Syphilis Guide

Syphilis is an incredibly infectious disease that has been prevalent within society for many hundreds of years and it is well documented in history, with individuals being affected dating back as far as the 16th century. Many millions of people all over the world have been infected, including many famous figures such as Vincent van Gogh and Oscar Wilde.  Even the wealthy nobility have been affected by syphilis in the distant past as, for example, Henry VIII contracted the often deadly disease during his lifetime.

When many people think of syphilis, they tend to associate it with a disease prevalent pre-1940, in an era where antibiotics such as penicillin had yet to be discovered.  The view present among a number of individuals is that syphilis is no longer prevalent within today’s society meaning that there is no possible chance that the infection can be contracted. However, this is a complete myth as over recent years the number of people affected by Syphilis has started to rise once again with increasing numbers of people in the population contracting the infection. Syphilis is a sexually transmitted infection (STI), sometimes referred to as a sexually transmitted disease (STD), meaning it can be spread through not only sexual intercourse, both vaginal and anal, but also through acts of oral sex. In relation to other STIs such as chlamydia, genital warts, gonorrhoea and genital herpes, syphilis is one of the less common infections seen within western society and indeed first world countries in general. Nevertheless, this does not mean that it should be forgotten about as for individuals affected it is still a potentially life threatening illness if left untreated. Pre-1940, it was common for individuals with a syphilis infection to die an unpleasant death due to the complications of long term syphilis illness, with problems such as blindness, brain damage, mental health difficulties and joint inflammation being common place.  In the world today, it is far more likely to see syphilis infections in countries of the developing world, with especially high rates being seen in the continents of Africa and Asia.


Both males and females can be affected by syphilis and the probability of catching the STI is not generally greater in one than the other gender.  The symptoms of the infection can be as severe in both genders, with only minor variations in the early stages but almost identical clinical presentation in the later stages. When sexuality is considered, there is a slight variation in syphilis rates amongst the genders.  In the UK, homosexual males have the highest rate of syphilis infections in comparison to heterosexuals and homosexual women. This is due to the method of sexual intercourse being anal sex and the higher risk this method carries with it. It is the younger generation that have the highest rate of syphilis infections, with contraction rates in women between the ages of 20 to 24 and from 25 to 30 in men being at a peak. Quite often, individuals who are carrying a current syphilis infection may be completely unaware of it because in the very early stages either no symptoms or symptoms that are so unnoticeable and causing little discomfort may be present.

If syphilis is left untreated very serious complications can occur, some of which are potentially life threatening. On the other hand, despite a potentially dire prognosis, the treatment for syphilis is simple, safe and pain free. All that is required is a course of antibiotics administered by injection to kill the bacteria causing the infection.  Hospitalisation is very rarely needed unless complications arise so it is far better to identify and deal with an infection early.

A syphilis infection transits through three different stages. The first stage, called primary syphilis, is characterised by symptoms isolate to the region of initial contact with the infected individual. Sores develop generally on the genitals or mouth. These sores are usually painless, with a round morphology and they are highly infectious, meaning at this stage it is incredibly easy to spread the syphilis infection. Primary syphilis sores gradually disappear and this make take anywhere up to six weeks after initial infection. Syphilis then progresses into the second stage, secondary syphilis. The symptoms characterising this stage appear more wide spread than those of primary syphilis. Individuals suffering secondary syphilis often present complaints such as a skin rash along with a sore throat, symptoms whicanah again only last for a few weeks before disappearing. The final and most life threatening stage is tertiary syphilis. Only a third of all people with untreated syphilis progress to this stage of infection but if this does occur, serious symptoms affecting many major body systems may arise and serious damage can be inflicted on the body.

Treatment

In the days before modern medicine, syphilis used to be treated using harmful chemicals such as mercury or arsenic as well as inducing fever within the patient by use of the malaria parasite.  In their day some of these treatments were considered to be a medical breakthrough, despite the fact that they were fatal to many of the patients they treated. Nowadays, much safer medical treatments are used thanks to the discovery of antibiotics.

Treatment is required for syphilis when an individual tests positive for syphilis in diagnostic tests, such as analysis of a blood sample or a sample directly from a syphilitic sore.  Before treatment commences, it is important that a health professional explains what testing positive actually means and the effects on wider individuals such as the partner, or in the case of pregnant women the unborn child.  The options for treatment should also be detailed to you so allowing you to give your full consent for the treatment.

As syphilis is a bacterially caused infection, the primary method of treatment is to disable or kill the bacteria that are causing the infection. Antibiotics have been highly effective in treatment due to their ability to stop the bacteria in causing the infection and allow the immune system to clear them from the body effectively.  Penicillin is the first choice antibiotic for treating syphilis. The drug is administered intramuscularly in the form of Benzathine penicillin G, due to its long acting nature within the bod. As a drug, penicillin is lethal to bacteria as it destroys a vital component of its bacterial structure, called the peptidoglycan, therefore not allowing it to survive. As a result, bacteria cannot replicate either as new bacteria require this peptidoglycan to be synthesised and as this is prevented, they cannot survive.

What if I am unable to take penicillin due to an allergy?

Not all people are able to have penicillin and it may be the case that you either knowingly or unknowingly have penicillin hypersensitivity therefore would react badly upon taking the drug. If this is a concern, a doctor is able to perform a simple skin test to rule out any severe adverse reactions before proceeding with the treatment.  If it is the case that you suffer from a severe allergic reaction to penicillin therefore it cannot be used in your treatment, there are other options that are available should you require them.

Other antibiotics are able to kill the bacteria that cause syphilis. Erythromycin is an example of such an antibiotic. It works to inhibit bacterial growth so not allowing them to replicate anymore until eventually they all die. This occurs as the drugs stops the bacteria being able to synthesise the vital proteins it requires to allow it to grow. Another example of an alternative to penicillin is tetracycline. This again works in a similar way to erythromycin by inhibiting bacterial growth due to stopping protein synthesis. One issue to tetracycline therapy though is the interactions the medication has with certain foods. Whilst taking the antibiotic, dairy products such as milk must be avoided as these can stop the medication from getting into the body therefore having the desired effect.   In addition, it is not possible to use this form of antibiotic in pregnant women as the medication may have undesirable side effects for the unborn child.

Unfortunately, treating syphilis using alternative antibiotics to penicillin will have an effect on the required duration of the treatment. This is because other antibiotics are not as effective as killing the bacteria that cause the infection as penicillin is. One potential way around such a problem, especially for pregnant women where penicillin therapy would be ideal, would be to desensitise the patient to penicillin prior to administration.  Prior to desensitisation, a skin patch test is performed to identify just how severe your allergy is. To desensitise someone to a substance, small doses are given either orally or intravenously, and when it is deemed appropriate the dose is increased slightly. The process is carried out in a hospital under highly controlled observation as the treatment may trigger a potential allergic reaction.  The process lasts as long as you are required to take penicillin for and when you stop, it is not the case that you are no longer allergic to penicillin. It is absolutely vital to bear in mind that is a resort treatment and ideally you would be given another antibiotic to rid your body of the infection.

How is Syphilis Transmitted? »