Last updated date: 09-Feb-2023

Medically Reviewed By

Medically reviewed by

Dr. Lavrinenko Oleg

Originally Written in English

Learn more about one of the world's oldest fatal diseases: Syphilis


    In 1495, an epidemic of a new terrible disease broke out among the soldiers of Charles VIII of France when he invaded Naples in the first of the Italian Wars. 

    The consequences of this disease on the people of Europe were devastating. This disease was syphilis or as was called the “great pox”.

    Syphilis didn’t have the same horrendous mortality rate as the plague; however, its symptoms are repulsive and very painful. 

    The appearance of genital sores followed by the appearance of foul abscesses and ulcers all over the body freaked people out then. The pain was also severe. 

    And because it is a sexually transmitted disease, it was shamed and stigmatized from the very beginning of the emergence of the disease. 

    In 1495, an Italian doctor called Nicolo Squillaci wrote a letter that contained the first written syphilis symptoms, and he wrote “There are itching sensations and an unpleasant pain in the joints”. He also wrote, “The skin is inflamed with revolting scabs and is covered in swellings and tubercules, which are of a vivid red colour at first and then become blacker”.

    “It most often begins with the private parts. Nothing could be more serious than this curse, this barbarian poison.”

    This letter was written during the first major syphilis epidemic to sweep through Europe. Squillaci also called syphilis the “French disease” in his letter, which led to an often-seen tendency in the early discussion of the disease to blame the people of that area, which is France here, for the illness.

    When syphilis first appeared in Europe in the 15th century, it appeared to be a more severe disease than it is today. It had killed its victims more quickly back then and it had spread faster. 

    Doctors think that syphilis was so brutal back then because it was a new disease in Europe and people had no immunity to it yet, just like it is the case with the new Coronavirus today. 

    People in the 15th century called it the “great pox” in light of its very painful and repulsive symptoms. 

    One of the major causes, why this disease was so brutal, was that treatments were so few and ineffective. Physicians back then tried remedies like mercury ointments which lead to mercury poisoning. Many patients died from these remedies because they were very painful. People also died from mercury poisoning. 

    Some physicians back then thought that sweat baths would help because they thought sweating can purge the body from syphilitic poison. 


    But what is Syphilis after all? What is the true nature of this disease? 

    Syphilis is a bacterial infection that is usually transmitted via sexual contact. It spreads through sexual contact with someone who has the infection. 

    The disease is caused by Treponema Pallidum bacterium, a bacterium classified under the spirochaetes phylum. There are more members in the treponema family of bacteria, however, syphilis is the only sexually transmitted treponemal disease and the other conditions are transmitted via direct contact with an infected person. 

    Without treatment, syphilis can cause some serious health problems. 


    What is the origin of the name Syphilis? 

    The first person to call this disease syphilis was an Italian poet called  Giralamo Fracastoro in a long poem of that title that was published in 1530. 


    How is Syphilis spread? 

    As we mentioned syphilis can spread through sexual contact. However, syphilis can also spread by direct contact with a syphilitic sore during vaginal, anal, or oral sex. Syphilitic sores can be found on or around the penis, vagina, anus, or rectum. They can also be found on the lips or in the mouth. Syphilis can also spread from an infected mother to her unborn baby. 


    How can someone know they have Syphilis? What are the symptoms of Syphilis?

    Syphilis is a unique disease in its development. It develops in stages and every stage has its unique symptoms. However, stages might overlap and they don't always occur in the same order. Some people might have syphilis and never notice any symptoms for years. 

    But let's have a look at the different stages of syphilis.

    • Primary syphilis. When a patient is infected with syphilis, the first sign is a small sore called a chancre. This smooth red sore or ulcer appears at the site where the bacteria entered the body such as the genitals or the mouth. Most people develop only one chancre; however, some people might develop more than one chancre. The chancre usually develops about three weeks after exposure. Patients usually don't notice the chancre because it is painless, looks like a pimple and might be hidden in the vagina, rectum or under the foreskin of the penis. Then the chancre will heal on its own in about three to six weeks.
    • Secondary syphilis. After the original chancre healing, within a few weeks, patients usually experience a rough, bumpy rash that usually begins at the trunk but eventually covers the whole body, even the palms and soles. The rash is usually not itchy and may appear with wart-like sores in the mouth or genitals. Some patients also reported flu-like symptoms such as muscle weakness, fever, sore throat, hair loss, and swollen lymph nodes. These symptoms either disappear within a few weeks or repeatedly come and go for a year.
    • Latent syphilis. If left untreated, syphilis moves from the secondary stage to the hidden latent stage. This hidden stage can last for years and symptoms may never appear again. In some cases, the disease develops to the third or tertiary stage.
    • Tertiary stage. About 15% to 30% of the untreated cases will develop severe complications known as tertiary syphilis. Tertiary syphilis includes some severe and serious health complications, including brain damage, dementia, mental health problems, heart disease, movement disorder, muscle problems, nerve damage, seizures, tumors on the bone and skin and vision problems. However, for many people, symptoms never progress further than the latent phase either because the symptoms are too mild to be noticed or because it cures itself. 
    • Neurosyphilis. When the disease causes serious damage to the brain and nervous system at any stage, it is called neurosyphilis.
    • Congenital syphilis. As we mentioned earlier, women who are infected with syphilis can pass the infection to their unborn baby through the placenta or even during birth. Babies born with congenital syphilis will mostly have no symptoms. But some babies might experience a rash on the palms of their hands and the soles of their feet. Later, those babies might develop other symptoms such as deafness, teeth deformities, and saddle nose, where the bridge of the nose collapses. In some cases, infected babies can be born too early, die in the womb or even die after birth. That's why all pregnant women must be screened for syphilis. It is a fatal disease for infants and babies.

    So, as we explained, symptoms of syphilis depend on the stage the disease is in at any given moment.

    Some people think that symptoms of syphilis can differ according to the gender of the infected person. I mean, some people believe that men have different symptoms than women.


    What are syphilis symptoms for men and women?

    Syphilis symptoms for men and women

    Actually, syphilis symptoms in men and syphilis symptoms in women are almost the same because most often, syphilis has very mild symptoms or no symptoms at all those patients don't notice. Besides, symptoms of different stages might overlap, but in the end, symptoms are the same for men and women.

    But let me sum the symptoms up for you again in a few points:

    • In the first stage, a small painless sore called chancre develops on the genitals.
    • In the second phase, a pink rough, bumpy rash appears on the body, usually on the palms and soles in addition to flu-like symptoms such as fever, fatigue, muscle ache and sore throat. During the first two phases, syphilis is very contagious and can be spread from one person to another via sex or direct contact with the chancre or the rash.
    • Then the infection either becomes hidden/ latent or develops to be more severe and involves other systems and body parts.


    At the beginning of our article, we mentioned how syphilis was an epidemic through Europe, but what about now? 


    How common is Syphilis now? 

    Surprisingly, syphilis cases have been increasing in recent years especially among bisexual and gay men. About 80,000 people are diagnosed with syphilis every year. 

    Syphilis is more common in men and usually appears in people in their early 20s.

    But in general, anyone who is sexually active might get syphilis. However, some people may be at a higher risk of getting syphilis more than others.

    The risk of getting syphilis gets higher when the patient is: 

    • Gay or bisexual.
    • Having unprotected sex with many partners.
    • HIV positive.
    • Having sex or have had sex with someone who tested positive for syphilis.
    • Having or tested positive for other STDs such as herpes, chlamydia or gonorrhea.

    In addition, because pregnant women can pass syphilis to their babies, they need to get tested for syphilis during pregnancy. We are emphasizing this piece of information because syphilis infection in infants can cause death or other severe health problems in babies and children.


    Now, you might ask, how is HIV a risk factor for Syphilis? What is the link between the two diseases? 

    Having a sore or break in the skin from an STD such as syphilis will allow HIV to easily enter the body.

    Besides, people who have syphilis are highly likely to acquire HIV as well. For example, approximately half of the gay men In the USA who have primary or secondary syphilis are also living with HIV.

    People with syphilis can easily acquire HIV as well because they are adopting the same behaviours and living the same circumstances that put them at a risk for getting another STD.


    But if Syphilis could be easily missed, regardless of its phases, how can doctors diagnose it? 

    The first thing you will go through if you want to know whether you have syphilis or not is to have a discussion with your healthcare provider. He or she will ask you about your sexual activity and you have to be honest during this discussion. Through this discussion, your health care provider will be able to assess your risk factors and recommend getting tested for STDs or not.

    To test for syphilis, your provider will physically examine your first, then will take a blood sample from you to look for signs of infection. 

    Syphilis can be diagnosed by testing samples of: 

    • Blood samples. Blood tests can confirm the presence of the antibodies the blood forms against certain infections. So, doctors usually search for the syphilis-fighting antibodies, they remain in the body for years, that’s why blood tests can be used to determine whether it is a current or past infection. 
    • Cerebrospinal fluid. When your healthcare provider suspects that you have a nervous system problem due to syphilis infection, your provider will suggest collecting a sample of your cerebrospinal fluid through a lumbar puncture. 

    After getting tested, you should also consider telling your previous sexual partners so they can be tested and get treatment too to stop spreading the infection. 


    So, if tests revealed current infection, how is Syphilis treated? Can syphilis be cured?

    In the past, a huge number of people died due to syphilis infection because nobody knew back then that it was a bacterial infection. 

    Currently, to treat syphilis at any stage, healthcare providers use penicillin, an antibiotic medication that can kill the bacterium that is causing syphilis. 

    Some people may be allergic to penicillin, in this case, doctors will use another type of antibiotic or use the penicillin desensitization approach. 

    The recommended treatment for primary, secondary, or early-stage latent syphilis is a single injection of penicillin because those early stages mean there is an infection within the last year. If a patient has had syphilis for more than one year, he or she might need additional doses of penicillin. 

    As for pregnant women with syphilis infection, penicillin is the only recommended medication. Women who are allergic to penicillin can undergo a desensitization process to be able to take penicillin later. 

    Children of pregnant women with syphilis should be tested for congenital syphilis after they are born, even if their mothers took their antibiotic course. If those infants are infected, they should receive antibiotic treatment. 

    A reaction known as Jarisch Herxheimer can be experienced after the first dose. Signs and symptoms of this reaction include fever, nausea, chills, headache and pain. But don’t worry, this reaction doesn’t last more than one day. 

    One of the simplest yet most important rules about syphilis treatment is that patients must complete the entire course of antibiotics even if the chancre or the rash go away. Besides, it is highly crucial to contact previous sexual partners to let them know about the infection and that they should be tested as well. 

    And always remember, when diagnosed and treated in its early stages, syphilis is easy to cure. 


    But after treatment, how to make sure that it works?

    After syphilis treatment

    After finishing the course of treatment, your healthcare provider will ask you to: 

    • Have periodic blood tests to make sure that your body is responding well to the usual dose of penicillin. However, the number of follow-up sessions you will have with your doctor depends on the stage of syphilis you are diagnosed with. 
    • Stop any new sexual contact with different partners until the treatment is completed and blood tests show that the infection has been cured. 
    • Get tested for HIV infection. 
    • Notify your sexual partners so they can be tested and get treatment if necessary. 

    It is really important to bear in mind that syphilis infection can happen again even after it has been cured. That’s why it is very important to practice safe sex and get tested regularly especially if there are many risk factors. 


    As we mentioned before, the earlier the treatment, the better the results. Many complications can arise if the disease is left untreated. Without treatment, syphilis can cause severe damage throughout the whole body. 

    Treatment can help prevent further damage but can never reverse the damage that has already occurred. 

    Let’s have a look at some of the complications untreated syphilis infection can cause: 

    • Small bumps or tumors. In the late stages of the disease, small bumps called “Gummas” can develop on the skin, bone, liver or any other organ, Gummas will disappear with the antibiotic treatment. 
    • Neurological problems. We mentioned before that syphilis can cause a number of problems to the nervous system such as headache, stroke, hearing loss, meningitis, dementia, sexual dysfunction in men, bladder incontinence and loss of pain and temperature sensations. 
    • Cardiovascular problems. Swelling or bulging of the aorta, the largest artery in the body, or damage to heart valves can happen due to syphilis infection. 
    • HIV infection. As we mentioned, both diseases can occur at the same time. In fact, adults with an STD like syphilis or other genital ulcers have a two-to-five-fold increased risk of contracting HIV. 
    • Childbirth problems. Congenital syphilis significantly increases the risk of miscarriage, stillbirth, and the death of the infant in a few days after birth. 


    So, how can we protect ourselves from getting infected in the first place? How can we prevent syphilis infection? 

    Unfortunately, unlike the human papillomavirus, syphilis doesn’t have a vaccine. However, you can protect yourself by following simple instructions, including:

    • Abstain or be monogamous. The only confirmed way to avoid syphilis is to avoid having sex. The second-best option is to have mutually monogamous sex in which both partners have sex only with each other. 
    • Use condoms. Condoms can reduce the risk of spreading syphilis when the condom covers the syphilitic sores. So, every time you have sex, use latex condoms the right way. It plays a significant role in the prevention of many sexually transmitted diseases.  Dental Dams are also used for people who practice oral sex. 
    • Avoid recreational drugs.  Alcohol and other drugs misuse can affect your better judgment and lead to unsafe sexual behaviours and practices. 


    Partner notification and preventive treatment, as we mentioned before, is one of the most crucial steps in the prevention of the spread of the disease. 

    If you have syphilis, you should inform other partners you have engaged sexually with in the last three months to one year. 

    Also, in light of the deadly effects of syphilis on unborn infants and newborns, it is recommended that all pregnant women get screened for syphilis infection. 

    Finding out that you have syphilis is not easy at all, and it is even more difficult to trace the infection back to the one partner who had passed the infection to you. You might feel angry and feel like you have been betrayed. 

    You may also be ashamed because you may have passed this infection to others as well. 

    But don’t feel bad, and don’t think that your partner has been unfaithful to you because you both may have been infected by a partner from the past. 

    Always talk to your healthcare provider when you feel that something is wrong in any part of your body especially in the genital area. 

    Most people don’t feel comfortable sharing their sexual activity details but at the doctor’s office, you have to be honest and provide all the needed information so you can get the right treatment for your case. 

    You should also be aware of any pre-appointment restrictions or instructions, so before your appointment with your doctor ask if there is anything you need to know in advance. Tell your doctor all the symptoms you are experiencing and when those symptoms started. Tell your doctor all the symptoms, even those you think are unrelated to the reason for which you have scheduled this appointment. 

    Your doctor will definitely ask you about any drugs you are taking and about your family history of diseases, be honest. Make a list of all the drugs, vitamins and even any OTC drugs you have regularly. 

    And last but not least, always stay safe by practicing safe sex.