Syphilis

Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum. It is one of the oldest documented STIs and remains a significant public health concern globally, including in India where congenital syphilis (passed from mother to baby) is a serious issue.

Syphilis progresses through four distinct stages — primary, secondary, latent, and tertiary — each with different symptoms. The good news is that syphilis is completely curable with antibiotics, especially in its early stages.

Syphilis follows a characteristic four-stage progression:

• PRIMARY (3–90 days after exposure): A single painless sore called a chancre appears at the site of infection — genitals, anus, lips, or mouth. The sore heals on its own within 3–6 weeks, but the infection continues without treatment.
• SECONDARY (weeks to months after the chancre): A non-itchy rash — often appearing on the palms of the hands and soles of the feet — is characteristic. Also: flu-like symptoms (fever, fatigue, sore throat), hair loss, white patches in the mouth, and flat grey wart-like growths around the genitals (condylomata lata).
• LATENT: No visible symptoms. The infection lies dormant. Early latent (<1 year) is still treatable with a single penicillin dose. Late latent can persist for years.
• TERTIARY: Severe organ damage to the heart, brain, nerves, and other organs. Neurosyphilis can cause dementia, blindness, deafness, and paralysis. This stage is now rare with access to treatment.

• Direct contact with a syphilis sore during vaginal, anal, or oral sex
• Mother-to-child transmission during pregnancy or at birth (congenital syphilis)
• Sores can be on the genitals, anus, lips, or inside the mouth

Syphilis CANNOT be spread through toilet seats, doorknobs, swimming pools, clothing, or sharing food and utensils.

• VDRL or RPR test — non-specific screening blood tests. Window period: 3–6 weeks after infection.
• TPHA or FTA-ABS — confirmatory specific tests for Treponema pallidum.
• Swab from an active sore — direct detection; useful during the primary stage.
• CSF (cerebrospinal fluid) testing for suspected neurosyphilis.

A two-step approach is standard: VDRL/RPR screening followed by TPHA/FTA-ABS confirmation. A positive VDRL alone is not sufficient for diagnosis.

Syphilis is highly responsive to antibiotics, particularly penicillin:

• Primary, secondary, and early latent syphilis: Single intramuscular injection of Benzathine penicillin G (2.4 million units)
• Late latent and tertiary syphilis: Three weekly penicillin injections
• Neurosyphilis: Intravenous penicillin G for 10–14 days
• Penicillin allergy: Doxycycline 100mg twice daily for 14 days (primary/secondary) or 28 days (latent)

• Any unexplained genital sore, even if painless
• Regular testing if sexually active with multiple partners (every 3–6 months)
• All pregnant women — mandatory under India's antenatal care guidelines
• Before starting a new relationship
• If a partner has been diagnosed with syphilis