Syphilis (syphilis)

Syphilis is a sexually transmitted infectious disease, also known as lues. In most cases, infection occurs through unprotected sexual contact. Swollen lymph nodes and ulcers on the genitals are among the typical first signs of the disease. The disease is caused by bacteria that can cause serious damage to the body's organs over time. Syphilis is widespread worldwide and the number of infections has been increasing for years.
Read everything you need to know about this sexually transmitted disease here.

This is what happens with syphilis

Syphilis, also known as "lues" or "hard chancre", is a sexually transmitted disease that is widespread throughout the world. The bacterium "Treponema Pallidum" is responsible for the transmission of this sexually transmitted disease. The pathogen penetrates through tiny gaps in the skin or mucous membrane.
Shortly after the bacterial infection, a so-called ulcer often forms, a painless mucous membrane ulcer at the corresponding entry point, for example on the penis, vagina, mouth (oral) or anal. The lymph glands also become larger.

The sexually transmitted disease syphilis is often chronic and has several classic stages. Without adequate medical treatment, the disease can have serious long-term consequences.

Syphilis is a highly contagious infectious disease. The bacterial pathogens are generally transmitted from one person to another through unprotected sexual intercourse. Infection through direct contact with infected blood, for example through contaminated drug paraphernalia, is less common.
In addition, pregnant women can transmit the bacterial pathogen to the unborn child: in such a case, it is referred to as congenital syphilis.
The name “syphilis” was coined in 1530 in the Italian city of Verona. The term comes from a Latin poem by a physician in which the hero, a shepherd named “Syphilius,” led a blasphemous life and became ill as punishment.
The name “Lues” is the Latin term for “contagious disease”.

In the ICD-10, the international classification of diseases, syphilis can be found in the chapter “Infections transmitted primarily through sexual intercourse” under numbers A50.-A53.9.

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Symptoms

Syphilis infection is asymptomatic in about half of all those affected, which means that no symptoms are noticeable.
The other half of those infected show certain symptoms, which can vary greatly from one person to the next. They range from painless changes in the skin to severe mental or physical limitations. The symptoms affect women and men equally.

Doctors differentiate between early syphilis and late syphilis.

Early syphilis  

Syphilis in the early stages is medically referred to as early syphilis. It progresses in two different stages, namely a primary and a secondary stage.

Early syphilis in the 1st stage (primary stage) 

Immediately after the infection, those affected generally do not experience any symptoms. Approximately 14 to 24 days after infection, a hard but painless nodule develops at the entry point of the bacterial pathogens - hence the previously frequently used term "hard chancre".

Since most infections occur through unprotected sexual contact, the nodules usually appear on the genital organs, i.e. on the male member (especially on the glans) as well as on the labia or in the vagina.
The bacteria can also be passed from one person to another through oral sex: In such a case, the syphilis nodules also appear on the lips or in the mouth of the affected person. If the infection occurs through anal sex, the nodules form on the anus or in the rectum.

Over time, the nodules harden and become a sharply defined, yellowish ulcer with a swollen edge and a sunken center. The ulcer often secretes a colorless, highly infectious fluid that contains a large number of syphilis bacteria. At the same time, the lymph nodes in the area of ​​the ulcer swell within a few days.

This ulcer, which forms in the primary stage, is also known as an "ulcus durum" or "hard chancre". Because it causes no pain, those affected often do not feel anything. While the swelling of the lymph nodes can persist for several months, the ulcer heals on its own after around four to six weeks. As a result, many infected people do not go to the doctor at all and the syphilis disease remains untreated and is often passed on unknowingly.

However, without medical treatment, the primary stage of syphilis infection progresses to the next stage (secondary stage).

Early syphilis in the 2nd stage (secondary stage)

If no medical treatment is given, the secondary stage of syphilis begins after a symptom-free period (the so-called second incubation period). This stage II begins approximately 10 weeks after infection. At this point, the bacterial pathogens have spread throughout the body via the lymphatic and blood systems and cause a wide range of symptoms over a period of several months.

These include the following complaints:

• Non-specific symptoms such as headache, fatigue, joint pain, reduced appetite, muscular pain and fever.

• Further hard swelling of the lymph nodes

• Patchy, non-itchy skin rashes (exanthema) and rashes on the mucous membranes. A characteristic feature is the appearance of reddish spots on the trunk and in the crooks of the arms and legs.

• As the disease progresses, the red spots on the skin develop into papules, which are particularly noticeable on the palms of the hands and the soles of the feet. These papules can burst and become wet, just like syphilis ulcers. The secretion is extremely contagious!
  Without treatment, there is a risk of the disease spreading unchecked, as many people are touched with the hands (e.g. shaking hands when greeting) and many objects are contaminated through touching.

• Wide, flat and weeping papules can also appear in moist areas of the skin, such as the genital area or in the skin folds (around the anus or under the breasts). This secreted fluid is also very infectious!

• Changes in the mucous membranes can also occur in the oral cavity: for example, red or whitish deposits can form. Swollen tonsils can also occur.

• Whitish spots in the neck area

• Hair loss in certain areas (alopecia syphilitica).

In the secondary stage, the symptoms of syphilis appear mainly in the mucous membranes and skin. However, all organs of the body are affected by the disease! This can lead to an enlarged spleen or liver, as well as anemia or inflammation of the joints, kidneys, eyes and bones.

Neurological symptoms can also occur. Signs of meningitis such as headaches, numbness, visual disturbances or a stiff neck can become noticeable.

These symptoms of the second stage of syphilis can completely disappear after a few weeks.
However, within the next 24 months, there may be a recurring relapse (recurrence). The symptoms may then become increasingly milder each time, but the pathogens can still be detected in the blood and the syphilis disease can therefore still be transmitted!

Lues latens – resting phase 

Approximately two years after infection with the syphilis pathogens, a symptom-free phase occurs. Doctors refer to this as a latent phase or “lues latens”.
During this resting phase, the syphilis infection can only be detected in the blood by the presence of antibodies against the Treponema pallidum bacteria. Symptoms no longer occur.

A syphilis infection can remain dormant for a lifetime and never cause any late complications. If the affected person takes antibiotics for a longer period of time for other health reasons, dormant syphilis can even heal. In medicine, such a case is referred to as accidental treatment.

However, in approximately 10% of affected individuals, so-called late syphilis occurs after several years.

Late syphilis in the 3rd stage (tertiary stage)

The syphilis symptoms no longer only affect the skin and mucous membranes, but also the internal organs of the body. Tissue nodules (gummas) now form throughout the body, containing a rubbery, thin and highly infectious secretion. These slowly growing nodules can break open over time and form one or more ulcers. In most cases, the body tissue in the ulcer dies. Doctors refer to this as necrosis.

If syphilis causes damage to the wall of the aorta (main artery), this is a serious and life-threatening complication for the affected person. This can occur even decades after infection with the syphilis bacteria.
In such a case, we speak of "mesaortitis luica". Bulging can occur in the aorta, so-called aneurysms. In these places, the vessel wall is particularly thin and can easily burst, which is life-threatening for those affected.
The body's main artery carries a lot of blood. If it is damaged and ruptures, the person affected can die within a very short time!

Late syphilis in stage 4

If the bacteria also penetrate the central nervous system, doctors speak of neurosyphilis, neuro-lues or “quaternary syphilis”.
Such inflammations in the brain and spinal cord can occur even 10-20 years after infection. The symptoms of the disease at this stage depend primarily on which part of the spinal cord or which areas of the brain are affected.

Possible symptoms include:

• If the spinal cord is affected: loss of reflexes. Movement coordination can also be impaired

• Abnormal sensations such as tingling of the skin

• Sharp pain in the legs and lower abdomen

• Fecal and urinary incontinence

• Meningitis including damage to the brain nerves (syphilitic meningitis).

• Loss of facial muscles and visual disturbances

• deafness

• Dizziness attacks

It can also lead to inflammation of the brain (encephalitis), which can cause various symptoms:

• Changed personality

• Perception and concentration disorders

• Memory disorders up to the reduction of the mental abilities of those affected (dementia)

• Paralysis (for example of the arms and/or legs)

• sleep disorders

• Headache

• Epileptic seizures

• Delusions

• Depression or manic-depressive states

Such a condition is called “progressive paralysis” and, without targeted therapy, results in the death of the affected person within four to five years at the most.

Approximately 25-30 years after infection, the final stage of the disease occurs, known as tabes dorsalis. Here, the nerve nodes (ganglia), the nerve sheaths and the nerve roots are destroyed. Characteristic of this final stage is a disturbed sense of temperature and pain. Gait disturbances or erratic movements can also occur. Many sufferers also suffer from impotence.

Symptoms of congenital syphilis

Unborn babies can become infected with syphilis in the womb. Without appropriate treatment, many of them die during pregnancy (stillbirth or miscarriage) or shortly after birth. Others are born too early (premature birth). During birth, the fetus can become infected in the birth canal.

Infected newborn babies are initially unremarkable and asymptomatic. Only a few babies experience water retention or breathing problems immediately after birth. Various other symptoms can also occur within the first 24 months of life, such as:

• Fever

• Inflammation of the intestine

• Reduced drinking ability of the infant

• Swollen lymph nodes

• Skin changes

• Enlarged spleen

• Enlarged liver

• Sniffles

If the disease remains untreated, damage occurs in various parts of the body. This often only becomes noticeable after the second year of life, for example through:

• Seizures in the central nervous system

• An inflammation of the cornea in the area of ​​the eyes

• Deafness in the ear area

• Cracked corners of the mouth in the skin area

• Sunken nose in the bone area

• Hutchinson teeth in the area of ​​the incisors (named after the British doctor Jonathan Hutchinson)

• Swelling of the shin

Such congenital syphilis is also called “congenital syphilis”.

The therapy of choice is treatment with high doses of penicillin.

Course

Syphilis can progress in many different ways. In some cases, the disease heals itself. The symptoms of the primary and secondary stages in particular can subside without any specific treatment. However, after years of being symptom-free, symptoms can return, leading to late-stage syphilis. In such a case, there is a risk of serious nerve disorders and nerve damage, bone changes and an attack on the internal organ systems.

However, if syphilis is consistently controlled and treated, the course and prognosis are good to even very good.

However, if syphilis treatment is only started at an advanced stage of the disease, the chances of recovery are significantly reduced. Many sufferers are left with long-term effects such as paralysis. They then need lifelong care.

incubation period

The time between infection with the syphilis bacteria and the appearance of the first symptoms of the disease is on average 10 to 90 days. In most cases, however, the sexually transmitted disease breaks out within two to three weeks.

Risk of infection with syphilis

Patients in the primary stage are highly infectious. In the secondary stage, the risk of infection is somewhat lower.
From the third stage of the disease (tertiary stage) onwards there is no longer any risk of infection.

Causes and risk factors

Syphilis is caused by a bacterium called Treponema Pallidum, which is transmitted from one person to another, particularly during unprotected sex. Infection is also possible through anal or oral sex. The risk group therefore includes people who frequently change sexual partners.

However, infection can occur through kissing. This is the case, for example, if the person infected with syphilis has a small ulcer in their mouth and their kissing partner has a small injury to their oral mucosa. This injury then becomes the entry point for the bacteria.

Infection can also occur via contaminated blood transfusions. In this country, all blood transfusions administered are therefore subjected to a syphilis test beforehand. This means that there is no risk of infection in Germany via this route.

Another possibility of infection is infected drug paraphernalia, such as needles from drug addicts.
If the injection equipment is shared, contact with infected blood may occur.

There is also a congenital form of syphilis. In this case, expectant mothers transmit the bacterial pathogen to the unborn child in their womb. The syphilis pathogen can be passed on to the unborn child from the fifth month of pregnancy. The risk of infection is particularly high in the early stages of the disease. If a pregnant woman becomes infected with the syphilis bacteria during the course of her pregnancy, the pathogens are almost always passed on to the unborn child.

Syphilis often occurs in conjunction with HIV. The ulcers that develop as a result of syphilis often also represent a gateway for AIDS pathogens (HIV). Both diseases can have a negative impact on each other over time.

therapy

Syphilis can be treated on an outpatient basis. In some cases, however, inpatient treatment may be necessary. This is particularly the case in cases of neurosyphilis, but also in cases of congenital syphilis.

• Syphilis is usually treated with penicillin. The bacterial pathogens are very sensitive to the antibiotic. There is currently no resistance to it. The duration and dosage of antibiotic therapy depend on the stage of the disease.

• In the case of early syphilis (primary and secondary stages), the patient can usually be injected with a single dose of penicillin. Those who cannot tolerate this medication can also be given another antibiotic.

• In the case of late-stage syphilis (exception: neurosyphilis), penicillin is also used for treatment. However, three injections are required, each given several days apart. Here, too, another medication can be used if the patient is intolerant to penicillin.

• Neurosyphilis requires higher doses of antibiotics in addition to inpatient treatment in a hospital. In most cases, patients are treated with high doses of penicillin every day for a period of two weeks. This is usually administered intravenously.

• In addition, in the case of neurosyphilis, specific symptoms of the disease are treated. For example, an anticonvulsant (antiepileptic drug) can be taken to combat epileptic seizures.

In some syphilis patients, it can be medically proven that the bacteria have infected the CNS (central nervous system), but no symptoms of the disease can be observed. However, such "asymptomatic neurosyphilis" must also be treated with antibiotics, just like neurosyphilis that causes symptoms.

People suffering from syphilis should absolutely refrain from sexual intercourse until the treatment is successfully completed. In addition, all previous sexual partners should be informed, as they could also have been infected. They should also urgently seek medical attention.

Treatment of syphilis in pregnant women 

Expectant mothers who have been infected with the pathogen must also be treated with penicillin at all stages of the disease. If there is an intolerance to penicillin, a so-called specific immunotherapy (hyposensitization) can be carried out.

Newborn babies infected with syphilis are given intravenous penicillin for 14 days. If the baby also has HIV, the antibiotic may need to be administered for a longer period. In this case, close consultation with the treating doctor is essential.

What you can do yourself

There is currently no vaccination to prevent syphilis infection. However, it is possible to keep the risk of infection low by using condoms. It is important to treat your own body and sexuality responsibly. This way you not only protect yourself, but also others from sexually transmitted diseases!

In order to prevent a syphilis infection from being transmitted to the unborn baby in the womb, appropriate screening tests as part of maternity care can be used to effectively prevent it.

Test yourself for syphilis (lues) with the sexually transmitted disease test STI Essential from DoctorBox.