[Health Column] Is it possible to cure syphilis? Five truths about syphilis

Director Choi Woo-hyuk

 

 

Hello, this is Director Choi Woo-hyuk.

 

Recently, with a surge in syphilis cases in Japan and the confession of a famous Japanese adult film (AV) actor testing positive for syphilis, interest in syphilis has also increased domestically. Syphilis, a disease transmitted through sexual contact, is a common sexually transmitted infection with over 6 million people infected worldwide each year. According to recent WHO data, the number of new syphilis infections among adults aged 15 to 49 increased to 8 million in 2022, showing a gradual upward trend. In this article, I will discuss the early symptoms of syphilis, reasons for infection, incubation period, cure rate, and treatment methods.

 

 

What is syphilis?

 

 

Syphilis is a bacterial infectious disease primarily transmitted through sexual contact and is classified as a sexually transmitted infection (STI). Syphilis begins as primary syphilis and, if left untreated, progresses to secondary syphilis. Subsequently, symptoms disappear, and the disease develops into a latent stage. About two-thirds of untreated patients remain in a latent syphilis state, while approximately one-third progress to tertiary syphilis. When it advances to tertiary syphilis, it can cause damage to internal organs such as the eyes and heart. Approximately 10% of untreated syphilis patients may develop neurosyphilis, which occurs when the syphilis bacteria invade the central nervous system, including the brain and spinal cord.

 

 

Early symptoms of syphilis

 

The initial symptoms of syphilis occur approximately three weeks after infection, and typically manifest as ulcers around the genitals or the infected area. These ulcers are painless and may disappear naturally, but the syphilis bacteria still remain in the body, requiring treatment. The symptoms of primary syphilis usually resolve spontaneously within 4 to 6 weeks, but if left untreated, about half of cases progress to secondary syphilis, while the remaining half develop into latent syphilis.

 

Secondary syphilis symptoms (palmar skin rash)

 

Secondary syphilis symptoms appear between 3 to 12 weeks after the initial symptoms of syphilis begin. The hallmark is skin rashes on the hands and soles of the feet, and other symptoms may include fever, painless lymphadenopathy, sore throat, headache, weight loss, and muscle aches.

 

 

Reasons for contracting syphilis

 

Syphilis is mostly transmitted through direct sexual contact, and rarely through kissing, blood transfusions, accidental inoculation, or transmission from mother to fetus via the placenta, making early diagnosis and treatment essential. The risk of infection increases with multiple sexual partners, unprotected sex, and a history of previous sexually transmitted infections.

 

 

Syphilis incubation period and stage-specific symptoms

 

The incubation period of syphilis generally varies from 10 to 90 days, and infected individuals go through stages of primary, secondary, latent, and tertiary. During the primary and secondary stages, symptoms such as ulcers and rashes appear, but during the latent stage, symptoms disappear, so the infection may go unnoticed. In the tertiary stage, damage can occur to internal organs and the nervous system, making early treatment extremely important.

 

I will briefly summarize the timing and symptoms for each stage.

▶ Primary Syphilis: The incubation period is 3 weeks, and symptoms occur between 10 to 90 days after contact with the syphilis bacteria. Symptoms typically include a painless ulcer around the genitals (usually a single ulcer), which usually resolves spontaneously within 4 to 6 weeks.

 

▶ Secondary syphilis: Occurs 3 to 12 weeks after primary syphilis. Occasionally, about 15% of patients have a mixture of primary and secondary syphilis. The most common symptom is skin ulcers on the hands and soles of the feet, but it can also occur throughout the body. Other symptoms include fever and muscle pain. Most cases resolve spontaneously within 1 to 6 months.

 

▶ Latent syphilis: There are no symptoms, but a positive reaction appears on syphilis testing. If secondary syphilis is left untreated, about one-third of patients progress to tertiary syphilis, while approximately two-thirds remain in a latent syphilis state.

 

▶ Tertiary syphilis (late syphilis): Symptoms mainly manifest as damage to various internal organs, with syphilis bacteria invading and affecting organs such as the eyes, heart, large blood vessels, bones, and joints.

 

Neurosyphilis: Occurs in less than 10% of untreated early syphilis patients. It results from the infection of the syphilis bacteria in the brain, spinal cord, and other areas. Neurosyphilis can occur at any stage of syphilis, including primary, secondary, latent, and tertiary syphilis. Symptoms may be absent or may include meningeal irritation symptoms, cerebrovascular symptoms, and others.

 

 

Syphilis treatment and the possibility of cure

 

Syphilis treatment mainly involves antibiotics such as penicillin, and the earlier the treatment is administered, the higher the cure rate. Primary, secondary, and early latent syphilis can mostly be treated with intramuscular injections of penicillin. In the case of late latent syphilis, if there is no involvement of the central nervous system, a treatment regimen of weekly penicillin injections is administered for three weeks. For neurosyphilis, a treatment involving intravenous injections of aqueous penicillin is carried out for 10 to 14 days.

 

 

✅ Syphilis diagnosis method

Syphilis diagnosis consists of screening tests and confirmatory tests, and additional testing is required if neurosyphilis is suspected.

 

▶ Screening Tests: The VDRL (Venereal Disease Research Laboratory) test and the RPR (Rapid Plasma Reagin) test are representative. They detect non-treponemal antibodies and are used to screen for syphilis infection. While they offer the advantage of rapid results, they have a high false-positive rate, so additional confirmation is necessary when results are positive.

 

▶ Confirmatory tests: There are FTA-ABS (Fluorescent Treponemal Antibody Absorption) test and TPHA (Treponema pallidum Hemagglutination Assay). These are used to detect antibodies specific to the syphilis bacteria to confirm infection. However, these specific tests remain positive even after syphilis treatment, making them unsuitable for follow-up testing.

 

▶ When suspecting neurosyphilis: Confirm central nervous system infection through cerebrospinal fluid examination.

 

 

Syphilis is a disease that can be cured with early treatment, so regular check-ups and early diagnosis are important. In particular, if detected before the latent stage, effective treatment is possible, but if it becomes chronic, it can cause permanent damage to the body. Regular sexually transmitted infection testing for early detection and treatment is the best preventive measure. To maintain sexual health, it is necessary to follow preventive measures and consult a specialist if needed to receive appropriate treatment.

 

 

Director Choi Woo-hyuk

Graduated from Korea University College of Life Sciences
Graduated from Kyung Hee University College of Medicine
Kyung Hee University Hospital Resident
Full member of the Korean Society of Dermatology and Aesthetic Medicine

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