Syphilis is a dangerous infectious disease that used to be widespread in Europe in the 17th to 19th century. However, even today, syphilis is an important sexually transmitted disease (such as gonorrhea, chlamydia infections and AIDS), which can seriously damage health and psyche of the infected and cause lifelong consequences.


Syphilis is an infectious disease caused by a bacterium known as treponema pallidum. This bacterium belongs among the spirochetes together with bacterium causing the Lyme disease. And really, both diseases bear some similarities. The treponema pallidum was brought to Europe in the late 15th century by sailors of Christopher Columbus, who contracted the disease from the inhabitants of America (mistakenly named as the “Indians”). The syphilis quickly spread throughout the Europe into all social classes including the governing elite.


The transmission occurs most often during a sexual intercourse or other sexual activities. Non-sexual transmission can no be excluded, but it requires a long-term continuous close contact with the patient (living in the same household, etc.). There is also possible the transmission from mother to a fetus during pregnancy.


The disease has more stages, which is a typical situation for infections caused by spirochetes.

1st stage

The first stage is also referred to as the “chancre” or “ulcus durum”. The stage occurs within few weeks after the infection at the point where the bacterium has penetrated into the body. The lesion looks like a hard and painless ulcer, which is usually located on the external genitals. However, when contracted during oral sex, the chancre may occur inside the mouth cavity, in the rectum during anal sex, etc. The ulcer is significantly infectious as it contains a large number of bacteria. The ulcerated lesion can be accompanied with local enlargement of the lymph nodes.

2nd stage

This stage occurs in about one third of the infected persons. The second stage manifests within several months after the infection. It is associated with the spread of treponema bacteria into the body by bloodstream. The possible symptoms include fever, skin rash all over the body, local loss of pigment in the skin, hair loss and sometimes even the condylomata lata. The condylomata lata are smelly growths on the skin in areas around the genitals, groin and skin folds. The condylomata lata are filled with treponema and therefore extremely infectious.

3rd stage

The third stage occurs only in about one third of patients who underwent the second stage and its development lasts for years or even decades. At this stage, the bacteria are present in multiple organs and the resulting damage is caused by response of the immune system. In developed countries, the 3rd stage of syphilitic infection is extremely rare and practically impossible to encounter. The symptoms include so-called tabes dorsalis, progressive paralysis and syphilitic aorta. Tabes dorsalis is caused by damage of the back nerve fibers of the spine that inform the brain about the position of body parts. The damage causes disorders of locomotion resulting in bizarre “tabic” gait. Progressive paralysis is a symptom of brain damage, which manifests with mood swings, megalomania, loss of judgment and ultimately irreversible personality disorders. Syphilitic aorta occurs when the aortal wall (usually in thoracic aorta) is damaged by treponema-related immune inflammation. The aorta can easily burst causing massive hemorrhage and death.


The diagnosis can be made from clinical symptoms in a patient with risky sexual behavior. The disease can be confirmed serologically by finding serum antibodies against the bacterium in the patient’s blood. In the first and second stage, the bacteria can be found in the blood or in samples of biological tissues (from the chancre or condylomata lata, etc.).


The best prevention is non-promiscuous behavior and preferring protected sex. Any patient with confirmed syphilis infection should be also diagnosed for other sexually transmitted diseases including the AIDS.


Antibiotics are effective in the first and second stage. However, it is necessary to warn against any self-treatment. The treatment should be done by a skilled physician, who reports the case and tries to seek the patient’s sexual contacts to prevent the disease from further spread.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources