Complications of Syphilis

Each case of syphilis — its signs, symptoms, and potential long-term complications — is unique. Syphilis can damage every type of tissue and every organ within your body, so the list of possible complications caused by syphilis runs long.

That list includes major physical and mental illnesses.

“Very early in the infection, the organism invades the bloodstream and the lymphatic system. This can happen even before the first chancre [sore],” says Sheila A. Lukehart, PhD, a professor emeritus at the University of Washington in Seattle and an expert on Treponema pallidum, the bacterium that causes syphilis.

This delicate, spiral-shaped microorganism can easily pervade every corner of your body. It invades the heart, bones, and digestive tract.

“It can impact your hearing, your vision, all your major organs. It can invade the liver, the skin. It goes everywhere,” says Damian P. Alagia III, MD, a senior medical director for Quest Diagnostics who is based in the Washington, DC, area. In a pregnant woman, Treponema pallidum crosses the placenta to infect a fetus.

When the bacterium infects the central nervous system — the brain and spinal cord — it’s called neurosyphilis. (1)

“Historically, [neurosyphilis] is one of the most feared forms of syphilis,” says Dr. Lukehart. “It can cause insanity, blindness, paralysis, and death.”

A One-Injection Cure

On the other hand, with early diagnosis and treatment, syphilis can usually be cured with one injection of penicillin. But the growing problem of antibiotic resistance has come into play with regard to syphilis treatment, and global health organizations have revised their treatment recommendations to address it.

The World Health Organization now strongly recommends a single shot of penicillin G benzathine instead of oral antibiotics. The injection works better and costs less than pills. (2)

Potential for Lifelong Infection

Untreated, Treponema pallidum lingers in the body indefinitely. “Individuals who have syphilis remain infected for life unless they take antibiotics,” says Lukehart.

Early treatment with antibiotics can prevent serious harm. But if your treatment begins after organs or tissues have been damaged, antibiotics cannot reverse that damage.

The bacteria’s ability to spread throughout your body gives syphilis the power to cause life-changing complications especially, but not only, in its latest stages.

A Complex Illness With Multiple Stages

Syphilis involves four different stages, but sometimes stages overlap or even occur at the same time. Not every stage will create noticeable symptoms either, and symptoms don’t appear in the same order for everyone.

The key thing to know about syphilis is that without treatment, syphilis lingers, makes a person contagious, and can do major harm. You must take antibiotics to cure a syphilis infection and to stop its progression through its various stages.

Here’s a rundown of the stages of syphilis, with the usual symptoms and potential for complications of each stage:

Primary Stage Early in the infection, a painless sore, called a chancre, crops up wherever the bacteria first entered your body. A chancre may be visible or hidden inside your mouth, vagina, cervix, anus, or elsewhere. These initial chancres usually heal within a month or two.

Secondary Stage Widespread rashes often occur in secondary syphilis and last about two to six weeks. This stage can also involve symptoms that mimic other common conditions, including the flu, psoriasis, and hemorrhoids. Secondary-stage symptoms go away on their own, yet the infection lingers. (3)

Extreme complications during the primary and secondary stages are rare but do sometimes occur. For instance, while severe damage to the heart and blood vessels usually occurs in the last stage of syphilis, such damage can also occur early in the illness. Doctors have seen people with early-stage syphilis who needed valve replacement and coronary bypass operations.

Latent Stage This symptom-free stage may last for a few years or for the rest of your life. In those who receive no treatment, about one-third of such cases progress to late, or tertiary, syphilis, during which many severe complications can occur.

Late, or Tertiary, Syphilis The late stage of syphilis is when the most severe complications usually arise. Here’s a partial list:

• Gummas Small bumps or tumors called gummas can arise on your skin, bones, liver, or any other organ, including the stomach and eyes. Gummas often arise in the palate and the structures of the nose. Other common sites include the face, scalp, trunk, and legs.
• Neurological Problems Syphilis can cause many nervous system problems, including sudden, searing pains. These spasms of pain may occur in various organs, often the stomach, and they may cause vomiting. Extreme, lightning-like pains in your rectum, bladder, and larynx may also occur. Syphilis can also cause the loss of sensation and of responsiveness to temperature changes. Visual problems or blindness, meningitis (an inflammation of the brain), and stroke may occur. Nervous system damage can also cause incontinence and impotence in men.
• Cardiovascular Problems These usually arise between 10 and 25 years after the initial syphilis infection. They may include inflammation and bulging of the aorta, the body’s main artery. Syphilis may also attack other blood vessels and heart valves.
• Pituitary Gland Involvement Rarely, syphilis can cause hypopituitarism, in which the pituitary gland secretes reduced amounts of hormones. In adults, this can cause premature aging, among other issues, and in children, dwarfism. (4)
• Heightened Risk for HIV Infection Sores caused by syphilis provide an easy path into the body for HIV. As a result, both men and women with syphilis have a risk of contracting HIV that is about two to five times higher than in adults who don’t have syphilis.
• Gastric Syphilis This relatively rare complication, affecting the stomach, usually strikes people in their 20s to 40s. It can cause pain, loss of appetite, nausea, vomiting, and weight loss. (5)
• Pregnancy and Childbirth Complications If you have syphilis while pregnant, you can pass it on to your child. Infected infants are at risk for being born with or developing many deformities. Syphilis during pregnancy greatly raises the risk of miscarriage or stillbirth, and infants who acquire syphilis from their mothers are at serious risk for dying during or shortly after birth.

All Syphilis Complications Are Avoidable

One injection of penicillin can cure syphilis in its early stages and protect you from these potential harms. If you belong to a group that’s at high risk of acquiring syphilis or other sexually transmitted diseases (STDs), talk to your doctor about your personal risk, whether you should be tested for syphilis, and, if necessary, getting treatment. Those at high risk include anyone with a partner who has recently tested positive for syphilis, men who have sex with men, and sexually active individuals living with HIV.

If you don’t have your own doctor, or prefer not to talk to your own doctor, seek help at a community health center or from Planned Parenthood. (6)

Centuries ago, if you caught syphilis you could not escape its harms. We are lucky today. Treatment is easy. Protect yourself, your partners, and your children.

Remember the old adage: “Prevention is better than cure.”