Syphilis

In cooperation with Gilead Sciences

What causes the disease?

Syphilis (which is sometimes called lues) is caused by a spiral-shaped bacterium, a so-called gram-negative spirochete, called Treponema pallidum. The bacteria can survive almost anywhere in the human body and can spread quickly.

How is syphilis transmitted?

Syphilis is transmitted through vaginal and anal intercourse and during oral sex. The bacteria can sometimes also be transmitted via kisses if you have primary mouth ulcers. A pregnant woman who is infected can infect her fetus via the placenta. In early syphilis (the first two stages) one is highly contagious, in late syphilis the contagiousness is low or non-existent.

How do you protect yourself against syphilis?

The best protection against transmission is a condom, but since sores can occur in places on the body that are not protected by the condom, protection is not always complete.

What are the symptoms?

Syphilis is, together with tuberculosis and HIV, one of the great “disease imitators”. This means that, depending on the stage of the disease, one can show pretty much any symptoms. Syphilis is usually divided into four stages:

Primary syphilis: About three weeks after infection, a red oval wound (a so-called chancre) appears where the bacteria has penetrated the body (picture). For men, most warts are seen on the penis, anus, and rectum. For women usually on the vulva, cervix, and between the vagina and the anus. The wound often looks clean, is free of swelling, and does not hurt, but can develop into an ulcer that secretes clear mucus when irritated. There is also often a painful swelling of the lymph nodes on the inside of the thighs and groin. The wound usually heals on its own after four to eight weeks.

Secondary syphilis: In this stage, the bacteria spread through the blood to the skin, liver, joints, lymph nodes, muscles, and brain. A rash on the body may appear six to twelve weeks after the chancre has healed. (Picture.) The rash, which neither itches nor hurts, can cover any part of the body, but is usually seen on the palms of the hands or under the soles of the feet. Several painless lesions can also occur in the mucous membranes of the mouth and pharynx and on the skeleton and internal organs. Since the bacteria are found in the secretions of the lesions, the disease is highly contagious at this stage. The rash usually heals without treatment within two to six weeks. Other symptoms may include fever, sore throat, fatigue, headache, neck pain, joint pain, nausea, and patchy hair loss. A large number of infected people show no symptoms at all at this stage.

Latent Syphilis: This asymptomatic stage manifests itself in two phases: early (within one year of infection) and late (after one year) and is followed by secondary syphilis. Late latent syphilis is not contagious because the bacteria is inactive in the lymph nodes and spleen. The latent stage can last three to thirty years and need not progress to tertiary syphilis. About 30% of infected people remain in the latent stage.

Tertiary syphilis: The final phase begins three years or later after infection. In this phase, the person can no longer infect others, but the bacteria is reactivated, multiplies, and spreads in the body. Damage to the heart, eyes, brain, nervous system, bones, and joints can occur, as can tumors of the skin, bones, testicles, and other tissues. Cardiovascular symptoms such as herniated arteries and damage to the aortic valves can occur, causing the central nervous system to decay and cause dementia, tremors, inability to coordinate muscle movements, paralysis, and blindness. The damage cannot be repaired and in the worst case can lead to death.

How is the examination and testing done?

Diagnosis is made using an antibody test, i.e. a blood sample taken from the patient. A first test can be taken about six weeks after the time of infection. In the event of a negative test response, a final antibody test should be taken after a total of three months have passed. Suspected cases of syphilis must always be handled by a specialist. The test is free of charge.

Where can you test yourself?

You can be tested at all health care centres, GP practices, youth clinics, skin and vein clinics, sex and relations clinics, and specialist clinics for sexually transmitted infections. Telephone numbers and links to many of the country’s receptions can be found here.

How to treat syphilis?

Syphilis should always be treated by a venereological specialist.

Primary, secondary, and early latent are treated with injection Tardocillin on two occasions with an interval of one week. Tertiary, late latent, or latent of unknown age is also treated with injection Tardocillin but on three occasions at one-week intervals. If you are allergic to penicillin, treatment can be given with antibiotics, eg Doxyferm or Ery-Max. Control samples after injection treatment must be taken after three and six months and after one year.

People with neurological symptoms of syphilis need to be hospitalized. The treatment consists of benzylpenicillin intravenously for 10 days and then three injections with Tardocillin.

If the treatment was started with late syphilis, control samples must also be taken at intervals of two and three years.

How common is the disease?

Syphilis is unusual in Sweden, but has started to increase in recent years. The domestic spread is currently most frequent among men who have sex with men in big cities. Even globally, the incidence of syphilis is relatively low but occurs more widely in Southeast Asia, Russia, the Baltic countries, parts of Africa, and in large cities in America and Europe.

What does the Infection Protection Act say?

Syphilis is classified according to the Swedish Infection Protection Act as a disease of public danger. This means that if you suspect that you have been infected, you are obliged to see a doctor to do the examinations and take the necessary samples. Syphilis is a disease subject to infection tracing, which means that you must provide information about the person or persons the infection may have come from and the person or persons to whom it may have been passed on. You can choose to contact your partners yourself or have a doctor or counselor do it. In that case, you are always anonymous to your partners through the confidentiality protection in the Infection Protection Act. Occurred cases are reported anonymously to the infectious disease doctor in the county council and to the Public Health Authority.