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Syphilis Treatment

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Syphilis Treatment

writtenByWritten by: Andy Wong
Andy Wong

Andy Wong

Andy is the Chief Marketing Officer at PlushCare. He's passionate about advancing healthcare solutions and improving access to care via health technology.

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August 23, 2017 Read Time - 9 minutes

Syphilis Treatment

According to a 2015 report by the Center for Disease Control, around 15 of every 200,000 individuals in the United States reports contracting syphilis, a rare but potentially devastating sexually transmitted disease.

Left untreated, syphilis can have unalterable and fatal repercussions, but with the proper care and management, is completely treatable.

Syphilis is a bacterial genital ulcerative disease that develops in stages, which are characterized by their symptomatic manifestations, or by their latency.  Syphilis is almost always symptomatic, but symptoms may take months or even years to appear, so it is possible to acquire or transmit the disease without knowledge.

Timing is extremely important in understanding the effects of syphilis, as each stage has its own associated symptoms, appearance, severity, and treatment.

It is crucial to recognize syphilis early on, as it becomes more and more dangerous as time passes, and deadly once it reaches the tertiary (post latent, third symptomatic) phase.

It is also heavily linked with the facilitation of HIV transmission and acquisition.  So, how do we treat syphilis?  First, let’s gain a practical knowledge of syphilitic symptoms and how to test for infection.

Understanding Syphilis

Syphilis is a contagious bacterial disease caused by the Treponema Pallidum bacterium, which is transferred via direct, typically sexual, contact with the lesions or bodily fluids of an infected individual.

Syphilis is a phasal disease, as it progresses through specific, sequential stages, with very little variation from person to person.   So, how long does syphilis last?  If diagnosed and treated in the primary or secondary stages, syphilis can be eliminated from the body within days.

If untreated, the disease can last for several decades, usually ending in fatality.  The first stage has the least severe symptoms, while the final stages, if left untreated, can be destructive.

These stages can progress quickly or take decades to manifest, but how do you know if you have it?  First, we take a look at the symptoms of the syphilitic stages.

What are the Symptoms and Stages of Syphilis?

The first symptoms of syphilis can occur from as soon as 10 days to as long as 3 months after acquisition.  The average onset of syphilis symptoms is 21 days.  So, what should you look for?

The Primary Stage

The first, or primary, stage of Syphilis is mild and can go by unnoticed, even when symptomatic.  The first sign of syphilis is the appearance of one or multiple chancre sores at the primary site of infection.  Chancre sores are typically firm, round, and painless.

Chancres start as pustules, spots with hard sloping edges with a fluid filled center, capable of bursting when pressure is applied.  Since syphilis is a sexually transmitted infection, chancres can occur on, in, and around the genitals, on the anus, in the rectum, or on the upper and inner thighs.

Syphilis can also be contracted in the mouth or throat, with oral chancres typically located on the pharynx.  The chancre pustule then scabs over to become an ulcer, which takes about 3 to 6 weeks to heal fully, regardless of treatment or lack thereof.

The Secondary Stage

The secondary stage of syphilis is markedly more severe and may overlap with the healing process of the primary stage.  The first sign of secondary syphilis is a reddish-brown rash upon several areas of the body.

The most characteristic area of syphilitic rash is on the palms and the bottom of feet, but rashes like this and other skin inflammation may occur elsewhere on the body.

These body rashes often resemble those of other diseases and conditions, such as contact dermatitis, acne, chicken pox, etc.  This characteristic has lead to syphilis’s acquisition of the moniker, “The Great Pretender.”  Syphilitic rashes are not usually itchy or painful, and can be so faint that they might not even be noticeable.

Along the mucous membranes and warm, moist areas of the body, such as the mouth, throat, genitals, and anus, and underarms, large white or grey lesions appear.  These are known as Condyloma Lata, which contain vast amounts of infectious Treponema Pallidum spirochetes, making them highly contagious. These occur in about 33% of syphilitic individuals.

Other possible symptoms of secondary stage syphilis include:

  • Fatigue
  • Fever
  • Hair loss
  • Headaches
  • Myalgia (muscle pain)
  • Sore throat
  • Swollen lymph nodes
  • Weight loss

Just as in the primary stage, secondary symptoms will go away on their own accord with or without treatment. However, if untreated, the infection will progress to the next stage.

The Latent Stage

Around 30% of those infected with syphilis are currently living in the latent, or dormant period of syphilis.  In the latent stage, there are no symptoms.

The bacteria reside in the spleen and lymph nodes, inactive for 3 to 30 years.  If untreated during the latent stage, the disease will develop into the tertiary stage.

The Tertiary Stage

The tertiary stage of syphilis may take years or even decades to arrive, but around 30-40% of all seropositive individuals will progress to it, since the undiagnosed primary and secondary syphilis followed by a long, asymptomatic period can lead to a false sense of security.

Though at this stage in the infection the bacteria are typically no longer contagious, their effects on the body can be devastating.

The bacteria living inside have at this point congregated and multiplied in one or more organ systems of the body.  Common infections include those of the central nervous system, the cardiovascular system, the bones, and the skin.

  • NeurosyphilisSyphilitic infection of the central nervous symptom.  Neurosyphilis may manifest itself in four forms:AsymptomaticThis form is mild and has no noticeable symptoms.May take place in any stage of a syphilis infection.MeningovascularOccurs in approximately 10-12% of those infected with neurosyphilis.Damages nerves connected to meninges and arterial walls, may result in:Heart attackBlood clotsBacterial meningitisTabes Dorsalis (Syphilitic Myelopathy)Degenerative disease that affects the dorsal column of the spinal cord, which are primarily responsible for the senses of spatial awareness, physical touch, and vibration.  Symptoms include:General Paresis (General Paresis of the Insane)Caused by syphilitic meningoencephalitis, a combination of meningitis and encephalitis, manifested by inflammation of the meninges, which protect the central nervous system, and inflammation of the brain.
  • Cardiovascular SyphilisMay cause syphilitic aortitisInflammation of aortaThickens the walls of the aorta, which restricts the blood flow and causes ischemia, eventually leading to an aneurysm
  • Gummatous SyphilisGummatous syphilis manifests itself in the growth of gummas, soft, tumor-like growths that form on the skin, the liver, and along the bones.

Syphilis Tests

Diagnostic tests are conducted with an array of methods. Syphilis shows up in blood tests and through direct observational methods.

  • Non-Treponemal Serologic Tests
  • Treponemal Serologic Tests
  • Direct Testing

Treponemal and non-treponemal tests should be both be given to confirm the presence of T. pallidum spirochetes in the patient with 100% accuracy.

For a closer look at syphilis testing, click here.

Testing Positive and Receiving Syphilis Treatment.

Testing is over, and you have received your results.  If you find yourself face to face with a positive syphilis test result, take a deep breath.  You are going to be okay.  It’s common to feel scared, a little embarrassed, and perhaps ashamed, but there are several ways to get help, and you have modern medicine on your side.

Since it is a bacterial infection, syphilis is curable, with the obvious course of treatment being antibiotic medication.  Which antibiotic the patient receives is dependent largely on what stage they reside in and which symptoms they are experiencing.  But, does syphilis go away after treatment?

The answer to that question is murky.  If caught and treated early on in the infection, the bacteria are destroyed and its effects can be reversed.  However, if the infection reaches the tertiary stage, the bacteria can be eliminated, but some of the effects will likely be permanent.

Penicillin G is the standard of treatment in syphilis patients of all stages.  The dosage and manner of therapy is dependent upon the stage and conditions of the patient.  For late stage syphilis, penicillin therapy must be administered for a longer term, as the bacteria may be multiplying more slowly than in other stages.

Early Infections (Primary and Secondary Stages)

  • Benzathine penicillin G.
  • In case of Penicillin allergies:TetracyclineOral antibiotic500 mg, four times daily for 14 daysDoxycycline Taken orally100 mg, twice daily for 14 daysUsually favored to Tetracycline, as it does not cause the same amount of gastrointestinal stress, and is taken with less frequency.Tetracycline and Doxycycline are not recommended for pregnant women, due to the risk of birth defects.Ceftriaxone 1-2 G daily, either intravenously or intramuscularly, for 10-14 days

Latent Infections

Due to the absence of chancres and rashes, syphilis is no longer sexually contagious once it passes into the latent phase.  Due to this, treatment of latent syphilis is focused mainly on preventing potential complications and transmission from expecting mothers to neonates.

The type of latent syphilis being treated is classified by when the primary infection began.  Latent syphilis whose primary infection occurred within the previous year is considered early latent syphilis.

If it takes longer than a year to arrive at the latent stage, it is considered late latent syphilis.  While the pharmaceutical treatment is largely the same, the dosages vary according to which form of latent syphilis the patient has.

  • Early Latent SyphilisBenzathine penicillin G.In adults:Given as single intramuscular shotDosage: 2.4 million units/shotIn children:Given as single intramuscular shotDosage: 50,000 units/kg weight of patient, limit of 2.4 million units (adult dosage)In case of Penicillin allergies:TetracyclineOral antibiotic500 mg, four times daily for 28 daysDoxycyclineTaken orally100 mg, twice daily for 28 daysCeftriaxoneMay be effective, but there is no ideal standardized dosage
  • Late Latent SyphilisBenzathine penicillin G.In adults:Given as three intramuscular shots, spaced one week apartDosage: 7.2 million units total, 2.4 million/shotIn children:Given as three intramuscular shots, spaced one week apartDosage: 50,000 units/kg weight of patient, limit of 2.4 million units (adult dosage) per shotIn case of Penicillin allergies:TetracyclineOral antibiotic500 mg, four times daily for 28 daysDoxycyclineTaken orally100 mg, twice daily for 28 daysCeftriaxoneMay be effective, but there is no ideal standardized dosage

Tertiary Syphilis

  • Gummatous and Cardiovascular Syphilis
  • NeurosyphilisAqueous Penicillin G18-24 million units per day, 3-4 million unit doses every 4 hours for 10-14 daysProcaine Penicillin G + ProbenecidProcain Penicillin G.2.4 million units, intramuscularly per dayProbenecid 500 mg four times dailyRegimen lasts for 10-14 daysCeftriaxone, Tetracycline, DoxycyclineUsed in various doses based on physician’s opinion in the case of penicillin allergy.

To learn what to do if you think you have syphilis, click here.

If you think you have symptoms of a syphilis, call or book online with PlushCare to set up a phone appointment with a top U.S. doctor today.

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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