Sex and STIs: Syphilis can kill you

"Safe sex" was common slogan in the 1980s when HIV was discovered and widely discussed, but the idea of safe, protected sex seems to have been forgotten again. Perhaps it's got something to do with whether you experienced the panic of the 80s. But there are indications that especially younger people lack an awareness about Sexually Transmitted Infections or STIs.

In this article, we're focusing on syphilis.

What are common symptoms of a syphilis infection?

The symptoms of syphilis can vary from person to person. Most often, however, you get an ulcer or boil where the bacteria that causes syphilis, treponema pallidum, enters the body. The sore can range from the size of a pimple up to a centimeter wide.

In men, the sore appears on the penis. In women, it can be found vaginally or on the labia. The infection can also form around the anus and other parts of the body.

"In some [people], an ulcer appears on the lips of the face or on the tongue. But you can also have this bacterium on your finger. This is the first stage of syphilis, the primary stage," explains expert Norbert Brockmeyer.

Early symptoms are often ignored

Often, people who get infected do not take the first signs of syphilis seriously — they may not realize what it is — and may assume that it will go away on its own.

But syphilis does not simply appear on its own, it is a result of sexual intercourse with an infected person, and it does not go away on its own either.

The problem does not resolve itself, even if it seems so at first — after about three weeks, in most cases, the ulcer appears to heal on its own.

"After an undefined period of time, a skin rash develops because the pathogens have spread throughout the body via the blood," says Brockmeyer. "That means you get skin lesions all over your body. Some are raised, some are a bit scaly, others are reddish."

Syphilis has different stages

Rashes usually appear on the soles of the feet or on the palms of the hands.

"They don't itch and are quite easy to distinguish from an allergic rash," Brockmeyer says. This phase is the second stage of an infection.

In the third phase, the infection becomes very serious. It can affect the internal organs, airways, stomach and liver, but also the muscles and bones. The situation gets critical when a "syphilitic node" forms on the aorta, the main artery. This can lead to an aortic aneurysm, which is life-threatening.

Syphilis can lead to chronic disease

Syphilis is a systemic disease and can have irreversible consequences in its fourth phase. This often includes inflammation of the heart, signs of paralysis, changes in liver function, and brain damage.

About 25% of syphilis patients develop chronic brain inflammation. The disease can even affect the eyes.

"There is disruption of the neural pathways as well as the cells themselves. In many famous people [who had syphilis], syphilis damaged their mental faculties," says Brockmeyer. Those people included, for example, Ludwig van Beethoven, Friedrich Nietzsche, and some research also suggests that Catherine the Great had syphilis, too.

Syphilis used to be called the "The Great Pretender" because it mimics many other illnesses.

A well-known Canadian physician, William Osler, remarked at the end of the 19th century that "he who knows syphilis, knows medicine."

Is syphilis curable?

Initially, syphilis was treated with salvarsan, an arsenic compound that came on the market in 1910.

Then in 1943, penicillin became the drug of choice and remains so today.

"Other antibiotics are already showing resistance," Brockmeyer cautions. "If the pathogen builds up resistance to penicillin, we will have a problem that can only be solved with enormous effort. That's why it's now high time to develop and test reserve antibiotics."

Syphilis was used as a weapon of war

There are numerous theories about how syphilis got to Europe. One of them is that the explorer Christopher Columbus and his men carried it in their cargo when they returned to Spain from an expedition to the Americas in 1492.

It is thought that the disease then spread through Italy and France and became an epidemic.

From Europe, the "French disease" — as it was also called — then moved on to Asia.

It quickly became clear that syphilis was an infectious disease and transmissible.

Sutlers were women who accompanied armies in wars and served as sex workers. "If it was known that some of the sutlers were infected with syphilis, they were sent to the enemy armies as love ambassadors," says Brockmeyer.

Some wars were decided by syphilis, as it were, when soldiers became infected and their ranks were decimated by the disease. So, even many centuries ago there was biological warfare," according to Brockmeyer.

Lack of money for education and treatment

Syphilis has become forgotten in society today, which makes it dangerous, because it is flourishing. Education, counseling, diagnostics and treatment are the most important measures to get a better grip on this dangerous infectious disease.

The best method of prevention is safe sex: use a condom because it can protect against STIs. But education is also very important, which is why the Center for Sexual Medicine and Health in Germany has put information and counseling at the top of the list. 

But Brockmeyer says there is a lack of money: "There is simply no long-term perspective. We need the money now so that we can see success in five years. We need to use the protection options against a wide range of sexually transmitted infections: vaccination against human papilloma viruses, tablets against HIV infection, screening," Brockmeyer says. If we take these steps, cases of syphilis will decrease, as well as rates of many other STIs.

This was translated from German and originally appeared on 9/4/2018 and was updated on 12/20/2022.