DoxyPEP: Using antibiotics to prevent STIs
Is Syphilis Curable? Learn About Treatment Options And Prevention
Medically reviewed by Soma Mandal, MDMedically reviewed by Soma Mandal, MD
Syphilis, a sexually transmitted infection (STI) caused by the Treponema pallidum (T. Pallidum) bacterium, is curable at all stages of infection. The antibiotic drug penicillin G is the treatment of choice, given in one or more injections, depending on whether you have primary, secondary, latent, or tertiary syphilis.
The treatment of syphilis remains crucial as infection rates continue to soar in the United States, reaching their highest level since the 1950s. This includes syphilis cases among newborns, the number of which has increased by more than tenfold from 2014 to 2024.
Understanding Syphilis TransmissionThe Treponema pallidum bacterium that causes syphilis is spiral-shaped and can pass through tiny breaks in the skin or intact (unbroken) mucous membranes of the mouth, genitals, and anus.
Syphilis is mainly transmitted (passed) through oral, vaginal, or anal sex. This generally occurs when you come into contact with a syphilis sore or rash. The odds of infection from someone with early syphilis run anywhere from 51% to 64%.
Though uncommon, it is also possible to get syphilis by kissing someone who has a syphilis sore on the lip.
Another common mode of T. Pallidum transmission is from a pregnant person to the fetus during pregnancy. Congenital (present at birth) syphilis mainly occurs when T. Pallidum is passed to the fetus via the placenta. It can also happen during childbirth if the baby comes into contact with a syphilis sore in the vaginal canal.
Cases of syphilis have been linked to blood transfusions and organ transplants, but these are considered rare.
How Common Is Syphilis Today?According to the Centers for Disease Control and Prevention (CDC), there were 203,500 reported cases of syphilis in the United States in 2022—an increase of nearly 80% since 2018. The number of congenital syphilis cases also rose from 1,325 in 2018 to 3,755 in 2022—an almost threefold increase over five years.
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What Are the Symptoms Associated With Syphilis?The symptoms of syphilis vary by the stage of infection. If left untreated, syphilis can progress through four characteristic stages—called the primary, secondary, latent, and tertiary stages—and affect multiple organ systems, often years or decades after the original infection.
Syphilis is often called the "great imitator" because the symptoms are so diverse that they can easily be mistaken for other diseases or medical conditions.
Primary StagePrimary syphilis happens two to 12 weeks after exposure to T. Pallidum. During this stage, a smooth, hard sore called a chancre will develop on your genitals, anus, or mouth. Most cases involve just a single sore, but it is possible to have more than one.
Because chancres are generally painless, you may not even know that you have the infection. This is especially true if the sore is in the vagina or anus or under the foreskin, where it may go unnoticed.
The chancre will eventually clear on its own within a few weeks or months. However, this doesn't mean that the infection is clear; you are still highly contagious and can transmit the infection to others.
It is important to get treatment, even if your sore goes away. Left untreated, around 1 in 4 people with primary syphilis will progress to secondary syphilis.
Secondary StageSecondary syphilis occurs four to 10 weeks after the syphilis sore disappears, leading to the spontaneous outbreak of a bumpy, red to reddish-brown rash. The rash can cover the entire body, including the palms of your hands and the soles of your feet. The rash is usually non-itchy.
Other symptoms of secondary syphilis may include:
Fatigue
Fever
Headaches
Joint pain
Muscle aches
Patchy hair loss
Sore throat
Swollen lymph nodes
Unintended weight loss
Wartlike skin patches
These symptoms may persist for 12 weeks or even longer before spontaneously disappearing. Even so, you are still contagious during the secondary stage and can readily transmit the infection to others.
The symptoms will resolve whether or not you get treatment, but getting treated is the only way to prevent the disease from progressing to the next stage.
Latent StageIf syphilis is not treated during the primary or secondary stages, it can go into an extended period of low disease activity—called latency—that can last up to 20 years or longer. Although there may be no outward signs or symptoms, the disease can progressively damage your heart, bones, nerves, and other organs.
Latent syphilis is largely silent, but roughly 1 in 4 people will experience an occasional flare-up of symptoms, which can easily be mistaken for an allergy or drug reaction.
During the early-latent stage (defined as up to one year following the initial infection), you can still transmit the infection to others. Thereafter, your risk of transmission rapidly declines. After two years, it is rare for transmission to occur.
Tertiary StageAround 1 in 3 untreated people will progress to the most advanced stage of infection, called tertiary syphilis. Tertiary syphilis tends to develop 10 to 30 years after the initial infection by which time the heart, kidney, and other organs may be severely—and sometimes irreversibly—damaged.
While tertiary syphilis can affect any organ system, it most commonly manifests as:
Cardiovascular syphilis: This is a complication that causes the swelling and weakening of the heart and blood vessels. Severe cases can lead to an aortic aneurysm (swelling of the blood vessel) and rupture.
Gummatous syphilis: This is a complication in which soft, tumor-like lesions (called gummas) form on the skin, bones, liver, and other organs, causing major damage.
Neurosyphilis: This is when syphilis affects the central nervous system, causing seizures, personality changes, hallucinations, dementia, paralysis, and even stroke.
Without treatment, syphilis may spread to the nervous system eyes, or ears at any stage of the disease:
Neurosyphilis symptoms can include severe headache, muscle weakness, and changes in mental state.
Ocular syphilis symptoms can include eye pain, red eyes, and changes in vision.
Otosyphilis symptoms can include hearing loss, tinnitus (noises in the ear), and dizziness or vertigo (feeling like everything is spinning around you).
Congenital syphilis occurs when a pregnant person passes the infection to the fetus during pregnancy or the baby during childbirth. Up to half of all babies infected with syphilis die shortly before or after birth.
Most babies born with congenital syphilis have no initial symptoms and may only develop signs by the age of 2, such as:
Failure to gain weight
Fever
Fluid discharge from the nose
Irritability
Irritated, cracking skin around the mouth, anus, and genitals
Painful leg or arm joints
Secondary syphilis rash
Swollen abdomen (caused by an enlarged liver or spleen)
If left untreated, congenital syphilis can lead to hearing loss, blindness, bone pain, and deformity of the nose, bones, and teeth.
Is Syphilis Curable?Syphilis is curable at all stages. It is far easier to treat during the early stages of infection, often with a single dose of penicillin G. During the primary, secondary, and early-latent stages, between 94.5% and 100% of treated individuals will experience complete clearance of the infection.
After that, response rates steadily decline. By late latency, a single shot of penicillin G will deliver a response (cure) rate of only 56% to 63%. Because of this, multiple doses of penicillin G are needed over several weeks to ensure a complete cure.
Early detection is key to protecting yourself and others from this widespread and increasingly complicated STI.
Due to the high rates of infection and reinfection, syphilis has begun to develop resistance to some antibiotic drugs. As a result, penicillin G is today the only antibiotic recommended by the CDC for all stages of infection.
Related: How Syphilis Is Diagnosed
Syphilis Treatment OptionsPenicillin G is the preferred antibiotic for syphilis. Also known as penicillin G potassium or benzylpenicillin, this long-acting antibiotic is given by intramuscular (IM) injection into a large muscle.
Penicillin G is preferred over other types of penicillin because it can reach parts of the body, such as the brain and spinal cord, that other forms of penicillin cannot.
The type used in the United States is called Bicillin L-A (benzathine penicillin G). Bicillin L-A is slowly absorbed after the injection, providing antibiotic action for as long as two to four weeks.
Depending on the stage of infection, the CDC recommends penicillin G in the following dosages:
Stage
Dosage
Primary syphilis
2.4 million units given as a single IM dose
Secondary syphilis
2.4 million units given as a single IM dose
Early-latent syphilis
2.4 million units given as a single IM dose
Late-latent syphilis
7.2 million units total, given in three IM doses of 2.4 million units over three weeks
Tertiary syphilis
7.2 million units total, given in three IM doses of 2.4 million units over three weeks
Congenital syphilis
Dosage based on body weight. Aqueous crystalline penicillin G administered intravenously or procaine penicillin G IM for 10 days
Common side effects of penicillin G include injection site pain, nausea, and diarrhea.
Alternatives to Penicillin GOther antibiotic drugs may be used if you are allergic to penicillin, some of which are highly active against T. Pallidum. These include:
Doxycycline was reported to have a response rate of between 83% and 100% in people with early syphilis, while ceftriaxone was reported to have a response rate of between 65% and 100%.
Even so, penicillin G remains the gold standard of treatment, particularly for people with tertiary syphilis. If a person with tertiary syphilis has a penicillin allergy, they should be treated in consultation with an infectious disease specialist.
Does My Sex Partner Need Treatment?If you have been treated for syphilis (primary, secondary, or early latent), your sex partners may likely need to be treated as well. The following factors determine the decision to treat or not treat:
Sexual contacts within the past 90 days should be treated even if their test results are negative.
Sexual contacts made more than 90 days ago should be treated if their results are unavailable and the chances of their returning for testing are low. If their results are negative, treatment is not needed.
Long-term sex partners of someone with late latent syphilis should be treated based on the results of syphilis testing.
Related: Complications of Untreated Syphilis
Syphilis Prevention and ManagementDespite ongoing public awareness campaigns, syphilis rates continue to climb in the United States. By 2023, the rate of new infections had become so high that shortages of Bicillin L-A were reported nationwide. This led to the temporary importation of an alternative form of benzathine penicillin G called Extencilline.
To help reduce the spread of syphilis and protect yourself and others from infection:
Use condoms consistently and correctly, including for oral sex.
Reduce your number of sex partners.
Get tested regularly for syphilis if you are sexually active. The CDC advises that sexually active men who have sex with men and people with human immunodeficiency virus (HIV) should be screened at least once yearly.
Ask a new or prospective sex partner to get tested.
Get tested for syphilis during your first prenatal visit if you are pregnant.
Advise sex partners if you get syphilis so they can get tested and treated, too.
Syphilis is a reportable disease in every state, although reporting requirements vary. In some states, sex partners are advised by a provider, clinic, or lab; in others, public health officials are tasked with notification.
With that said, don't assume that these systems are infallible. Consider contacting your partners yourself and explaining the situation without accusation or blame. If you feel too uncomfortable or embarrassed to do so, ask your healthcare provider to notify them for you (or with you).
SummarySyphilis is a curable sexually transmitted infection caused by the Treponema pallidum bacteria. It is mainly transmitted through oral, vaginal, or anal sex but can also be passed from pregnant person to fetus or child during pregnancy or childbirth.
Penicillin G is the treatment of choice for all stages of syphilis. Primary, secondary, and early-latent syphilis can usually be cured with one intramuscular injection. Late-latent and tertiary syphilis can usually be resolved with three intramuscular injections given over three weeks. Congenital syphilis may be treated with IV or IM penicillin for 10 days.
Sexual partners should also be tested and treated.
Related: Which STIs Are Curable and Incurable?
Read the original article on Verywell Health.
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At-Home Syphilis Test Could Increase Access And Combat Epidemic
August 26, 2024
4 min read
At-Home Syphilis Test Could Increase Access and Combat Epidemic
An easy-to-access rapid test could lower barriers to detecting syphilis, which is surging nationwide
Illustration, Treponema pallidum bacteria which causes syphilis.
Robert Brook/Science Photo Library/Getty Images
On August 16 the U.S. Food and Drug Administration authorized the sale of the first over-the-counter at-home test for syphilis in an effort to contain a national surge in the sexually transmitted infection (STI).
The new test, which turns around results within 15 minutes, takes finger pricks of blood and scans them for immune molecules called antibodies that bind to the bacterium that causes syphilis. A positive finding warrants a follow-up with a health care provider who can confirm ongoing infection and provide effective antibiotic treatment. Manufacturer NOWDiagnostics says the product is expected to reach pharmacies and retail stores later this year.
Other kinds of rapid syphilis tests can only be administered by medical professionals or certain community organizations. Yet stigma often prevents people and the providers who work with them from bringing up sexual health concerns. Like an at-home test for gonorrhea and chlamydia that was approved late last year, the new syphilis assay offers people the privacy to test themselves in their own home.
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"This is a real breakthrough," says Jeffrey Klausner, former director of the San Francisco Department of Public Health's STD Prevention and Control Services and an epidemiologist at the Keck School of Medicine of the University of Southern California.
Cases of the majority of STIs, most notably syphilis, have mushroomed in the U.S. Over the past decade. From 2018 to 2022 alone, the number of syphilis cases in the U.S. Increased by nearly 80 percent, surpassing 207,000—a 70-year high. The disease is increasingly common in pregnant people, who can also transmit the infection to their fetuses in utero through the bloodstream or during vaginal birth. In 2022 syphilis appeared in 280 out of every 100,000 people who gave birth and 3,700 babies were born with the disease, according to the Centers for Disease Control and Prevention.
A subset of people with untreated infections incur serious damage to their heart, brain or other major organs. When passed along during pregnancy, syphilis often causes miscarriage or infant death.
Public health experts say soaring infection rates reflect widespread difficulties in accessing health care. "Syphilis is like the canary in the coal mine," explains Barbara Van Der Pol, an epidemiologist at the University of Alabama at Birmingham. "When our public health infrastructure starts to fail, syphilis always increases."
Funding for sexual health clinics in the U.S., when adjusted for inflation, has dropped over the past two decades. As a result, many groups that raise awareness of and help screen for STIs have closed their operations, Van Der Pol and Klausner say.
To the untrained eye, syphilis can be hard to detect. Immediately after infection, people often develop genital sores and, several weeks later, body-wide rashes and fever. But the sores tend to be painless and can hide inside the vagina or anus. And doctors can mistake syphilis's second wave of symptoms for those of common viral infections. After a year the bacteria go dormant in the body, but people remain somewhat contagious and can sporadically develop severe health complications. Some otherwise healthy adults now run into these complications weeks or months after infection, according to Arlene Seña-Soberano, a public health researcher at the University of North Carolina at Chapel Hill.
Individuals at high risk of infection include people who have unprotected sex or have multiple sex partners, men who have sex with men, people with HIV and other immunosuppressive conditions and people who use injectable drugs. The CDC also recommends that all sexually active people aged 15 to 44 be offered annual screening for the infection, regardless of their individual sexual habits, in areas with a greater than 0.0046 percent incidence of syphilis among women in that age group. All pregnant people are encouraged to undergo testing at their first prenatal visit.
To more effectively stop the spread, the U.S. Needs to develop a culture of regular STI testing, Van Der Pol says. "If we get to the point where people test annually at least or whenever they have concerns in the back of their mind—if we make [testing] a really normal activity—then we're going to start to be impactful," she adds.
As Klausner sees it, stigma also prevents communities from mobilizing to spur further governmental action. "The reality of living in a democracy is that resources go to those who scream the loudest," he says. Earlier this year the Department of Health and Human Services established a national task force to respond to the syphilis epidemic. Klausner imagines activists could pressure the federal government to make rapid tests like the recently approved one available for free via local health departments and community organizations.
With an estimated sticker price of $29.98, the new test might not benefit some of the most vulnerable populations, such as people who are unhoused or those with substance use disorders. Sexual health advocates might also encourage the government to manufacture penicillin. Global supply chain disruptions caused a shortage of the frontline treatment that began in June 2023 and only partially eased months ago. (An alternate treatment exists, but it is more cumbersome to use and is not safe for pregnant people.)
"When I was the public health director in San Francisco, it was very clear that when we had political will and adequate resources, we could bring these types of infections under control," Klausner says.
Number Of Babies Born With Syphilis Is Surging
Over ten times as many babies were born with congenital syphilis (CS) in 2022 than in 2012. Think about that for a minute. Then know that nine out of ten of those cases could have been prevented. An article published by the Centers for Disease Control and Prevention on December 14 of last year goes on to say that two in five women who gave birth to babies with CS didn't seek any prenatal care. Therefore, the problem?
We all know that people who are sexually active can get syphilis. It's a common, curable sexually transmitted infection. However, there are reasons people don't get tested and treated. Planned Parenthood explains, "The signs of syphilis can be so mild you don't even notice them. Sometimes people confuse syphilis symptoms with other things, like pimples or rashes. Syphilis symptoms come and go over time, but that doesn't mean the infection goes away."
With the rate of syphilis among those 18 to 45 rising to an all-time high, the CDC says that the increasing rates of syphilis among babies is because too many women are not being tested and treated early enough during their pregnancy.
"Testing for and treating syphilis during pregnancy more than 30 days before delivery can prevent this infection in newborns," they say.
Congenital syphilis can cause miscarriage, stillbirth, prematurity, low birth weight or death shortly after birth. If the baby survives, he or she may have deformed bones, severe anemia, enlarged liver and spleen, jaundice, brain and nerve problems, like blindness or deafness, meningitis or skin rashes.
However, the CDC adds that "it is possible that a baby with CS won't have any symptoms at birth. However, if the baby does not receive treatment right away, the baby may develop serious problems. Usually, these health problems develop in the first few weeks after birth, but they can also happen years later."
Whether you're a man or a woman, you can prevent your baby from getting syphilis by not getting it yourself. If you're sexually active, have several partners or a new partner who's had several partners, you should get tested for sexually transmitted diseases on a regular basis. The best prevention is for the male to properly use condoms any time you have sex, be it vaginally, anally, or orally.
The CDC encourages healthcare providers to understand who should get tested for syphilis. They recommend they talk to patients "about sexual health and test for sexually transmitted infections, and repeat syphilis testing during pregnancy, and treat syphilis immediately." By the way, treatment is a course of antibiotics, typically penicillin.
They also encourage people to ask their healthcare provider about how to prevent syphilis, to talk to their partner(s) about sexually transmitted infection "and consider what safer sex options are right for you. And get tested for sexually transmitted infections, especially if you or your partner are pregnant or planning to get pregnant."
Even if you've been tested before, you should get tested when you find out you're pregnant. "Remember that it's possible to get syphilis and not know it. Having syphilis once does not protect you from getting it again. Even after successful treatment, you can get syphilis again. For this reason, you must continue to take actions that will reduce your risk of getting a new infection," the CDC says.
When you visit your healthcare provider be sure to tell him or her about any "new or unusual physical symptoms you may be experiencing; any drugs or medicines you are using, and whether you have new or multiple sex partners. Also ask about your risk for syphilis, such as the number of syphilis cases in your area," they advise.
If everyone plays their part in avoiding congenital syphilis, the numbers will go down. Please know that worrying about the stigma of sexually transmitted disease isn't worth jeopardizing your baby's life or your own.
Both Sandpoint Women's Health (208-263-2173) and Bonner General Family Practice (208-265-2221) are accepting new patients. Call today for an appointment.
Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.Com.
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