Syphilis: signs, symptoms and complications

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Syphilis signs and symptoms depend on the stage of infection. The first is associated with a painless ulcer on the genitals, rectum, or mouth. After healing, the second stage begins, in which the rash usually appears. After a prolonged absence of symptoms (stage three), stage four can develop suddenly, causing extensive damage to the brain, nerves, eyes, or heart.

Syphilis symptoms often resemble other conditions such as psoriasis , hemorrhoids , and ulcers . For this reason, syphilis is often called the "great copycat." For the same reason, syphilis infection is often overlooked and left untreated.

Illustration by Joshua Song. © Get Drug Information, 2018.

Primary syphilis (stage 1)

Primary syphilis is the first stage of infection. This usually begins with the appearance of an ulcer called a chancre 10 to 90 days after the first contact; on average 21 days. Ulcers will develop at the site of contact, most often on the cervix, vagina, penis, anus, rectum, or mouth.

There may be one or more injuries ranging from an eighth of an inch to an inch or more. Since the sores are painless, they can be skipped if they are inside.

Sometimes swollen lymph nodes can develop near the site of infection. These are small glands that, among other things, contain white blood cells that help fight infection, called lymphocytes.

Without treatment, the chancre heals in three to six weeks.

Secondary syphilis (stage 2)

If left untreated, the primary infection will turn into secondary syphilis. Symptoms usually appear two to eight weeks after the chancre appears.

At this stage, a person may experience general symptoms of the disease such as:

  • Hot
  • Throat pain
  • Fatigue
  • Weightloss
  • Headache
  • Muscle pain

They may also experience symptoms that can be a bit more revealing:

  • Unexplained hair loss (syphilitic alopecia)
  • Cracks in the corner of the mouth (fissure cheilitis)
  • General swelling of the lymph nodes.
  • A generalized, non-itchy rash on the palms and soles of the feet, trunk, or extremities.

The appearance of a syphilis rash can vary greatly. Lesions may be flat or raised, scaly or hive-shaped , or they may present with pus-filled blisters. However, the lesions are highly contagious and can easily spread the disease to other people.

In rare cases, secondary syphilis affects the liver, kidneys, bones, and central nervous system and can cause accompanying symptoms and complications.

Symptoms of secondary syphilis usually go away without treatment within weeks to months.

Latent syphilis (stage 3)

Latent syphilis is the third stage of infection called "latent". It is notable for the relative absence of symptoms and positive blood tests.

In addition, this stage is divided into two stages:

  • Early latent syphilis is the period within a year after the initial infection. Secondary symptoms can sometimes reappear at an early latent stage.
  • Late latent syphilis is the period of one year after the initial infection. This can last for years or even decades without any signs of disease.

Although the infection can be transmitted during the early latent phase, it is less likely to be transmitted during the late latent phase.

Syphilis and HIV

The progression of syphilis can be accelerated if HIV is also contracted during infection, a so-called co- infection . An open chancre sore gives HIV an easy route into the body. And the joint presence of HIV and syphilis increases the risk of complications in the later stages, even in the early stages of infection.

Tertiary syphilis (stage 4)

Tertiary syphilis is the most serious stage of this infection and is characterized by three main complications:

  • Gummatic syphilis causes the formation of soft, tumor-like formations called gums. These benign lesions can cause large ulcers on the skin and mouth and destroy tissue in the heart, liver, muscles, bones, and other vital organs. Symptoms usually appear three to ten years after a person's first infection.
  • Cardiovascular syphilis can cause severe swelling of the aorta, edema, and weakening of the aortic wall ( aortic aneurysm ). This usually happens 10 to 30 years after infection.
  • Neurosyphilis affects the central nervous system and usually develops 4 to 25 years after the initial infection. While some people do not develop symptoms, others may develop serious problems such as meningitis (inflammation of the membrane that surrounds the brain and spinal cord) or the spinal cord (a condition characterized by nerve pain, loss of motor skills, disability visual, deafness, etc.).). urinary incontinence). Seizures, personality changes, hallucinations, dementia , and stroke can also occur.

Although syphilis infection can be treated in the tertiary stage, any damage to the heart, kidneys, and other organs can be irreversible and can lead to end-stage organ failure. Treatment depends on the type and extent of damage.

Complications in newborns

Congenital syphilis is a serious condition in which a pregnant mother with syphilis transmits T. pallidum , the bacteria that causes the infection, to her developing baby.

Lack of treatment for syphilis during pregnancy can sometimes lead to miscarriage or stillbirth.

Two-thirds of babies born with syphilis are asymptomatic during the first two years of life.

If left untreated, symptoms can include:

  • Enlargement of the liver and spleen.
  • Purple spots on the skin caused by broken capillaries (petechiae)
  • Profuse nasal discharge with a discharge of highly infectious mucus (known as syphilitic mucus)
  • Neurosyphilis
  • Pneumonia
  • Yellowing of the skin and eyes (jaundice).
  • Seizures

By age 2, a child may have characteristic physical or facial deformities and significant sensory deficits, including:

  • Blunt upper front teeth (known as Hutchinson's teeth)
  • Collapse of the bony part of the nose (saddle nose)
  • Protruding jaw and shortened upper jaw.
  • The frontal bone that protrudes from the skull (frontal tubercle)
  • Swollen knees
  • Curvature of the leg bones (saber feet)
  • Inflammation and scarring of the cornea, a transparent covering on the front of the eye (interstitial keratitis)
  • Glaucoma is a condition that damages the optic nerve and can cause paleness.
  • Deafness
  • Developmental delays

The associated death in these children is usually caused by bleeding (hemorrhage) in the lung.

When to see a doctor

Because symptoms of syphilis can be missed or misdiagnosed, you need to take action if there is a possibility that you have become infected.

If you have been or have ever been at risk for sex , whether through unprotected sex, having multiple partners, or being HIV positive, you should consider getting tested for STDs , whether you have symptoms or not.

Resolution of symptoms should never be seen as a sign that the infection has disappeared or has never disappeared. Get tested. The tests are simple and can usually produce results in a few business days.

Frequently asked questions

  • Yes, syphilis can be treated with antibiotics. However, the associated damage to some parts of your body, such as your kidneys, can be irreversible.

  • Syphilis is known to be contagious in the primary, secondary, and early latent stages. It is less contagious during the latter part of the latency stage or in relapse. However, it is best to indulge yourself and avoid sexual activity until your doctor gives you permission.

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