Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. If left untreated, syphilis can progress through four stages, with the final stage being tertiary syphilis. Tertiary syphilis can develop 10-30 years after initial infection, and in rare cases, the infection may persist for up to 50 years.
What are the stages of syphilis?
Syphilis progresses through the following stages:
- Primary syphilis – Usually occurs 3-90 days after exposure and causes a painless sore at the site of infection (usually the genitals, rectum, or mouth). The sore typically heals on its own but the underlying infection remains.
- Secondary syphilis – Develops 2-10 weeks after the original sore heals. Symptoms include rash, swollen lymph nodes, fever, sore throat, hair loss, headaches, weight loss, muscle aches, and fatigue.
- Latent syphilis – After secondary syphilis resolves, the infection enters a latent (hidden) phase. Early latent syphilis occurs within the first year of infection. Late latent syphilis occurs after the first year and can last for years.
- Tertiary syphilis – The most severe stage that occurs 10-30 years after infection. It leads to severe medical problems throughout the body.
What are the symptoms of tertiary syphilis?
Tertiary syphilis can cause serious complications such as:
- Neurosyphilis – inflammation of the brain and spinal cord leading to headaches, altered behavior, paralysis, numbness, vision problems, dementia, and death.
- Cardiovascular syphilis – aortic aneurysms, coronary artery ostial stenosis, and aortic regurgitation.
- Gummas – rubbery tumors that form on skin, bones, liver, and other organs.
Can syphilis really last 50 years?
It is extremely rare, but yes, syphilis can theoretically last 50 years or longer in some cases:
- If syphilis goes untreated, roughly one-third of individuals will develop tertiary syphilis.
- Tertiary syphilis develops about 10-30 years after initial infection on average.
- However, documented cases have reported tertiary syphilis up to 50 years after the initial infection.
- Neurosyphilis and gummas may develop at any point in the disease process, even 50 years later.
A study published in the Journal of the Royal Society of Medicine described an 89-year-old man diagnosed with tertiary syphilis. He reported being treated for syphilis 50 years earlier but still progressed to late-stage disease after such a long period.
How does syphilis evade the immune system?
Syphilis manages to avoid immune detection and survive in the body for decades due to the following factors:
- Hiding in the central nervous system – The syphilis bacteria crosses the blood-brain barrier and hides from the immune system.
- Surface proteins – Syphilis has genes called tpp47 and tpr that encode surface proteins that change over time. This makes the bacteria appear “in disguise” so the immune system does not recognize it.
- Avoiding inflammation – The bacteria does not elicit a strong inflammatory immune response, allowing it to hide undetected.
How is tertiary syphilis diagnosed?
Diagnosis of tertiary syphilis involves:
- Medical history – The physician will look for a history of syphilis infection, sexual risk factors, and antibiotics treatment.
- Blood tests – Serological tests look for antibodies to the syphilis bacteria. The VDRL and RPR tests are positive in 85-100% of tertiary syphilis cases.
- Cerebrospinal fluid analysis – In suspected neurosyphilis, cerebrospinal fluid is tested for syphilis antibodies and white blood cells.
- Imaging – CT scans, MRIs, ultrasounds, angiography may reveal signs of gummas, neurosyphilis, or cardiovascular syphilis.
- Biopsy – Taking a small sample of the gumma lesions can confirm tertiary syphilis through microscopic identification of spirochetes.
How is tertiary syphilis treated?
Tertiary syphilis is treated with antibiotics:
- Penicillin – Penicillin G given intravenously for 10-14 days is the preferred antibiotic. This is the only known effective antibiotic for neurosyphilis.
- Ceftriaxone – Can be used as an alternative to penicillin for most patients with late-stage syphilis.
- Azithromycin or Doxycycline – May be effective alternatives for patients allergic to penicillin.
Without treatment, tertiary syphilis can be fatal. With prompt antibiotic treatment, the outlook can be good provided there is no permanent organ damage.
How can tertiary syphilis be prevented?
The best way to prevent tertiary syphilis is to detect and treat syphilis in its early stages:
- Screening for syphilis in pregnant women and high-risk groups.
- Educating people about practicing safe sex by using condoms.
- Getting tested regularly for syphilis and other STIs if engaging in unprotected sex with new partners.
- Notifying recent partners about possible syphilis exposure and encouraging testing.
- Following up after syphilis treatment to confirm the infection is cured.
Early diagnosis and prompt antibiotic treatment can prevent progression to the debilitating late stage complications of tertiary syphilis.
Key Points
- Tertiary syphilis can occur 10-30 years after initial infection, with rare cases progressing for 50 years or more.
- Syphilis evades the immune system by hiding in the central nervous system, altering its surface proteins, and avoiding inflammation.
- Neurosyphilis, cardiovascular syphilis, and gummas are severe complications of tertiary syphilis.
- Diagnosis involves blood tests, CSF analysis, and imaging to confirm antibodies and inflammation.
- High-dose penicillin is required to treat the late stage infection.
- Prevention relies on early testing, treatment, partner notification, and safe sex practices.
Conclusion
In conclusion, although exceedingly rare, syphilis infection can persist for up to 50 years before progressing to the most severe complications of tertiary syphilis. This occurs when syphilis goes undiagnosed or untreated initially and the body cannot clear the infection entirely. The bacteria manages to avoid the immune response and hide over decades. Without proper antibiotic treatment, tertiary syphilis can be fatal. However, the outlook is generally good if it is caught early and treated promptly with penicillin before permanent end organ damage arises. Preventing the progression to long-lasting syphilis relies on effective screening, early diagnosis, antibiotic treatment, partner notification, and safer sexual practices.