Contributors:Elizabeth Nixon-Shapiro, MSMI, CMI, Alaina Mueller, Kaylee Neff, Alexandru Duhaniuc, MD
Syphilis is a sexually transmitted infection or STI, that primarily affects the skin and mucous membrane of the external genitalia, and over time disseminates throughout the body, ultimately causing serious damage to the cardiovascular and nervous systems.
Now, syphilis is caused by a spirochete or spiral-shaped bacteria called Treponema pallidum. This infection is mainly transmitted from person to person during sexual contact through body fluids, such as vaginal secretions, semen, or blood, and it can also be transmitted via contact with skin or mucous membranes, including eyes, mouth, throat, and anus. The main risk factors for contracting syphilis include having vaginal, anal, and oral unprotected sex, as well as having multiple or anonymous sexual partners.
Pregnant clients can also transmit the infection to their fetus, either via the placenta, which may result in spontaneous abortion, fetal death, or poor fetal growth; or during childbirth, causing congenital syphilis.
Now, syphilis has four stages: primary, secondary, latent, and tertiary. The first stage as soon as the client gets infected is called primary syphilis or early localized stage, in which the bacteria start replicating at the contact site, most often the skin and mucous membrane of the external genitalia. After 10 to 90 days from the initial infection, clients typically develop a lesion called chancre, which contains a high number of replicating bacteria and is highly contagious. Now, the chancre typically heals on its own within 3 to 6 weeks, but during this time, the bacteria manage to disseminate to nearby lymph nodes and into the bloodstream.
This leads to the second stage, called secondary syphilis, also called the dissemination stage, which can occur about 2 to 10 weeks after the chancre develops. This dissemination results in a generalized rash that self-resolves within 4 to 12 weeks.
At this point, the disease enters a dormant stage called latent syphilis, which can last from 1 year up to even 20 years! During the latent stage, a small amount of bacteria can be found in the tiny capillaries of various body organs and tissues, so clients are typically asymptomatic, but may still be contagious.
Eventually, clients who don’t get treatment can progress into the final stage, which is called tertiary syphilis. Here, the body mounts a massive immune response against the bacteria in the capillaries of organs and tissues. This results in the formation of granulomatous lesions called gummas, and ultimately causes tremendous organ damage, especially to the cardiovascular and nervous systems, which are respectively called cardiovascular syphilis and neurosyphilis.
Now, throughout each stage, clients with syphilis have different clinical manifestations. In primary syphilis, the chancre presents as a firm, oozing, painless ulcer appears at the contact site, such as the genitals, anus, lips, or mouth.
On the other hand, secondary syphilis presents with flu-like symptoms, such as fever, headache, and malaise; as well as generalized lymphadenopathy; and a generalized maculopapular rash, with small reddish bumps that start on the trunk and spread out to the arms and legs, including the palms and soles, and eventually to the genitalia, and other mucous membranes. In addition, some clients may develop condylomata lata, which are gray-white wart-like lesions that appear over moist areas like the genitals, the anal region, and the armpits. Lastly, some clients at this stage may experience weight loss and alopecia.
Then, the latent stage is asymptomatic; and finally, the tertiary stage is characterized by gummas, which are chronic destructive lesions that can affect any body organ, especially the liver, bones, skin, and mucous membranes. In addition, clients with tertiary syphilis can develop cardiovascular syphilis, which may lead to aortitis, aortic aneurysms, aortic insufficiency, and heart failure. Finally, clients at this stage may develop neurosyphilis, characterized by confusion, dementia, and tabes dorsalis, which is a slow and progressive degeneration of the spinal column, leading to a loss of the sensation and proprioception, as well as ataxia or lack of coordination, and weakness or even paralysis.