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Syphilis is a sexually transmitted infection that can cause serious health problems without treatment. It is caused by a spiral bacteria called traponema pallidum.
In Singapore, we are seeing an average of about 1500 cases of newly diagnosed syphilis yearly for the past 5 years.
In Europe and America, there has been an increase in the number of syphilis cases, going up by as much as 70% over the past 10 years.
How Syphilis Spread
Syphilis is spread from person to person through sexual contact with the infected ulcers called chancres.
It can occur in, on or around the penis, vagina, anus, rectum and lips or mouth. They can spread during vaginal, anal or oral sex.
Pregnant ladies with syphilis can also transmit the infection to their unborn child.
You cannot get syphilis through casual contact with objects such as
- toilet seats, door knobs
- swimming pools
- hot tubs and bath tubs
- sharing of clothes or utensils
Symptoms of Syphilis
You can start to show symptoms of syphilis 10 days to 3 months from the exposure. Syphilis is referred to as “ The Great Pretender “ as its symptoms can mimic many other diseases.
Stages of infection
The infection can be divided into a few stages Primary, secondary, latent and tertiary syphilis.
The primary stage is the first stage of infection. A skin papule or bump will first appear and subsequently develop into an ulcer or multiple ulcers that are often painless, firm and round.
This happens usually at the location where syphilis enters the body such as the private areas like the vagina or penis.
The chancre usually last 3-6 weeks and disappear on its own whether or not you receive the treatment and if left untreated, the disease will progress to the secondary stage within 1 to 2 months.
In the secondary stage, there are a few prominent signs that may occur. First would be skin changes like a rash, hair loss or skin growths called condyloma lata. Secondly, patients may develop flu like reactions.
Lets talk more about the skin changes.
- The typical rash usually appear as rough red or reddish-brown spots or patches on the body, palms and soles and they usually do not itch. However it may appear in various forms as well that may be mis-diagnosed as other conditions.
- Condyloma lata are skin growths that can be skin coloured or greyish white. They are typically raised and occurs in moist areas like the groin, private and peri anal area, even mouth and armpit. They tend to occur near to where the initial chancre was seen. They can be mistaken as warts in some cases.
- Hair loss is another common skin change. Loss of hair (known as alopecia ) may occur on the scalp, eyebrow or beard area in patches or widespread.
The flu like symptoms that may occur includes
- fever, headache and body ache
- lethargy and fatigue
- sore throat, swollen lymph nodes
- loss of appetite and weight loss
The Great Pretender
So as you can see in secondary syphilis, The skin rash may look like other skin conditions, condyloma lata can be mistaken as viral wart and flu like symptoms can present like any other flu conditions, even COVID 19! Hence its infamous Alias “ The great pretender ".
We must always have high index of suspicion to diagnose syphilis.
Secondary syphilis will progress to latent syphilis if no treatment is given. This stage is the hidden stage where there are no symptoms and signs and it can last for years. However individuals in the latent stage may still be infectious and spread the bacteria to their sexual partners.
Finally about a third of patients with latent syphilis will progress to tertiary syphilis where the bacteria will attack our internal organs and result in serious medical complications.
The doctors must first have a high index of suspicion as symptoms of syphilis may mimic many other conditions. When someone who has a history of sexual exposure presents with primary or secondary syphilis symptoms, a venous blood sample is all we need to achieve a diagnosis.
Fortunately, there are treatment for syphilis.
For patients in the primary, secondary and early latent syphilis, a single dose of benzathine penicillin injection is recommended.
In patients in late latent syphilis or syphilis of unknown duration, 3 doses of benzathine penicillin injection is recommended at weekly intervals. Alternatives if patients are allergic to penicillin includes doxycycline and tetracycline.
People receiving syphilis treatment should abstain from sex until they are proven to be cured. They should also notify their sex partners so that they too can be tested and treated if necessary.
Link Between Syphilis and HIV
Now, there is actually a significant link between syphilis and HIV. In the United States, 50% of men who has sex with men diagnosed with primary & secondary syphilis has HIV infection as well.
Additionally, these men who are HIV negative and diagnosed with syphilis are at a higher likelihood to get HIV in future. Reason is that the genital sores in primary syphilis makes it easier for the HIV virus to be transmitted.
Furthermore, Syphilis and other STDs may indicate ongoing behaviours and exposure that may place the person at a greater risk of acquiring HIV.
So please, to avoid getting syphilis or any other STD, please practise the below steps
- Be in a long-term mutually monogamous relationship
- Use condoms correctly during sexual interactions
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)