Syphilis Treatment

What is syphilis?

Syphilis is an infectious disease caused by Treponema pallidum, a corkscrew-shaped bacteria. This is a sexually transmitted disease that in early stages causes a genital ulcer.  If the bacteria is not treated, the disease can progress into later stages with more complications.  Secondary syphilis infection is characterized by systemic symptoms (eg, fever, malaise, anorexia) and rash all over the body.  Tertiary syphilis typically results in heart disease, brain and spinal cord abnormalities, and bone disease.  Patients may also develop neurosyphilis – this often results in dementia, peripheral neuropathy, and tabes dorsalis. 

The prevalence of primary and secondary syphilis is on the rise in the United States.  Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions

  • What causes syphilis?
  • How common is syphilis?
  • What are the symptoms and signs of syphilis?
  • How is syphilis diagnosed?
  • How is syphilis treated?

What causes syphilis?

Syphilis is caused by the bacteria Treponema pallidumPatients acquire the infection through sexual contactthis involves contact with the mucocutaneous skin lesions in an infected individual.  The bacteria accesses tissues through microscopic abrasions in the skin.  The first lesion is characteristically called the chancre and often involves the penis or female external genitalia.  The bacteria then travels to local lymph nodes and may disseminate widely throughout the body – this often includes the heart, brain, spinal cord, skin, and bones.  The disease can also be transmitted from mother to child in primary and secondary stages of syphilis.

How common is syphilis?

Cases of primary and secondary syphilis in the United States have generally increased from 2001 to 2015.  This rate increase has occurred in men, women, and every region of the country.

Primary syphilis is often managed by primary care doctors, but secondary, tertiary, and neurosyphilis often require referral to infectious disease specialist.  Neurosyphilis also typically requires a neurology specialist.

What are the symptoms and signs of syphilis?

Symptoms and signs of syphilis depend on the stage of infection.  There are 3 main stages, which include:

  • Primary infectionpainless ulcerative lesion on the genitalia (chancre) that heals in weeks
  • Secondary infection (weeks to months later) - fever, diffuse rash, headache, malaise, decreased appetite, weight loss, and lymphadenopathy
  • Tertiary infection – brain and spinal cord disease, heart disease, aortic insufficiency central, skin and bone disorders

Neurosyphilis may occur at any time following primary infection.  It is typically characterized by dementia, peripheral neuropathy, tabes dorsalis, and Argyll-Robertson pupil.  Tabes dorsalis is a disease described by degeneration of the posterior columns of the spinal cord – this results in sensory loss in the lower extremities and trouble balancing.  Patients also tend to develop severe shooting pain (lancinating pains).  Individuals with Argyll-Robertson pupil have a constricted pupil that accommodates on convergence testing, but does not respond to light.

How is syphilis diagnosed?

The diagnosis of syphilis is suggested based on symptoms and physical examination, but typically confirmed with serologic blood tests.  This usually includes a rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) study.

If you doctor suspects neurosyphilis, they may perform a lumbar puncture (spinal tap).  During this procedure, they will position you in a sitting position or lying flat on the side (lateral decubitus position).  They will then sterilize your lower back area with povidone-iodine or chlorhexidine and mark anatomic landmarks.  A needle is then inserted into the fluid-fill sac surrounding the spinal cord.  Fluid is drained into tubes and analyzed for features such as protein, glucose, cell counts, grain stain, and culture.  Specific tests for neurosyphilis may also be analyzed in the cerebrospinal fluid.  If the diagnosis of neurosyphilis is not clear, your doctor may order an MRI of the brain and or spine to rule out tumor or stroke.

Since syphilis is a sexually transmitted disease, your doctor will likely evaluate you for other sexually transmitted infections such as HIV, hepatitis C, gonorrhea, and chlamydia.

Commonly ordered routine blood tests include a CMP (comprehensive metabolic panel), CBC (complete blood cell count), thyroid function tests (TSH, free T4), and urine analysis.  Your doctor will likely obtain an EKG (electrocardiogram), chest x-ray, and ultrasound of the heart (echocardiogram) if they are concerned for heart disease.

How is syphilis treated?

Every stage of syphilis is treated with Penicillin.  Depending on the stage of your infection, antibiotics may be administered intramuscularly (IM) or intravenously (IV).  Intravenous penicillin G is generally reserved for patients with neurosyphilis.  For patients who are allergic to penicillin, alternative agents include:

  • Vibramycin (doxycycline)
  • Rocephin (ceftriaxone)
  • Zithromax (azithromycin)

Your doctor will monitor you closely and continue to follow serologic tests to make sure the bacteria has cleared.

Syphilis Patient Summary:

  • Syphilis is an infectious disease caused by Treponema pallidum, a corkscrew-shaped bacteria. This is a sexually transmitted disease that in early stages causes a genital ulcer. 
  • Symptoms of syphilis depend on the stage of infection.
  • Primary infection is characterized by a painless ulcerative lesion on the genitalia (chancre).
  • Secondary infection is characterized by fever, diffuse rash, headache, malaise, decreased appetite, weight loss, and lymphadenopathy.
  • Tertiary infection causes brain and spinal cord disease, heart disease, aortic insufficiency central, skin, and bone disorders.
  • Neurosyphilis may happen at any time during infection as is characterized by dementia, peripheral neuropathy, and tabes dorsalis (spinal cord disease), and Argyll Robertson pupil.
  • The diagnosis of syphilis is suggested based on symptoms and physical examination, but typically confirmed with serologic blood tests. This usually includes a rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL).
  • If you doctor suspects neurosyphilis, they may perform a lumbar puncture (spinal tap) to obtain spinal fluid and implement additional testing.
  • You will likely need an EKG (electrocardiogram), chest x-ray, and ultrasound of the heart (echocardiogram) if they are concerned for heart disease.
  • Every stage of syphilis is treated with Penicillin. Depending on the stage of your infection, antibiotics may be administered intramuscularly (IM) or intravenously (IV).
  • For patients who are allergic to penicillin, alternative agents include: Vibramycin (doxycycline), Rocephin (ceftriaxone), and Zithromax (azithromycin).
  • Your doctor will monitor you closely and continue to follow serologic tests to make sure the bacteria has cleared.

References:

  1. Ghanem KG, Workowski KA. Management of adult syphilis. Clin Infect Dis 2011; 53 Suppl 3:S110.
  2. Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 315:2328.

Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA 2014; 312:1905.

Popular Syphilis Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.