Syphilis Treatments and Medications

Over the past several years, the rates of sexually transmitted diseases (STDs) have dramatically increased. The combined cases of syphilis, gonorrhea, and chlamydia are at an all-time high, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC estimates that 55,400 people in the United States contract syphilis each year.

There are numerous factors causing the rise in STDs, including syphilis. "Many people are having hook-up, condom-less sex and not having the proper screening evaluation before being intimate with someone," says Dr. Alyse Kelly-Jones, a gynecologist at Novant Health. She goes on to say, “When you can go on your phone and find a partner quickly, the risk seems less."

Access to, or lack of, health care also plays a role. "Many of our population have limited or no access to healthcare,” Dr. Kelly-Jones says. “Getting a routine screening for STDs can be expensive and not covered by some of our limited health plans. Going to the health department can be difficult and time-consuming.”

While syphilis can cause long-term damage when untreated, it can be cured with antibiotics, although damage to the body may remain. Researchers continue to look for new, more accessible diagnostic tests and treatments for syphilis—such as urine and saliva tests that detect syphilis instead of a blood test. Additionally, new syphilis treatments could include oral medication rather than needing one or more injections at your doctor's office. Some researchers are conducting research that might eventually lead to a vaccine, according to the National Institute of Health (NIH).

What is syphilis?

Syphilis is a systemic, sexually transmitted disease (STD) caused by the Treponema pallidum bacterium, according to the CDC. It can be spread from person to person through vaginal, anal, or oral sex when there is skin-to-skin sexual contact with syphilis sores or lesions. In the secondary stage, it can also spread by direct contact with mucous membrane lesions. The third way it is transmitted is called vertical transmission, which is when pregnant women pass it to unborn babies through the bloodstream. A child born with an infection has congenital syphilis.

There are four main stages of syphilis, according to the CDC Pocket Guide for Providers:

1. Primary syphilis: During this stage of syphilis, people are highly infectious, and it is easy to pass the disease to a sexual partner. Symptoms usually appear about three weeks after exposure. They include lesions, called chancres, that present around the external genitals, anus, in the vagina, in the rectum, or in and around the mouth. The lesions are small, firm, round sores, which are painless. They may heal within a few days or weeks, with or without treatment. However, the underlying disease cannot be cured without medication.

2. Secondary syphilis: People with syphilis are highly contagious during the secondary stage. Clinical manifestations of this stage include mucocutaneous lesions or rashes on the skin. These usually appear on the torso, but they can also appear on the palms of the hands or soles of the feet. Around one-fourth of those with syphilis will develop condyloma lata, moist wart-like lesions in the genital area. As with primary lesions, secondary-stage symptoms also clear up on their own anywhere from two weeks to three months after they appear. Although the lesions might disappear, the underlying infection is still present without antibiotic treatment.

3. Latent syphilis: The early latency period is within one year of onset of symptoms. The late latency stage is more than one year after the start of symptoms. People in these stages might or might not have symptoms or may only have mild symptoms that can easily go unnoticed.

4. Tertiary syphilis: The tertiary stage occurs when the infection spreads to the skin, bones, brain, and cardiovascular systems. During this stage, the person is not contagious.

When syphilis spreads to the nervous system, it is called neurosyphilis. Neurosyphilis may occur at any stage of infection. Although the nervous system might become infected within hours of exposure, it can take weeks or years before symptoms appear, or symptoms might never appear. Early neurosyphilis can appear as meningitis or meningovascular syphilis. It can affect the neurologic, ophthalmologic, and audiologic systems of the body. Late-stage neurosyphilis can lead to dementia, muscle weakness, and paralysis.

How is syphilis diagnosed?

The diagnostic process for syphilis usually includes a physical examination for lesions, blood tests, reverse sequence screening, and questions about sexual history. Your doctor may order one or more of the following tests:

• A rapid plasma reagin (RPR) blood test detects specific antibodies in your body that are present when you have a syphilis infection.

• A sample of cerebrospinal fluid (CSF) via lumbar puncture can determine if neurosyphilis is present.

• An enzyme immunoassay test (EIA) can help confirm a syphilis diagnosis.

Who should get screened for syphilis?

Anyone can get screened for syphilis, regardless of whether they have any symptoms. Planned Parenthood recommends that anyone who is sexually active should get tested for STDs annually. Women who are pregnant should also get screened because of the high risk to the unborn child.

Screening for syphilis is an essential part of preventing the spread of sexually transmitted infections (STIs), according to the U.S. Preventive Services Task Force. It recommends the following populations receive regular screenings because of their elevated risk:

• Men who have sex with men

• Women and men who are living with HIV infection

Dr. Kelly-Jones adds, "If I have a patient that has unprotected sex with a new partner, I would be screening for syphilis. Any patient that has signs or symptoms suggestive of syphilis, any pregnant woman, any person that has been in contact with someone who has had syphilis would all be reasons to screen."

Anyone who notices a sore in the genital area and those who have had unprotected sex should seek health care from a doctor or clinic for STI testing. You can receive diagnostic tests and treatment for syphilis through your primary care physician or gynecologist. You can also search for a sexual health clinic or general health clinic that tests for and treats STIs on the American Sexual Health Association website. You should notify your sex partners if you receive a syphilis diagnosis, as they should be tested and treated, too.

Doctor-patient discussions

Talking with a physician about STDs, such as syphilis symptoms, is not easy. It can be embarrassing, and you might worry that the doctor will judge you for your choices. However, most doctors who diagnose and treat STDs are not judgmental and want to make sure you stay healthy and continue to make healthy choices.

During these doctor's appointments, a physician will ask about a patient's general health history in addition to their sexual health history and their recent sexual activity, including the reason they're seeking STD screening.

Just as necessary as it is for you to share information with your doctor, you should ask questions to make sure you understand your risks and, if needed, treatment options. The Office of Disease Prevention and Health Promotion (ODPHP) suggests you ask your doctor the following questions:

• Am I at risk for syphilis?

• Do I need to get tested for syphilis?

• How often do you recommend I get tested for syphilis?

• What happens during the test?

• How will I find out my test results?

• When will I get my test results?

• If I have syphilis, what will happen next?

• Can you give me some information about syphilis to take home with me?

Syphilis treatment options

Antibiotics can cure syphilis. Early detection and management of syphilis are important. Although the treatment can eradicate the syphilis infection, it cannot undo the damage the infection might have caused, according to the CDC.

An intramuscular injection of long-acting Bicillin L-A (penicillin G benzathine) is used for primary to early latent syphilis. However, late latent syphilis requires three weekly doses of the same medication.

Doxycycline and tetracycline are some options for those allergic to penicillin.

For neurosyphilis, penicillin or ceftriaxone are the first choices of drugs. When neurosyphilis is involved, your doctor might suggest clinical and laboratory follow-ups to monitor whether the medication is effective.

Syphilis medications

Antibiotics treat syphilis. Bicillin L-A (penicillin G benzathine) is the most commonly used antibiotic for syphilis. Depending on the stage, you might need a single injection or a weekly shot for three weeks.

Some common side effects include:

• Nausea

• Vomiting

• Diarrhea

• Flushing

• Headache

• Drowsiness

Other brand-name antibiotics that are available for those allergic to penicillin include:

• Acticlate (doxycycline)

• Avidoxy (doxycycline)

• Doryx (doxycycline)

• Mondoxyne NL (doxycycline)

• Oracea (doxycycline)

• Vibramycin Hyclate (doxycycline)

• Tetracycline HCl (tetracycline)

Some of the common side effects of these medications include:

• Nausea

• Vomiting

• Diarrhea

• White patches or sores in your mouth

For neurosyphilis, penicillin or the cephalosporin antibiotic, Rocephin (ceftriaxone), is used. The medication is injected into a muscle or given intravenously for 10-14 days. People with a penicillin allergy should not take these medications. Some common side effects of ceftriaxone include:

• Black, tarry stools

• Chest pain

• Cough

• Fever

• Painful urination

• Shortness of breath

• Sore throat

Researchers are also looking at the antibiotic azithromycin as a treatment for syphilis.

What is the best medication for syphilis?

Syphilis treatment options are limited. The first-line treatment is Bicillin L-A, which is an injection of penicillin. Other medications are available for those who are allergic to penicillin. The following lists the primary drugs used for syphilis:

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Best medications for syphilis