Syphilis, and other treponemal infections

Syphilis, and other treponemal infections 

Syphilis is a chronic bacterial infection that can be transmitted through sexual contact. Syphilis is caused by a type of bacteria known as Treponema pallidum.

People have been getting, treating, and surviving syphilis for hundreds of years. In fact, treatments are so well established that at one point it was thought possible to eradicate syphilis completely. Despite this, rates of syphilis are actually rising among several demographics in the United States.

In 2020, 133,945 new cases of syphilis (all stages) were reported in the United States, according to the Centers for Disease Control and Prevention (CDC). Syphilis in people with vaginas is rising slightly more than people with penises, though both groups are seeing an uptick in cases overall.

Syphilis can be challenging to diagnose. Someone can have it without showing any symptoms for years. However, the earlier syphilis is discovered, the better. Syphilis that remains untreated for a long time can cause major damage to important organs, such as the heart and the brain.

Other treponemal infections

Infection with other T. pallidum subspecies (i.e., T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum) is acquired through contact with infected skin. These may result in a simple rash, but may progress and cause disfiguring skin lesions. Unlike syphilis, these infections are not considered sexually transmitted. Long-term infection can lead to deformation of bone and nasopharyngeal tissue. Infection with any of these subspecies can also cause seroreactivity for treponemal and nontreponemal tests used for diagnosis of syphilis; therefore, it is important to obtain a history of sexual and nonsexual exposures and consider T. pallidum subspecies in persons from areas where these infections are endemic.

Cause of Syphilis

Syphilis is caused by the bacteriaTreponema pallidum. You get it through direct contact with a syphilis sore on someone else’s body. This usually  happens during sexual activity, but the bacteria can also get into your body through cuts on your skin or through your mucous membranes.

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

Symptoms of Syphilis 

Some people with syphilis have no symptoms, so you may not know you have it unless you get tested. There are 4 stages of syphilis infection: primary, secondary, latent and tertiary.

The signs and symptoms of syphilis depend on the stage of disease.

Primary syphilis occurs 3 or 4 weeks after infection (although it can take up to 90 days for the sore to appear). Symptoms may include a single painless sore usually about a centimetre big at the site where the infection entered the body — such as on the penis, vagina, cervix, mouth or anus. There may also be swollen lymph nodes.

The sore, or sometimes multiple sores, can go unnoticed because it is usually painless and may be hidden from view in areas such as the back of the throat, vagina or anus.

These sores usually go away by themselves after 3 to 6 weeks, even with no treatment. However, even though the sore heals, if you haven’t been treated, you are still infectious and can pass it on to others.

Secondary syphilis can occur 7 to 10 weeks after the initial infection. Symptoms can last for 6 months or more and may include:

  • a red rash on the palms, soles, chest or back
  • fever
  • enlarged glands in the armpits and groin
  • sore throat
  • hair loss
  • weight loss
  • headaches
  • pain in the bones, muscles and joints
  • tiredness
  • ulcers in the mouth, nasal cavity or genitals
  • neurological symptoms

Latent (sleeping) syphilis generally has no symptoms and it is only picked up on blood tests. If syphilis is not treated at this stage, it can remain latent or develop into tertiary syphilis. Latent syphilis is infectious within the first 12 to 24 months.

Tertiary syphilis can appear anywhere from 5 to 20 years after primary infection. At this stage, the bacteria can damage almost any part of the body including the heart, brain, spinal cord, eyes and bones, resulting in heart disease, mental illness, blindness, deafness and neurological problems.



Syphilis can be diagnosed by testing samples of:

Blood: Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the syphilis-causing bacteria remain in your body for years, so the test can be used to determine a current or past infection.

Cerebrospinal fluid: If it's suspected that you have nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a lumbar puncture.

Through the Centers for Disease Control and Prevention, your local health department offers partner services, which will help you notify your sexual partners that they may be infected. Your partners can be tested and treated, limiting the spread of syphilis.

               Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, diseases of the nervous system, vascular system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC 8015, and DC 9301).

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, diseases of the nervous system, vascular system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC 8015, and DC 9301).

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