Syphilis is called the ”great imitator” because it shows signs that other diseases show. The organism that causes syphilis is a spirochete bacterium known as Treponema Pallidum.

The history of syphilis

Syphilis was first noted in the past around the 1490s as Morbus gallicus, or the French Disease, after soldiers returning from war in Naples brought back home with them the disease. The disease’s antiquity is still debated, however some claim that the disease originated in the Americas. Syphilis causing bacterium, Treponema pallidum, is just one of four treponemes that infect humans (Bowers, 2001).

Syphilis was once a major public health threat, commonly causing serious long-term health problems such as arthritis, brain damage, and blindness. It defied effective treatment until the late 1940’s when the antibiotic penicillin was first developed.

New cases of syphilis doubled between 2005 and 2013, often in combination with human immunodeficiency virus (HIV). This has been attributed partly to increased promiscuity, prostitution, the decreasing use of condoms, and unsafe sexual practices among men who have sex with men. Syphilis is thought to have infected 12 million additional people worldwide in 1999, with greater than 90% of cases in the developing world.

How is syphilis transmitted?

Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex.  By having vaginal, anal or oral sex without a condom with someone who has the infection; from mother-to-baby across the placenta during pregnancy. Syphilis is spread by contact with open sores (usually during sex). Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact. Syphilis prevalence is growing, particularly among men who have sex with men.

Syphilis cannot be spread by toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the various stages of development?

There are three stages of Syphilis.

Stage 1: Primary chancre

10 – 90 days

After an incubation period of 12 to 90 days (average of 21 days), it starts with a small painless sore where the bacteria entered the body.  A single sore’s appearance marks the first (primary) stage of syphilis symptoms, but there may be multiple sores. The sore appears at the location where syphilis entered the body. The sore is usually firm, round, and painless. Because the sore is painless, it can easily go unnoticed.  The sore lasts 3 to 6 weeks and heals regardless of whether or not a person is treated. However, if the infected person does not receive adequate treatment, it progresses to the secondary stage.

Stage 2:  Secondary eruptions

Six weeks to 6 months

It begins with the appearance of one of the systemic manifestations of the disease. Skin rashes and sores in the mouth, vagina, or anus (also called mucous membrane lesions ). This stage usually starts with a rash on one or more areas of the body. Rashes associated with secondary syphilis can appear when the primary sore is healing to several weeks after the sore has healed. The inflammation usually does not cause itching. This rash may appear as rough, red, or reddish-brown spots on the palms of the hands and the feet’ bottoms. However, this rash may look different in other parts of the body and look like rashes caused by other diseases.

Picture of rash:

Large, raised, grey or white lesions may develop in warm, moist areas such as the mouth, underarm or groin region. Sometimes rashes associated with secondary syphilis are so faint that they are overlooked. Other symptoms of secondary syphilis include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The symptoms of secondary syphilis will go away with or without treatment. Without appropriate treatment, the infection will progress to the latent and possibly late stages of the disease.

Stage 3: Tertiary disease

10 – 30 years after a period of latency

 The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person can continue to have syphilis in their body even though there are no signs or symptoms. This latent stage can last for years. Syphilis that has been left untreated can cause heart problems, mental issues, and even death.

Approximately 8% of individuals with untreated syphilis will develop Neurosyphilis, a stage that includes physical and psychiatric symptoms. Neurosyphilis frequently affects more men than women and Caucasians more frequently than African Americans. This condition may appear at any given point ranging between five through thirty-five years after primary syphilis onset (Frey, 2006).

Congenital syphilis


Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child. Depending on how long a pregnant woman has been infected with syphilis, she has a good chance of having a stillbirth (birth of an infant who has died before delivery) or giving birth to a baby who dies shortly after birth.

If not treated immediately, an infected baby may be born without symptoms but could develop them within a few weeks. These signs and symptoms can be severe. Untreated babies may become developmentally delayed, have seizures, or die.

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Prevention of syphilis

The only way to avoid STD’s is not to have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting syphilis:
• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore.

Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.
Because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be evident that a sex partner has syphilis. Unless you know that your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an untreated sex partner. Having syphilis once does not protect you from getting it also. Even after you’ve been successfully treated, you can still be re-infected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your health care provider is recommended to make sure that your treatment was successful.


Early-diagnosed syphilis can be treated and cured easily with an injection of penicillin (preferred) or 14 days of antibiotics (for patients allergic to penicillin). For people who have syphilis that was undiagnosed for more than one year, it can be treated and cured with a longer course of more potent antibiotics (an injection once a week for three weeks)



You can do a self-test quiz to learn more about the symptoms of STD’s and your risk of being infected

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