Syphilis is a chronic bacterial infection that primarily spreads through sexual contact. Historically, it has been a major public health issue, but modern antibiotics have made it highly treatable. Despite this, syphilis remains prevalent in many parts of the world due to inadequate screening, and the number of cases has been rising. Correct and consistent use of condoms is the best way to prevent the disease.
Syphilis can remain latent for years without noticeable symptoms, but it can still progress to serious complications if untreated.
Symptoms of syphilis vary depending on the stage of the infection. Many individuals remain asymptomatic during the latent phase, making routine testing important.
If left untreated, syphilis can progress to the tertiary stage, which may occur years or decades after the initial infection. This stage can cause irreversible damage to vital organs, including:
In pregnancy, untreated syphilis can result in congenital syphilis, causing stillbirth, neonatal death, or severe birth defects.
Syphilis is primarily transmitted through direct sexual contact with an infected person, including vaginal, anal, and oral sex. The infection enters the body through tiny breaks in the skin or mucous membranes. The infection can also be passed from an infected mother to her unborn child.
Syphilis is effectively treated with antibiotics, most commonly penicillin. Early-stage infections usually require a single dose, while later stages may need longer courses of treatment. There are alternatives for people who are allergic to penicillin but treatment may take longer. Penicillin can also be given to pregnant women. Follow-up blood tests are essential to ensure the patient has recovered.
Preventing syphilis involves safe sexual practices, including consistent use of condoms and dental dams. Regular sexual health screening and early treatment of sexual partners are vital to reduce transmission. Pregnant women in the UK are routinely tested for syphilis (as well as HIV and hepatitis B).
The first syphilis epidemic hit Europe in the 1490s, thought to have been brought back from the New World by Christopher Columbus. However, there has been debate about its origins with some academics arguing that the disease was already present in Europe. At the time the disease was known as the pox but was given its name in an epic poem by the Italian scholar Girolamo Fracastoro who described how the Greek god Apollo visited the terrible disease upon a shepherd boy, Syphilus.
Since its earliest origins the disease has been viewed through a moral prism, seen as a punishment for a life of sin. This, coupled with the disease’s characteristic skin lesions and the madness that would afflict those in its later stages, means that the disease has proved fertile ground for artists and writers.
It was not until the discovery and widespread use of penicillin in the 1940s that the disease came under control. In the UK cases spiked at around 20,000 in 1948 but soon fell and in the late 1990s and early 2000s it was thought to be a disease of a previous age, with numbers at historically low levels. However, syphilis began to resurge and in 2022 numbers of diagnoses were the biggest since 1948. Public health experts believe an increase in testing partly explains the rise, but the main culprit is falling condom use.
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