Syphilis: Information & Doctors Specializing in Syphilis

Syphilis is caused by infection with the pathogen Treponema pallidum. This is a spiral- or screw-shaped rod-shaped bacterium belonging to the spirochete family.

The bacterium is most commonly transmitted through unprotected sexual intercourse with an infected partner. Syphilis is therefore classified as a sexually transmitted disease. The probability of infection averages 40 to 60 percent, depending on the stage of the disease.

The bacterium enters the human body through tiny skin breaks or intact mucous membranes. Once inside, it initially infects regional lymph nodes. The syphilis pathogen then spreads throughout the body via the lymphatic system and the bloodstream. Eventually, all organs and the central nervous system are affected.

The syphilis pathogen can also be transmitted through blood transfusions. However, this is rather rare in Germany.

It is also possible for the bacterium to be transmitted to the unborn child during pregnancy. This can sometimes result in birth defects, congenital syphilis, or a miscarriage.

Syphilis typically progresses through four stages if the infection is left untreated. The disease alternates between active phases with severe symptoms and so-called latent phases. During latent phases, the infected person may remain symptom-free for years.

People with syphilis are most contagious during the acute first stage (primary syphilis). In the second stage (secondary syphilis), the risk of transmission decreases. In the third and fourth stages (tertiary and quaternary syphilis), the infected person is no longer contagious.

The First Stage: Lues I

The first stage of syphilis is also called Lues I. The first symptoms usually appear 10 to 30 days after infection.

At the site where the bacteria entered the body, small, painless sores with hard edges (known as chancres) first form. They are accompanied by severe but painless swelling of the nearby lymph nodes. In men, the site of entry is the penis or anus. In women, the vagina, labia, or anus are initially affected.

These sores secrete a colorless fluid. It contains large amounts of the syphilis pathogen and is therefore extremely contagious. In most cases, these sores in the genital area heal on their own after several weeks. However, they almost always leave a scar.

The Second Stage: Lues II

In the second stage of syphilis, the pathogen spreads throughout the body via the bloodstream and lymphatic system. About eight weeks after the genital sores have disappeared, the infection usually manifests as

• skin rashes,
• mucosal inflammation,
• hair loss, and
• swollen lymph nodes throughout the body.

Rashes on the hand in stage II syphilis © nuengneng | AdobeStock

General symptoms of illness such as

• headaches or sore throats,
• fever,
• joint and muscle pain,
• nausea and vomiting,
• fatigue, and
• loss of appetite

may occur at this stage of syphilis. This may be followed by a latent phase during which the infected person may show no symptoms for years.

The Third Stage: Lues III

The third stage of syphilis is also known as Lues III or late syphilis. It usually begins three to five years after the initial infection. By this point, the syphilis pathogen has spread throughout the body and affected numerous tissues and organs, such as

• the skin,
• the blood and respiratory tracts,
• the bones and muscles,
• the throat,
• the esophagus,
• the stomach, and
• the liver.

Rubbery, hardened lumps (called gummas) then form in

• the subcutaneous tissue,
• the bones, and
• the organs.

An aneurysm may also form in the aorta. If this aneurysm ruptures, it poses a life-threatening risk.

The Fourth Stage: Lues IV

The fourth stage of syphilis is called Lues IV or neurosyphilis. In this stage, due to the bacterial infection of

• the brain,
• bone marrow, and
• nervous system

. These include, among other things,

• paralysis,
• gait disturbances,
• sensory disturbances,
• loss of reflexes,
• hearing and vision problems,
• dementia,
• personality changes, and
• hallucinations.

If left untreated, this final stage usually begins after another symptom-free latent phase. This symptom-free phase typically lasts ten to twenty years.

In about 10 percent of cases, these late complications of untreated syphilis ultimately lead to the death of the affected person.

Overall, about two out of every 100,000 people in Western Europe contract syphilis each year. In Germany, this amounts to approximately 3,000 to 3,500 cases of syphilis per year.

Men are most commonly infected. They are usually between 30 and 40 years old. In 80 percent of cases, they become infected through same-sex sexual contact.

According to the Infection Protection Act of January 1, 2011, syphilis is a notifiable disease in Germany.

If syphilis is suspected, the doctor takes a blood sample and a swab from the sore or rash. These are then sent to a laboratory for testing.

The blood test determines whether the patient’s body has already produced antibodies against the syphilis pathogen. If so, it is highly likely that the pathogen is present in the body.

To confirm the diagnosis of syphilis, the swab sample is also examined under a microscope. This allows the syphilis pathogen itself to be detected.

Syphilis is usually treated with the antibiotic penicillin. It is typically injected into the patient’s gluteal muscle or administered as an infusion.

If the infected person is allergic to penicillin, other antibiotics such as

• erythromycin,
• tetracycline, or
• doxycycline

can be used as alternatives.

The dosage and duration of antibiotic treatment depend on the stage of syphilis. In the first and second stages of syphilis, it is usually sufficient to administer a long-acting antibiotic via injection once or twice.

The infected person’s partner must also be tested for syphilis and, if necessary, receive treatment as well. In the case of an infection that occurred some time ago, previous partners must also be informed. They, too, may have contracted syphilis and must therefore be tested.

The prognosis for syphilis is generally good to very good today. However, it depends on the stage at which antibiotic treatment is started. In the first two stages, syphilis can be successfully treated with consistent therapy. This leaves no lasting damage.

If syphilis is not detected and treated until the third or fourth stage, long-term complications may result. If treatment begins during the neurosyphilis stage, the prognosis is generally poor.

In such cases, the infected patient may suffer from paralysis or other complications. These often require lifelong care for the patient. If left untreated, syphilis can even be fatal in about 10 percent of cases.