Syphilis: what are the symptoms of this sexually transmitted infection (STI)?


Syphilis is a sexually transmitted infection (STI) that can cause dermatological, cardiovascular or even neurological symptoms. The point with a specialist.

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Contrary to what one might think, syphilis has not disappeared: in France, 2,500 cases were diagnosed in 2020. And in the United States, some health professionals even speak of a “syphilis epidemic”: the number of patients increased by 26% between 2020 and 2021.

What exactly is syphilis?

Syphilis belongs to the family of sexually transmitted infections (STIs). It is caused by a bacterium: pale treponema (or Treponema pale of its scientific name), which resembles a microscopic “twisted snake”.

Pale treponema is transmitted by contact between the mucous membranes: “when you are a carrier of the bacteria, unprotected vaginal, bucco-genital and anal sex is at risk; a simple kiss can transmit the bacteria“explains Dr. Adrien Dereix, general practitioner.

According to the doctor, syphilis”is a relatively common pathology, especially in homosexual circles and among sex workers“Since mid-September 2022, an “epidemic of syphilis” has been raging in the world of pornography, putting all X film production on hold in Europe.”All people who have risky sex can be affected“says Dr. Dereix anyway.

What are the main symptoms of syphilis?

Syphilis evolves in several phases, with primary, secondary and tertiary manifestations.

Two to three weeks after contamination, we see a chancre appear at the level of the mucous membrane concerned (in the mouth, around the anus, at the level of the vulva, on the glans…). “It is an ulceration similar to a mouth ulcer: it is not painful, it is quite “hard” to the touch, it is “clean” (it does not ooze)… This lesion is characteristic of syphilis“says Dr. Adrien Dereix.

The chancre is the witness of the development of the disease on a local scale; this first symptom may possibly be accompanied by lymphadenopathy, ie swelling of the groin glands.

Attention !Because it is neither painful nor bothersome, syphilitic chancre can go completely unnoticed, especially if it appears in the folds of the anus” emphasizes the doctor. Moreover, the ulceration can disappear spontaneously after about 2 weeks: “it does not mean that we are curedwarns us Dr. Dereix. On the contrary: the disease progresses.

At least 6 weeks after the onset of the chancre, secondary manifestations of syphilis appear. “The bacterium disseminates in the body: it can then reach the skin, the eyes, the lymph nodes, the joints, the liver..” describes Dr. Adrien Dereix.

The symptoms are essentially cutaneous: “we can observe the development of roseola (an eruption of pink patches on the body, and in particular on the trunk) and / or syphilides (red pimples that peel on the hands and mucous membranes, in particular)“explains the doctor. These dermatological manifestations can be accompanied by uveitis, that is, inflammation of the tissues located inside the eye.

Tertiary manifestations of syphilis are much rarer”because the disease is usually detected and treated before it gets to that point” emphasizes Dr. Dereix. It may then be a question of bone damage and / or large blood vessels (aortitis …).

Syphilis: how is it diagnosed?

Can you die from syphilis? Syphilis is fatal in about 15% to 20% of patients. On the other hand, in the absence of appropriate treatment, the disease can leave serious sequelae: cardiovascular, neurological, psychiatric disorders…”There is thus a specific form of syphilis, called neurosyphilis, which is characterized by damage to the neurological system and the meninges: this can lead to cognitive disorders, memory problems, paralysis or even impaired spinal cord…remarks Dr. Dereix.

I had unprotected sex or with a person with syphilis, what do I do? It is best to consult your general practitioner without delay; you can also go to a free information, screening and diagnosis center (CeGIDD).

Screening methods depend on the progress of the diseaseexplains Dr. Adrien Dereix. If the risk report is recent, the doctor / healthcare professional will carry out a clinical examination in search of a chancre. The diagnosis will then be clinical: in case of doubt, there will be a sample taken from the chancre for laboratory analysis..”

If the consultation is later, a blood test (serology) will be carried out: “we then do a comprehensive screening for syphilis, HIV, hepatitis B and C, chlamydia, gonococcus…” remarks the doctor.

I happen to have risky sex: how often should I get tested? If you regularly have sex without a condom and/or if you do not know if your sexual partners are carriers of the bacteria Treponema paleDr. Adrien Dereix recommends screening for all STIs every 3 months.

What are the treatments for syphilis?

Treatment for syphilis depends on its stage. If there is less than a year between the appearance of the chancre and the screening (this is then called “early syphilis”), the treatment consists of giving an injection of penicillin G intramuscularly. If more than a year ago, 3 injections of penicillin G (intramuscularly) will be necessary, 1 week apart.

In case of allergy to penicillin, the antibiotic treatment will be taken orally: it will then be doxycycline, to be taken for 2 weeks in tablets“develops the doctor.

Can I have sex during the treatment? Wearing a condom does not completely prevent transmission of the bacteria Treponema pale. It is necessary to count at least 7 days after the beginning of the treatment to avoid contagion. “The best thing is to abstain for the duration of the treatment…” recommends Dr. Dereix.

Thanks to Dr. Adrien Dereix, general practitioner and medical director of the Paris-Republic Medical Center (ELSAN group).

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