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Syphilis is a bacterial infection that usually spreads through sexual contact.



Syphilis starts as a painless sore on the genitals, rectum or mouth and it is gradually progressing, affecting all people coming to direct contact with the sores on the skin and mucous membrane.

After the initial infection, the syphilis bacteria can lie dormant in the organism for decades before becoming active again. Early-stage syphilis can be cured, sometimes with a single injection of penicillin. If left untreated it  can severely damage your heart, brain or other organs, and can be life-threatening.


It develops in stages, while its symptoms vary with each stage. However, sometimes the stages may overlap, with the symptoms not always occurring in the same order. There are chances of infection without noticing any symptoms for many years.

Primary syphilis. The first sign is a small sore, which is also called a chancre and appears at the spot where the bacteria entered the body. While most people infected develop only one chancre, some people develop several sores. The chancre usually develops about three weeks after exposure. Many patients don’t notice the chancre because it’s usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within six weeks.

Secondary syphilis. Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience muscle aches, fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent syphilis. If the patient is not treated, the disease moves from the secondary to the latent stage, in which there are no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary stage.

Tertiary syphilis. About 15-30% of infected people who don’t get treatment will develop complications, which, in the late stages, may damage the patient’s brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection. Depending on the area where the lesion is localised, the disease gets its name. The most characteristic types include cardiovascular syphilis, neurosyphilis and syphilis of the bones.

Congenital syphilis. Babies born to infected women can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. If the disease progresses, it may cause deafness, as well as teeth and nose deformities.

When to visit a dermatologist

Arrange an appointment with the dermatologis-venereologist if you observe any unusual discharge, sores or rashes, particularly if these occur in the groin area.


It is caused by a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes.

It is contagious during its primary and secondary stages, and sometimes in the early latent period. It cannot be transmitted by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs. Once cured, it doesn’t recur. However, you can become reinfected if you have contact with someone’s syphilis sore.

Risk factors

Factors that may increase the risk of acquiring syphilis include:

  • Unprotected sexual contact
  • Large number of sexual partners
  • Sexual contact between men
  • HIV infection, the virus that causes AIDS

Complications of syphilis

If it remains untreated, it can lead to serious damage throughout your body. It also increases the risk of HIV infection, while for women it can cause problems during pregnancy. Treatment can help prevent future damage but can’t repair or reverse damage that has already occurred.

Small bumps or tumours. These bumps may develop on the skin, bones, liver or any other organ in the late stage of the disease. These bumps or tumours usually disappear after treatment with antibiotics.

Neurological problems. It can cause a number of problems with your nervous system, such as stroke, meningitis, deafness, visual problems or dementia.

Cardiovascular problems. Syphilis may lead to aneurysm and inflammation of the aorta (the major artery of the body), as well as of other blood vessels. Syphilis may also cause damage of the heart valves.

HIV Infection. It has been estimated that adults with sexually transmitted syphilis or other genital ulcers have around 2 to 5 times more chances to be infected with HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter your bloodstream during sexual activity.

Pregnancy and childbirth complications. If a woman is pregnant, she may pass syphilis to her unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.

Tests and diagnosis

Syphilis can be diagnosed by testing samples of:

Blood. Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the bacteria that cause syphilis remain in your body for years, so the test can be used to determine a current or past infection.

Fluid from sores. Your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. This test can be done only during primary or secondary syphilis, when sores are present. The scraping can reveal the presence of bacteria that cause syphilis.

Cerebral spinal fluid. If it’s suspected that you have nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture (spinal tap).

Treatments and medications

If the diagnosis and treatment of syphilis is conducted in its early stages, it can be cured easily. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. For patients who are allergic to penicillin, it is possible to use another antibiotic.

A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses.

Penicillin is the only recommended treatment for infected pregnant women. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you’re treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.

The first day you receive treatment you may experience what’s known as the Jarisch-Herxheimer reaction. Signs and symptoms include fever, chills, nausea, achy pain and headache. This reaction usually doesn’t last more than 24 hours.

Follow-up period

After the administration of treatment, the dermatologist-venereologist will ask the patient to:

Have periodic blood tests and exams to make sure you’re responding to the usual dosage of penicillin

Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured

Notify your sex partners so that they can be tested and get treatment if necessary

Be tested for HIV infection


Transmission can be prevented if:

You abstain from sexual contacts or you are monogamous. The only certain way to avoid syphilis is to forgo having sex. The next-best option is to have mutually monogamous sex with one partner who is uninfected.

Use a latex condom in each and every sexual contact. Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.

Do the relevant exams before becoming pregnant. If you are planning to have a baby, it is advisable to have a test for syphilis and other sexually transmitted diseases before becoming pregnant.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

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