Syphilis: Information & syphilis doctors

Syphilis is also known as lues (venerea), hard chancre or French disease. It is a sexually transmitted disease that is widespread worldwide. It is caused by an infection with the bacterium Treponema pallidum. In the past, syphilis resulted in severe illnesses with long-term damage and even death. Today, infection with Treponema pallidum tends to be chronic.

Causes of syphilis

Syphilis is caused by an infection with the pathogen Treponema pallidum. This is a spiral or helical rod-shaped bacterium from the spirochete family.

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

The bacterium enters the human organism via the smallest skin tears or intact mucous membranes. Here it first infects regional lymph nodes. The syphilis pathogen then spreads throughout the body via the lymphatic system and the bloodstream. Finally, all organs and the central nervous system are affected.

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

The bacterium can also be transmitted to the unborn child during pregnancy. This sometimes results in malformations, congenital syphilis or a miscarriage.

Symptoms of syphilis

Syphilis usually progresses in four stages if the infection is not treated. There are alternating phases of illness with severe symptoms and so-called latent phases. In latency phases, the infected person is sometimes symptom-free for years.

People infected with syphilis are most infectious in the acute first stage (primary syphilis). In the second stage (secondary syphilis), the risk of infection 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 known as Lues I. The first symptoms usually appear 10 to 30 days after infection.

Initially, small, painless ulcers with hard edges (so-called hard chancres) form at the site of bacterial entry. They are accompanied by a massive but painless swelling of the neighboring lymph nodes. In men, the entry point is the penis or anus. In women, the vagina, labia or anus are affected first.

These ulcers secrete a colorless fluid. It contains large quantities of the syphilis pathogen and is therefore extremely contagious. These ulcers in the genital area usually 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 blood and lymph channels. Around eight weeks after the disappearance of the ulcers in the genital area, the infection usually manifests itself in the form of

• skin rashes,
• inflammation of the mucous membranes,
• hair loss and
• swelling of the lymph nodes all over the body.

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

General symptoms of the disease such as

• Headache or sore throat,
• fever,
• joint and muscle pain,
• nausea and vomiting,
• fatigue and
• loss of appetite

can occur at this stage of syphilis. This may be followed by a latency phase in which the infected person may not show any 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 actual infection. By then, the syphilis pathogen has spread throughout the entire body and infected numerous tissues and organs, such as

• the skin
• the blood and airways
• the bones and muscles,
• the throat,
• the oesophagus,
• the stomach and
• the liver.

Rubbery, hardened lumps (known as gummas) then form in the subcutaneous tissue.

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

An aneurysm can also form in the main artery(aorta). If this aneurysm bursts, there is a high risk of death.

The fourth stage: Lues IV

The fourth stage of syphilis is known as Lues IV or neurosyphilis. Here, due to the bacterial infestation of

• brain,
• bone marrow and
• nervous system

to severe neurological disorders. These include

• Paralysis,
• gait instability,
• sensory disturbances,
• loss of reflexes,
• hearing and visual disorders,
• dementia,
• personality changes and
• hallucinations.

In the absence of treatment, this final stage usually begins after a further symptom-free latency phase. This symptom-free phase usually lasts ten to twenty years.

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

Frequency of syphilis

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

Men are most frequently infected. They are usually 30 to 40 years old. In 80 percent of cases, they become infected during same-sex sexual intercourse.

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

Diagnosis of syphilis

If syphilis is suspected, the doctor takes a blood sample and a swab from the ulcer or rash. These are then examined in the laboratory.

The blood test reveals whether the patient's body has already produced antibodies against the syphilis pathogen. If this is the case, there is a very high probability that the pathogen is present in the body.

In order to subsequently confirm the diagnosis of syphilis, the swab taken is also examined under a microscope. In this way, the syphilis pathogen itself can be detected.

Syphilis treatment

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

If the infected person suffers from a penicillin allergy, other antibiotics such as

• erythromycin,
• tetracycline or
• doxycycline

can be used instead.

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

The partner of the infected person must also be examined for syphilis and, if necessary, treated. Former partners must also be informed if the infection occurred a long time ago. They may also have been infected with syphilis and must therefore be tested.

Prognosis and chances of recovery from syphilis

The prognosis for syphilis today is generally good to very good. However, it depends on the stage at which antiobiotic treatment is started. In the first two stages, syphilis can be successfully treated with consistent therapy. No permanent damage remains.

If syphilis is only recognized and treated in the third or fourth stage, late damage can be the result. If treatment begins in the neurosyphilis stage, the prognosis is rather unfavorable.

This can leave the infected patient with paralysis or other damage. They often require lifelong care of the syphilis patient. If left untreated, syphilis even leads to death in around 10 percent of cases.