What is Syphilis?

Syphilis, also known as lues, is a sexually transmitted infection caused by a type of bacterium. It typically begins with painless sores on the genitals, anus, or mouth. If not diagnosed early and treated, the infection can progress and cause damage to organs such as the heart and brain. Information about syphilis and commonly asked questions can be found in the following sections of this text.

What is Syphilis?

When it comes to sexually transmitted diseases, one of the first that comes to mind is syphilis. Scientific studies show that approximately 5 million people worldwide contract syphilis each year (1). Syphilis is a bacterial infection. The source of the disease is a bacterium called Treponema Pallidum (2). A person infected with syphilis can live with the disease for years without showing any symptoms. However, early diagnosis is crucial for the treatment of the disease. In cases where treatment is not initiated in the early stages, the bacterial infection can spread to other organs, leading to more serious complications.

What Causes Syphilis?

The cause of syphilis is sexual contact with a person infected with the Treponema Pallidum bacterium. The bacterium can enter the human body through the genitals, anus, or mouth. Additionally, in some cases, there is a risk of transmission of syphilis to babies born to mothers infected with the syphilis bacterium during childbirth.

What Are the Stages of Syphilis?

Experts classify syphilis into four distinct stages: congenital and acquired. The symptoms of syphilis vary depending on the stage. The main stages of syphilis can be listed as follows (3, 4):

• Primary Syphilis (10-90 days): The primary stage is considered the most suitable for the treatment of the disease. After the virus enters the body, a painless, red lump known as a chancre, about the size of a lentil, appears in the genital area, anus, or mouth within three months. After this lump appears, the bacteria settle in the lymph nodes near the chancre within approximately 8-10 days, causing the lymph nodes to swell. If treatment is not started at this stage, the disease progresses to the second stage.
• Secondary Syphilis (1-3 months): In this stage, swelling occurs in other lymph nodes as well. The second stage is characterized by skin rashes. Symptoms such as high fever, loss of appetite, muscle pain, involuntary weight loss, and headaches may arise during the secondary syphilis stage. If the infection is not treated in the secondary stage, it progresses to a latent syphilis or hidden stage. In cases of untreated secondary syphilis, the disease may begin to regress spontaneously within approximately 4-12 weeks. However, this does not mean that the patient has recovered. In cases where no symptoms are observed, the infection can continue to spread within the body.
• Tertiary (Late) Syphilis (1-4 years): In about 20% of syphilis patients, symptoms are mild and spontaneous recovery may occur. However, approximately ⅓ of patients who do not receive early treatment progress to the third stage of the disease. The infectivity of the bacterium is lower in this stage compared to the others. However, in this stage, involvement can be seen in the cardiovascular system, nervous system, and organs such as the liver and brain, leading to serious complications.
• Congenital Syphilis: In some cases, pregnant women infected with syphilis can transmit the infection to their babies either through the placenta while the baby is still in the womb or during childbirth.

What Are the Symptoms of Syphilis?

The symptoms of syphilis vary according to the stage of the disease. In the initial stage of the disease, one or more painless, red swellings known as chancres may be observed in the genital area or the sites where the bacteria entered the body. The most contagious period of the disease is typically during its early stages. However, since the swellings that appear at this stage are mostly painless, the majority of patients may not realize they have syphilis.

As the first chancre heals or a few weeks after healing, red or brown itchy rashes may appear on the skin. In addition to the rash, the main symptoms of syphilis seen at this stage can be listed as follows:

• Wart-like sores in the genital area or mouth
• Hair loss
• Muscle aches
• High fever, especially at night
• Sore throat
• Fatigue
• Unexplained weight loss
• Swelling in the lymph nodes

Approximately 30-40% of patients who do not begin treatment in the secondary stage may progress to the third stage, also known as late-stage syphilis. At this stage, involvement of organs such as the brain, heart, liver, and eyes can be observed. Congenital syphilis, which occurs in newborns, can present with the following main symptoms:

• Fluid-filled blisters, especially on the baby's hands and feet
• High fever
• Jaundice in the skin and eyes
• Anemia
• Enlargement of the spleen and liver
• Bone abnormalities

In addition to the symptoms listed above, signs of syphilis in infected infants may not appear immediately after birth. Symptoms in these children can be observed at age 4 or older.

What Causes Syphilis?

The main cause of syphilis is the bacterium Treponema Pallidum. The primary route of transmission of the disease is through contact with the sores of an infected person. Treponema Pallidum can also enter the body through small cuts or abrasions in the skin. Generally, the disease is more contagious in its early stages. However, patients can occasionally transmit the infection to their partners during the latent stage after the secondary stage.

In some cases, syphilis can be transmitted through kissing or touching a sore located on the lips, tongue, mouth, breasts, or genital areas. Additionally, it can rarely be passed to babies during pregnancy and childbirth, or through breastfeeding. Syphilis is not transmitted through objects touched by an infected person. In other words, there is no risk of infection from shared spaces such as pools, baths, toilets, or towels.

While anyone engaging in unprotected sexual intercourse is at risk of contracting syphilis, certain factors may increase the risk. The primary risk factors for syphilis are as follows:

• Unprotected sexual intercourse
• Having multiple sexual partners
• Being infected with the virus that causes HIV/AIDS.

Treatment of Syphilis

Patients who suspect they have syphilis should first be thoroughly examined by a specialist doctor in a healthcare institution. At this stage, a blood sample taken from the patient is examined in the laboratory to investigate the presence of Treponema Pallidum bacteria. If deemed necessary, specialists may take a tissue sample from the patient’s sore and examine it under a microscope.

After confirming the presence of syphilis, specialists may prescribe antibiotics. The treatment of syphilis with antibiotics is possible. The dosage and duration of the antibiotic are adjusted according to the stage and symptoms of the syphilis. After the antibiotic treatment is completed, there is no risk of syphilis spontaneously reappearing. However, those who have sexual contact with an infected person may contract the disease again even after treatment.

If left untreated, syphilis can cause serious complications. Problems such as miscarriage and premature birth may occur during pregnancy. Swellings in the skin, bones, liver, and other organs, neurological issues, eye problems, and cardiovascular problems are among the main complications of syphilis. Additionally, sores in the genital area can increase the risk of contracting HIV.

How to Prevent Syphilis?

Currently, there is no definitive way to prevent syphilis. However, taking certain precautions can minimize the risk of contracting syphilis. Some measures that can be taken include:

• Safe sex is the most effective way to prevent syphilis. The use of condoms during intercourse can reduce the risk of syphilis. Additionally, being in a monogamous relationship can help protect against syphilis.
• Douching can disrupt the vaginal flora (the natural balance of bacteria), increasing the risk of bacterial infection. Therefore, specialists recommend avoiding douching.
• Syphilis is an infectious disease that can be treated with appropriate antibiotic therapy. Don’t hesitate to make an appointment with a specialist doctor for detailed information about syphilis.