Syphilis: back with a bang
Historical figures who suffered from syphilis (clockwise from left to right): Abraham Lincoln, King Henry VIII, Ludwig van Beethoven, Napoleon Bonaparte and Al Capone
Like a bad fashion trend, syphilis is making an unwanted comeback and is on the rise in the UK. In 2012 there were almost 3000 new cases of this sexually transmitted infection (STI) diagnosed in the UK, putting rates at their highest levels since the mid-1950s. It can be readily treated if caught early, so knowing those first signs and symptoms can be key to a successful cure.
Syphilis is caused by a bacterium called Treponema pallidum. It has numerous stages to its development, primary syphilis being the first stage of the disease that can appear up to 3 months after infection. It often presents as a painless ulcer (called a chancre) around the genitalia. This can be on the shaft of the penis, or around the labia in women. In some instances, a chancre can also develop around the mouth. The chancre usually oozes clear fluid – and this fluid is highly infectious. As a result, any close contact of genitalia during this period quickly leads to spread.
A primary syphilitic chancre on the head of the penis
Another symptom one may note is that the glands in the groin (similar to those in the neck) can also swell in response to the infection. The ulcer will gradually heal, but this does not mean the infection is gone. Unfortunately, syphilis easily spreads to other parts of the body and can remain dormant there, only to rear its ugly head and potentially cause problems months to years later.
Syphilis is easily diagnosed with a combination of the history and an accurate blood test, and as mentioned already, the earlier it is detected the easier it is to treat. During the primary stage syphilis is exquisitely sensitive to a single dose of penicillin but later stages may require repeated doses. It is important to note that sex should be avoided altogether until the ulcers are healed and a repeat blood test is performed that is negative.
If left untreated then the next stage that can develop is secondary syphilis. This usually develops 1 to 3 months after the initial infection and the classic sign is a widespread, non-itchy pinky-red rash that can affect any part of the body including the palms and soles of the feet. The rash can form raised up patches or pustules that are full of infectious bacteria. Importantly around 50% of people who develop secondary syphilis do not recall developing a chancre at any point, which highlights the fact that it may not always appear. Secondary syphilis often brings with it general flu-like symptoms of headache, fever, sore throat and feeling very run down.
Two good examples of the rash of secondary syphilis. All those spots are teeming with infectious bacteria.
Secondary syphilis clears by itself, but just as the chancre resolving, this does not mean it has been eradicated – it usually means it has entered its latent phase, hibernating in the body so to speak. This latent phase can last years, anywhere from 3 to 15, before tertiary syphilis develops. This can take different forms, including:
Neurosyphilis - affecting the brain and nervous system (causing anything from meningitis, muscle weakness all the way through to dementia)
Cardiovascular syphilis – affecting the vessels leaving the heart and possibly causing aneuryms, or abnormal swellings there
“Gummatous” syphilis – the growth of large fleshy lumps anywhere on the body
A portrait of gummatous syphilis affecting the forehead
There is another mechanism of syphilis transmission, and that is from mother to baby, causing congenital syphilis. At worst, this can cause stillbirth, but there are often numerous birth defects that can affect almost any organ in the developing baby. These can be evident early (at birth) or present later after the age of around 2 years old.
Syphilis can be easily detected with an accurate and quick blood test. Always remember to get checked for other STIs too such as HIV, chlamydia and gonorrhoea, as more than one can, and often are, transmitted at the same time. Ultimately, if you have any symptoms that make you think you might have syphilis, get checked out sooner rather than later as it is vastly easier to treat earlier on!
I perform a full range of sexual health screening and treatment at both my clinic locations. Contact us for more information or if you'd like to discuss this further.
