Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It progresses in stages, each with different symptoms. If left untreated, syphilis can cause serious long-term health problems, including damage to the heart, brain, and nervous system. Early diagnosis and proper antibiotic therapy provide excellent outcomes.
Modes of Transmission
- Unprotected sexual contact
- Direct contact with syphilitic sores
- Mother-to-child transmission during pregnancy (congenital syphilis)
Stages and Symptoms of Syphilis
1. Primary Syphilis
- A painless sore called a chancre appears at the site of infection
- Usually heals within 3–6 weeks without treatment
2. Secondary Syphilis
- Skin rashes (often on palms and soles)
- Fever, sore throat
- Swollen lymph nodes
- Patchy hair loss
- Mucous membrane lesions
3. Latent Syphilis
- No symptoms
- Infection remains in the body for years
4. Tertiary Syphilis
Serious complications may develop after years of untreated infection:
- Brain and spinal cord damage
- Heart and blood vessel damage
- Vision problems
- Gummas (soft, tumor-like growths)
Congenital Syphilis
- Poor growth
- Bone abnormalities
- Nervous system damage
- Rash and breathing problems
Diagnosis
- Non-treponemal tests: VDRL, RPR – used for screening
- Treponemal tests: TPHA, FTA-ABS – confirm diagnosis
- Dark-field microscopy for chancre lesions
Treatment
The treatment of choice for all stages of syphilis is penicillin.
1. Primary, Secondary, and Early Latent Syphilis
- Benzathine penicillin G single intramuscular dose
2. Late Latent and Tertiary Syphilis
- Benzathine penicillin G weekly for 3 weeks
3. Neurosyphilis
- IV penicillin G for 10–14 days
Penicillin Allergy
- Doxycycline or tetracycline (alternative)
- Desensitization recommended for pregnant women
Jarisch–Herxheimer Reaction
After starting treatment, some patients may develop fever, chills, and headache due to rapid killing of bacteria. This is temporary and can be managed with antipyretics.
Complications of Untreated Syphilis
- Brain and nerve damage
- Blindness
- Heart valve damage
- Paralysis
- Pregnancy complications and stillbirth
Prevention
- Practice safe sex (use condoms)
- Limit number of sexual partners
- Regular STI screening
- Treat both partners simultaneously
Patient Counseling
- Complete the full course of treatment
- Avoid sexual activity until cured
- Get tested for other STIs
- Prenatal screening for pregnant women
- Return for follow-up testing to confirm cure
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