Tertiary Syphilis: Something Dangerous Happens When Syphilis Goes Unnoticed

Syphilis is undoubtedly one of the most common STDs most people have heard of. In the United States, cases of syphilis were starting to resurge in 2019 as more than 129,800 cases were recorded. This number is two times higher compared to case counts in the previous 5 years. In Singapore, according to the Department of Sexually Transmitted Infections Control (DSC), syphilis is the third most common STD after chlamydia and gonorrhea.

It is important to know that syphilis is curable. An STD caused by a bacterium called Treponema pallidum, syphilis happens in stages and may not cause serious damages if a person is treated before it is too late. However, as with other STDs, syphilis often shows no symptoms, making people think that they are free from it. Once this STD advances into the final stage, which is tertiary syphilis, a person’s brain, nerves, heart, joints, liver and bones can be damaged. In this article, we will delve deep into the stages of syphilis, symptoms of tertiary syphilis, its diagnosis and whether or not it is curable.

How does tertiary syphilis happen?

Syphilis is a disease which has 4 stages. Each stage presents different symptoms and signs. A person may contract tertiary syphilis if the disease remains untreated in the earlier stages and progresses into the final stage.

  • Primary syphilis, the first stage of the disease, is normally acquired through sexual activity (contact with body fluids). Treponema pallidum will then spread and dissipate to the bloodstream. Symptoms usually appear 3 to 4 weeks after exposure and they revolve around painless sores (single or multiple) which are often found in the penis, vagina, anus, rectum and lips that will heal on their own.
  • Secondary syphilis takes place a few weeks after the sores go away. This stage is signified by the emergence of skin rashes that cover the penis, vagina or anus as well as other parts of the body including the palms of the hand. These rashes are not itchy and may be accompanied by other symptoms such as muscle aches, fever, sore throat and swollen lymph nodes.
  • Latent syphilis is the only stage where there are no visible symptoms. This stage may last up to years.

Years or decades after the initial infection, tertiary syphilis may occur. At this stage, syphilis is no longer contagious. According to the CDC, tertiary syphilis is gravely serious and can cause internal organ damages that lead to death. The interval between the initial infection and tertiary syphilis ranges from 10 to 30 years. Syphilis is often referred to as ‘the great imitator’ or ‘the great pretender’ as its symptoms can resemble other diseases. Due to this reason, diagnosing the disease when it has come to later stages can get tricky. Tertiary syphilis can be diagnosed after running multiple tests.

Symptoms of Tertiary syphilis

Not getting treatment for syphilis can lead to life-threatening consequences. For instance, syphilis can damage the brain, nervous system, eye and ears. In some cases, stages of syphilis may not happen in order and can overlap. It is important to remember that tertiary syphilis only happens in one-third of those who do not receive proper treatment. Signs of tertiary syphilis include:

  • Gumma. Gummas are granulomatous lesions or tender, tumor-like development of tissues. These abnormal growths are usually found in the bones, skin and organs. Gummas typically develop due to inflammation and contain various immune cells.
  • Late neurosyphilis. Neurosyphilis is actually one damage of syphilis that can occur in any stage mentioned above. Signs of neurosyphilis are intense headache, weakened muscles and shifts in mental state (dementia, trouble concentrating, and personality change). However, late neurosyphilis is signified by escalating damage to the posterior part of the spinal cord. As a result, people may experience losing the sense of vibration and proprioception/kinaesthesia (the ability to sense movement and positions). Other cases of late neurosyphilis can affect blood vessels that cater to the brain and spinal cord and cause slurred speech, memory loss, and paralysis.
  • Cardiovascular syphilis. As the name suggests, this symptom affects some things related to the heart. Most common indications of cardiovascular syphilis are inflamed aortic walls which can result in aortic aneurysms and the swelling of the aortic root.

Besides damages mentioned above, untreated syphilis can lead to ocular syphilis that damages the eye and otosyphilis that affects the ears. However, these two complications can occur at any stage of syphilis (not limited to tertiary syphilis).

  • Ocular syphilis can present symptoms such as pain in the eye, redness, and even blindness
  • Otosyphilis can result in hearing loss, tinnitus (buzzing or ringing in the ears) and vertigo

Diagnosing tertiary syphilis

Since syphilis is sneaky in nature (lesions can go unnoticed), people may not know that they are infected until the later stages take place. For this reason, the diagnosis of tertiary syphilis encompasses in-depth physical examination and checking through a person’s medical history.

After these two steps are performed, if a person is suspected to suffer from tertiary syphilis, blood tests to detect antibodies against Treponema pallidum will be carried out. These blood tests are categorized into non-treponemal tests and treponemal tests. Usually, the test begins with non-treponemal tests. If the results come back negative, then a person does not suffer from syphilis. But, since non-treponemal tests can give false-positives, a follow-up treponemal test is required to confirm the tertiary syphilis diagnosis.

Treating and curing tertiary syphilis

Syphilis can be effectively treated with antibiotics (penicillin). People suffering from latent or tertiary syphilis will need a weekly penicillin injection for three consecutive weeks. Some cases such as people with neurosyphilis will require higher doses of penicillin intravenously (for 10-14 days). If a person is allergic to penicillin, doxycycline is used as a substitute. Tertiary syphilis can be completely cured but can be contracted again if a person decides to do risky sexual activities.

One way to make sure syphilis does not go unnoticed is by getting regular STD testing. Shim Clinic is a STD clinic based in Singapore that caters to STD screenings, diagnosis and treatment. We also carry HIV prevention methods such as HIV PEP (most effective when taken within 72 hours after a possible exposure), HIV PrEP and HPV vaccination (Gardasil-9).