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Syphilis is a sexually transmitted infection. Syphilis is curable, especially when detected early, with antibiotics, most commonly penicillin. It develops in four stages: primary, secondary, latent, and tertiary. Each stage has its distinct symptoms.

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Syphilis is primarily contracted through direct contact with a syphilitic sore, or chancre, during vaginal, anal, or oral sex. The bacteria that cause syphilis, Treponema pallidum, enter the body through tiny cuts or mucous membranes in the skin. These sores can occur on the external genitals, in the vagina, around the anus, or in the mouth, making it possible to contract the infection even if the sore is not visible. Syphilis can also be transmitted from a pregnant person to their baby during pregnancy or childbirth, which is known as congenital syphilis. While it is most commonly spread through sexual contact, syphilis is not spread through casual contact like hugging, sharing utensils, or using the same toilet as an infected person.

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The primary stage of syphilis is the first phase of the infection and typically begins with the appearance of a single sore, known as a chancre, at the site where the bacteria entered the body. This sore is usually firm, round, and painless, which can make it easy to overlook. It commonly appears on the genitals, anus, or mouth, depending on how the infection was transmitted. Even though the sore is painless, it is highly infectious. It usually develops about three weeks after exposure but can appear anywhere from 10 to 90 days later. The chancre heals on its own within three to six weeks, even without treatment, but the infection remains in the body and will progress to the next stage if not properly treated with antibiotics.

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The secondary stage of syphilis occurs a few weeks after the initial chancre heals and is marked by a range of symptoms that can affect multiple parts of the body. The most common sign is a non-itchy skin rash, often appearing on the palms of the hands and soles of the feet, though it can occur elsewhere on the body. Other symptoms may include fever, swollen lymph nodes, sore throat, patchy hair loss, muscle aches, fatigue, and mucous membrane lesions in the mouth or genitals. These symptoms may come and go over several weeks or months, and like the primary stage, they will eventually resolve on their own without treatment. However, the infection remains in the body and can progress to the latent and potentially the tertiary stage if not treated.

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The latent stage of syphilis is a period in which the infection is still present in the body but shows no visible signs or symptoms. This stage can begin after the symptoms of the secondary stage disappear, and it can last for years. During the early part of the latent stage, a person may still be contagious, especially within the first year, though this risk decreases over time. Despite the lack of symptoms, the bacteria remain active in the body and can continue to cause damage. Without treatment, syphilis can eventually progress to the tertiary stage, which may result in severe health complications. Diagnosis during this stage is typically made through blood tests, as there are no physical signs to observe.

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The tertiary stage of syphilis is the most severe and can occur years or even decades after the initial infection if left untreated. During this stage, the bacteria can cause serious damage to various organs and systems in the body, including the heart, brain, nerves, liver, bones, and joints. This can lead to life-threatening complications such as neurosyphilis (which affects the brain and nervous system), cardiovascular syphilis (which can damage the heart and blood vessels), and the development of gummas—soft, tumor-like growths that can appear on the skin or internal organs. Symptoms of tertiary syphilis vary widely depending on which organs are affected, but the damage caused at this stage is often irreversible. Although rare due to the effectiveness of modern antibiotics, the tertiary stage remains a serious concern when syphilis goes undiagnosed and untreated.

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Treponema pallidum is the bacterium responsible for causing syphilis, a sexually transmitted infection. It is a spiral-shaped, or spirochete, bacterium that moves with a corkscrew motion, allowing it to penetrate mucous membranes and enter the bloodstream easily. Treponema pallidum is extremely delicate and cannot survive outside the human body for long, making direct contact with an infected person's sores or mucous membranes the primary mode of transmission. It is notoriously difficult to culture in laboratory settings, which has made research and testing more challenging. Despite its fragile nature outside the body, once inside, the bacterium can spread throughout the body and remain hidden for years, leading to chronic infection if left untreated. Early detection and treatment with antibiotics, particularly penicillin, are effective in eliminating Treponema pallidum and preventing the serious health complications it can cause.

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If left untreated, syphilis can lead to serious long-term effects that may appear years after the initial infection. These complications typically occur during the tertiary stage and can cause permanent damage to vital organs and systems in the body. Long-term effects may include neurosyphilis, which impacts the brain and spinal cord, leading to problems such as paralysis, dementia, vision or hearing loss, and coordination difficulties. Cardiovascular syphilis can result in damage to the heart and major blood vessels, increasing the risk of aneurysms or heart failure. Additionally, untreated syphilis can cause destructive lesions known as gummas to form on the skin, bones, and internal organs. These long-term consequences are often irreversible, which is why early detection and treatment are critical to prevent lasting harm.

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When syphilis is passed from a pregnant person to their baby, it is called congenital syphilis, and it can have serious, sometimes life-threatening effects on the newborn. The infection can be transmitted during pregnancy or at birth, and without proper prenatal care and treatment, it can cause miscarriage, stillbirth, or premature birth. Babies born with congenital syphilis may show symptoms at birth, such as low birth weight, bone deformities, anemia, enlarged liver or spleen, jaundice, and skin rashes. In some cases, symptoms might not appear until weeks or even months later, potentially leading to developmental delays, seizures, vision and hearing loss, or damage to the teeth and bones. However, if detected early during pregnancy, syphilis can be effectively treated with antibiotics, greatly reducing the risk of transmission and protecting the baby’s health.

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Syphilis is highly treatable, especially when caught in its early stages. The most common and effective treatment is a course of penicillin, an antibiotic that kills the bacteria Treponema pallidum responsible for the infection. For most people, a single injection of penicillin is sufficient to cure syphilis, particularly in the primary, secondary, and latent stages. If the infection has progressed to the tertiary stage or has caused severe complications, more extensive treatment may be needed, but penicillin remains the cornerstone of therapy. For individuals who are allergic to penicillin, alternative antibiotics can be used, though penicillin is the most widely recommended option. It is crucial to complete the full course of treatment and to follow up with medical check-ups to ensure the infection is completely eradicated. Additionally, sexual partners of the infected person should also be tested and treated to prevent re-infection and further spread of the disease.