed closely by sub-Saharan Africa. 

It is very common during the years of peak sexual activity. Most new cases occur in men and women aged 20 to 29 years. Men are affected more frequently with primary or secondary syphilis than women. The past decade has seen a sharp rise in syphilis cases among men, driven mostly by the MSM community.


Treponema pallidum
Treponema pallidum Syphilis bacterium, the bacterium responsible for the dangerous sexually transmitted infection syphilis.

The bacterium, Treponema pallidum is the causative agent for the disease. You get it through direct contact with the sore of an infected person, usually during sexual intercourse. You can find sores on or around the penis, vagina, or anus, on the lips, or in the mouth.

The bacteria can also get into your body through cuts on your skin, blood transfusion and sharing sex toys with an infected person. It can also be spread from an infected mother to her baby.


The symptoms and signs of syphilis vary depending on which of the stage it presents. But the stages may overlap, and symptoms do not always occur in the same pattern. You may be infected with the disease and not notice any symptoms for years.


syphilitic sore or chancre
Adapted from medscape

This stage occurs 3-6 weeks after contact with an infected person. A small, round and often painless sore (chancre) appears at the site where the bacteria entered your body. Syphilis is highly infectious at this stage and is spread through any contact with the sore. You may be unaware of the sore because it is painless and may be hidden inside the vagina and anus.

Sores can occur anywhere but are most common on the following:

  • Vulva, cervix, rectum, and perineum in women
  • Penis, anus, and rectum in men
  • Lips or mouth in either sex

It usually heals 4 to 8 weeks with or without treatment.


The bacteria spread to the body through the bloodstream and lymphatic system. The most distinct feature in the stage is a widespread rash on your skin (including the palms and soles of your feet) and mucous membrane which occurs 2 to 10 weeks after the primary sore in about 75% of untreated people.

Syphilis rash
syphilitic rash

The syphilitic rash is non-itchy, highly contagious and may be accompanied by wart-like lesions (condyloma lata) in your genital area, inner thighs, armpit and mouth. 

Other symptoms you may include;

  • Swelling in your lymph nodes
  • White patches inside your mouth
  • Patchy hair loss
  • Mild fever
  • Fatigue
  • Weight loss
  • Joint pain

Secondary syphilis may also affect your central nervous system, which manifests as headache, neck stiffness, facial numbness and deafness. 

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 the disease.


The latent or hidden stage of syphilis is a period when you experience no signs or symptoms of the disease . Without treatment, you will continue to have syphilis in your body even though there are no signs or symptoms. 

Early latent stage is latent syphilis where infection occurred within the past 12 months. Late latent stage is latent syphilis where infection occurred more than 12 months ago. Latent syphilis can last for years.


Tertiary syphilis develops in about one-third of untreated people years to decades after the initial infection. It has 3 main forms which may occur singly or in combination.

Forms of syphilis:

  • Cardiovascular syphilis
  • Neurosyphilis
  • Benign tertiary syphilis

Cardiovascular syphilis

It usually appears 10 – 25 years after the initial infection. The bacteria infect the blood vessels connected to the heart, including the aorta. The following may result:

  • The wall of the aorta may weaken, forming a swelling (aneurysm). The aneurysm may press on the windpipe or other structures in the chest, causing difficulty breathing, a cough, and hoarseness.
  • The valve leading from the heart to the aorta may leak (aortic valve insufficiency).
  • The arteries that carry blood to the heart (coronary arteries) may narrow.

These problems can cause chest pain, heart failure, and death.


This which affects the brain and spinal cord. It occurs in about 5% of all people with untreated syphilis. Symptoms of neurosyphilis include: 

  • severe headache;
  • difficulty coordinating muscle movements; 
  • Inability to move certain parts of your body (paralysis) 
  • numbness; and 
  • dementia (mental disorder).

Benign tertiary syphilis

It often develops 3-10 years after the initial infection. It is characterized by the formation of growths (Gumma) on the skin, bone, liver and virtually any organ in the body. In the bone, gummas may cause pain, swelling and pathological fractures while on the skin, it may form an open sore. Gummas grow slowly, heal gradually, and leave scars.


Syphilis and pregnancy

If you are pregnant and have syphilis, you can infect your unborn baby. Having it can lead to a low birth weight baby. It can also make it more likely you will deliver your baby too early or stillborn (a baby born dead). To protect your baby, you should be tested for the disease at least once during your pregnancy. If tested positive, you will be placed on the appropriate antibiotics to treat the disease.

An infected baby may be born without symptoms or signs but could have them within a few weeks if the disease is not treated immediately. These signs and symptoms can be fatal. Untreated babies may have delays in their development, have seizures, or die.


You are at risk of getting it if you

  • Are sexually active
  • Engage in unprotected sex
  • Have multiple sexual partners
  • Are a man who have sex men
  • Have HIV 


Syphilis test

It can be diagnosed by testing the blood and CSF.

  • Blood test. Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the bacteria remain in your body for years, so the test can be used to determine a current or past infection.
  • Cerebrospinal fluid. If it is suspected that you have neurosyphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a procedure called a spinal tap.


It is curable when treated at the early stage. But if it is treated too late, it can permanently damage your heart and brain even after the infection is gone.

If you have had syphilis for less than one year, a dose of penicillin is usually enough to eliminate the infection. Supposing you are allergic to penicillin, you might get an alternative medication. If you are in a later stage of the disease, you’ll need more doses.

However, if you are pregnant and allergic to penicillin, your doctor will probably have you undergo a process called desensitization, which will let you take the drug safely.


Previous syphilis infection does not protect you from getting it again. Even after been treated successfully, you can still be re-infected. 


You can protect yourself from getting it by:

  • abstaining from sexual intercourse
  • maintaining long term mutually monogamous relationship with a partner who does not have syphilis
  • using a latex condom, although these only protect you against genital sores and not those that develop in other parts of the body
  • using a dental dam, or plastic square, during oral sex
  • avoiding sharing sex toys
  • refraining from recreational drugs that could potentially lead to unsafe sexual practices

F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.


  • https://www.msdmanuals.com/professional/infectious-diseases/sexually-transmitted-diseases-stds/syphilis
  • https://www.mayoclinic.org/diseases-conditions/syphilis/diagnosis-treatment
  • https://www.webmd.com/sexual-conditions/syphilis

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