by | Feb 26, 2024 | Family Health, Healthy Living
How long does it take to cure syphilis?
With national syphilis cases increasing from an all-time low in 2000, healthcare professionals are struggling to correctly identify them. In 2024 the Charlotte, NC area had the dubious distinction of ranking 28th of 100 large cities with the highest rates of sexually transmitted diseases (STDs) in the country based on information collected by the Centers for Disease Control (CDC). The good news is that syphilis is easily cured once discovered. It’s the discovering part that might be the biggest challenge.
A Brief Introduction to Syphilis
Syphilis is a sexually transmitted disease (STD) that spreads through sexual contact between two people. In 2020- 7.1 million were infected globally. Unlike other STDs, which can be quite painful, there is generally no pain associated with the sores that can develop from syphilis. Most cases in the U.S. are diagnosed among men (or those assigned male at birth) who are gay, bisexual, and those who have sex with other men. Despite this, the rate of infection across all sexes and genders is increasing. The cause of the infection is the corkscrew-shaped bacteria Treponema pallidum. There are four stages of syphilis, each with its own set of symptoms and characteristics, though stages can overlap.
Syphilis is a serious infection that has the potential to cause a person, or their fetus, great harm. If you suspect you may have had syphilis at some point, but thought it went away, you should get tested immediately because the bacteria remain in your body unless treated with antibiotics.
A simple blood test can reveal if you have syphilis. If you test positive for syphilis, you should also be tested for HIV because a syphilis infection can lower your ability to fight off HIV infection.
Treatment Options for Syphilis
Antibiotics are the best treatment for syphilis bacteria, but not all antibiotics will cure it. Azithromycin, or Zithromax, is a strong antibiotic, however, the syphilis bacterium has become resistant to it, so it should not be prescribed.
Penicillin injected into muscle is the preferred antibiotic and method to treat syphilis. Congenital syphilis is what syphilis is called when a pregnant woman is infected. Pregnant women may only receive penicillin as the other common antibiotic used to treat syphilis, doxycycline, can lead to serious birth defects. The U.S. has experienced a shortage of penicillin and other antibiotics after COVID, therefore the injectable used for congenital syphilis is often set aside to make sure it is available to pregnant women even though it requires refrigeration and has a limited two-year shelf life. Pregnant women who are allergic to penicillin can get it, however, they will have to go through the process of desensitization. Desensitization occurs when a medication is administered in tiny amounts over a few hours and under direct medical supervision allowing the person to tolerate it temporarily without any allergic reaction.
Though used as the first-choice cure for syphilis for over 70 years, penicillin has a 10-20% treatment failure within 12 months of treatment in patients with early syphilis where insufficient antibodies are produced. This may be related to penicillin resistance-related gene mutations of T. pallidum. Penicillin is the only known cure for people who have a later stage of syphilis called neurosyphilis.
Stages and Treatment
The four stages of syphilis are:
- Primary (or early)
- Roughly 3-6 weeks after infection
- Secondary (stage 2)
- Beginning one to six months after infection
- Latent (often called the hidden stage)
- ‘Early’ latent stage is when the initial infection occurred within the previous 12 months and the person is still infectious.
- ‘Late’ latent stage is when the infection occurred more than 12 months in the past and this stage may last for as long as 20 years.
- Tertiary (or late)
- 30%-40% of untreated infections may reach this stage 10-30 years after infection. This stage can have profound impacts on multiple organ systems including the nervous system, heart, eyes, ears, spinal cord, liver, bones, joints, and liver.
The treatment for primary syphilis is one intramuscular shot of penicillin. If you’ve had secondary or early-stage latent syphilis for longer than a year, you may need a shot a week for three additional weeks.
Doxycycline is an alternative 14-day therapy for early syphilis (100mg 2x’s) and a 28-day treatment for late syphilis. Some evidence suggests that it is most effective the earlier a case is caught and treated.
Those who test positive for syphilis and receive treatment should be tested at both 6- and 12-month intervals post-treatment to be sure the infection has cleared, and no reinfection has occurred. Some people do not produce the number of expected antibodies over a year due to their stage of disease, level of titers when first tested, or age. These people should be retested annually and reevaluated for HIV infection.
Syphilis can be cured at any stage, however, any damage that may occur in Tertiary or late-stage syphilis causes cannot be reversed.
Additional Concerns
All persons who have primary or secondary syphilis should be tested for HIV at the time of diagnosis and treatment. HIV can make syphilis harder to treat. Those persons whose HIV test results are negative should be offered HIV PrEP. In regions where HIV prevalence is high, those with primary or secondary syphilis should be offered PrEP and retested for HIV in 3 months if the initial HIV test result is negative. HIV-positive syphilis patients should get blood drawn and tested at 3,6,9,12, & 24 months post-syphilis treatment.
Avoiding Reinfection
Anyone being treated for syphilis should avoid any form of sex for 7 days and until all sores are healed to prevent spreading the infection to others. A follow-up blood test with a health provider is important to make sure treatment has been successful. All sexual partners should be notified so they may also be tested and begin necessary treatment to avoid passing it back and forth. Remember, there is no immunity imparted once someone has had syphilis—it is a bacterium that can reinfect you at any time.
The only way to avoid syphilis reinfection is by practicing abstinence. If you do have sex, make sure to use latex or polyurethane condoms and dental dams. Your local health department may offer partner services. These help you notify your sexual partners that they may be infected so they can seek testing and treatment.
Visit AFC Urgent Care on Monroe Road for a fully equipped team to help you on your journey.
