Syphilis Explained to Africans: Symptoms and Treatment

By Isma Butt, DPT. Freelance Medical Writer and DLHA Volunteer. Medically reviewed by A. Odutola, MB BS, PhD 

African couple showing affection. Image credit: Freepik.

Highlights

• Syphilis is a common and curable STI that has a significant impact in Africa, particularly among female sex workers and people living with HIV.

• The infection progresses through four stages with symptoms ranging from painless sores to serious organ damage if untreated.

• Testing and early diagnosis (including antenatal screening) are vital to prevent severe complications like congenital syphilis.

• Penicillin is the primary, effective treatment, but partner notification and treatment are essential to stop reinfection.

• Prevention focuses on condom use, reducing multiple partners, community education, and overcoming stigma associated with STIs.

Introduction

Syphilis is a serious infection that affects many people across Africa. It spreads mainly through sexual contact but can also be passed from a mother to a baby during pregnancy. Even though it is common, many people do not fully understand the disease or its effects on health. This lack of awareness often leads to late diagnosis, which harms individuals and allows the infection to spread further within the communities.

Like many sexually transmitted infections (STIs), syphilis is often hidden behind silence, shame, and fear. This stigma makes it harder for people to talk openly or seek timely care, leaving the infection undetected. The truth is that syphilis is preventable and completely curable with the right treatment.

This article explains how you can catch syphilis, how it spreads, the symptoms to watch for, how it is treated, and why early testing is vital to protect individuals, families, and communities.

What is Syphilis?

Syphilis is a sexually transmitted infection (STI). It is caused by a bacterium (tiny germ) called Treponema pallidum, which enters the body mainly through small cuts or sores during sex. After infection, syphilis travels through the body in stages and causes different health problems if untreated. 

With proper treatment, syphilis is curable. Recognising early signs and understanding how it spreads are essential for prevention and treatment.

Light microscopic appearance of Treponema pallidum, the bacteria (germ) causing syphilis under a magnifying glass overlay. Click on image to enlarge

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How common is Syphilis in Africa?

Syphilis is common in Africa. A 2024 study in five sub-Saharan African countries of Ethiopia, Tanzania, Zimbabwe, Uganda and Zambia, found a population based prevalence of syphilis in about 1 in 100 people in Tanzania and Zimbabwe, 2 in 100 people in Uganda, and 3 in 100 people in Zambia. The occurrence of syphilis was higher among people living with HIV than among those without HIV and the odds of active syphilis were higher among people living with HIV than in those who were HIV negative. It was also high among divorced, separated and widowed individuals as well as those reporting two or more sexual partners in the last 12 months.

How does syphilis spread?

Syphilis can be transmitted:

• By having unprotected sex (vaginal, anal, or oral) with someone who has syphilis sores. 
• Rarely, through blood transfusions or sharing needles.
• From a mother to the baby during pregnancy or birth (congenital syphilis).

What is Congenital Syphilis?

If a mother has untreated syphilis, the baby can be infected in the womb or during birth. Congenital syphilis may cause:

• Stillbirth (baby dies before birth). 
• Early death in the newborn
• Birth defects: bone deformities, eye problems, and hearing loss.

Who is most at risk of getting syphilis?

Fig. 1: Syphilis Risk Factors. Click on image to enalrge.

 

Anyone can get syphilis, but some groups in Africa face a higher risk. See fig 1:

• Sex workers
• Young people aged 15 - 30 years 
• Men who have sex with men
• Long distance truck drivers and travellers going to areas with high syphilis infection
• People with multiple sexual partners 
• People who do not use condoms or other protective barriers
• People with another STI, such as HIV, gonorrhoea or chlamydia
• People with previous syphilis infection
• Injection drug users
• Babies born to pregnant females with untreated syphilis who do not attend antenatal (before birth) care.
• Individuals living in areas with limited access to healthcare and testing services 

Syphilis symptoms: What to look for?

Syphilis develops in stages, and the symptoms can vary at each stage. In some people, the signs are mild or may disappear for a time, making the infection easy to miss. Because symptoms can resemble other illnesses, syphilis is often called the “great imitator. The disease progresses through 4 stages and the symptoms of each stage differ. See fig. 2

Fig 2: Symptoms and Stages of Syphilis Click on image to enlarge.

 

1. Primary Stage:

• The first sign is a painless sore called a chancre.
• It usually appears where the bacterium entered the body, such as the genitals, anus, or mouth. 
• The sore is usually firm, round, and small.
• Because it does not hurt, many people do not notice it.
• The chancre may last for three to six weeks and then heals on its own. However, the infection stays in the body and moves to the next stage if untreated.

2. Secondary Stage

• A few weeks after the chancre heals, an infected person may develop a rash on their palms, soles, or other parts of the body. 
• This rash is usually not itchy. Other symptoms may include:
  • Fever 
  • Fatigue
  • Sore throat 
  • Swollen lymph nodes
  • Muscle aches
  • Hair loss in patches 

These symptoms come and go, and sometimes are so mild that they are overlooked.

3. Latent Stage

• At this stage, the infection hides in the body without symptoms. This stage can last for years. 
• Even without symptoms, syphilis can still damage the body and may still be transmitted to others. 
• Without treatment, the disease can progress to the tertiary stage.

4. Tertiary Stage

• This stage can cause serious problems affecting multiple organs including brain, nerves, heart and eyes.
• Tertiary syphilis can be life-threatening and difficult to treat once it develops.

When to see a Doctor for Syphilis 

Because syphilis can remain hidden in the body for years, you should see a healthcare provider right away if:

• You notice a painless sore or ulcer on your genitals, anus, or inside the mouth.
• You get a rash, especially on the palms of your hands or soles of your feet.
• You are pregnant and have not been tested for syphilis.
• You have been told you had contact with someone who has syphilis.
• You feel very sick, including fever, swollen glands, and unexplained weight loss.

How is Syphilis diagnosed?

Your doctor is able to diagnose you with syphilis after obtaining your complaints including all your symptoms, asking you several questions including your sexual history. Your doctor will then check you out throughout your body looking for evidence of sores, rashes, and enlarged lymph nodes. Following these, your doctor may request that you undergo a number of tests, including: 

Common Tests

• Rapid Plasma Reagin (RPR) and the Venereal Disease Research Laboratory tests: These tests detect antibodies your body produces in response to the infection.
• Treponemal tests: This confirm syphilis by detecting antibodies that specifically target the syphilis-causing bacterium (Treponema pallidum).
• Sore (chancre) test: If you have a sore, the fluid from it may be examined under a microscope or tested in a lab to identify the germ that causes syphilis.
• Cerebrospinal fluid (CSF) tap and analysis: The procedure and test are performed when neurosyphilis is suspected and the CSF fluid is collected and tested for direct or indirect evidence the bacteria.

Special Considerations

• All pregnant women should be tested during antenatal visits. Early testing and treatment protect the baby.
• People at high risk (multiple partners, unprotected sex, or another STI) should get tested regularly even when they do not have any complaints.

How is Syphilis treated?

Syphilis is easily treated with antibiotics, especially when found early. The exact treatment depends on the stage of the disease and the patient’s health.

Standard Treatment

• Benzathine penicillin G injections given into a muscle (intramuscularly) are the most common and effective treatment.
• A single dose usually cures early-stage syphilis.
• In later stages, several doses may be needed including doses given directly into a blood vessel (intravenous) in case of late stage syphilis.
• Penicillin is also safe for pregnant women and protects the baby if given early.
• People allergic to penicillin may receive other antibiotics or undergo desensitisation to allow safe penicillin use.

After Treatment

• Patients should return for follow-up blood tests to confirm the infection is cured.
• Even if symptoms go away, completing the full treatment is essential.
• Sexual partners must also be tested and treated to prevent reinfection.
• People with allergies to penicillin may receive other types of antibiotics like azithromycin or doxycycline.

How to prevent Syphilis?

Preventing syphilis is possible with simple and consistent actions (see fig. 3):

Fig. 3: Syphilis Prevention  Click on image to enlarge.

• Practice safe sex. Use condoms correctly every time you have sex, including vaginal, anal, and oral sex.
• Limiting the number of sexual partners.
• Get tested regularly for STIs if you are sexually active, and encourage your partners to do the same.
• Attending antenatal care during pregnancy.
• Avoid sharing needles or unsterile equipment for medical, tattooing, or piercing purposes.
• Promoting awareness and education about syphilis and safe sex in your community.
• Supporting better healthcare access, especially in rural and underserved areas.

Complications of Syphilis

Fig. 4: Syphilis complications. Click on image to enlarge.

 

Without treatment, syphilis can cause serious harm throughout the body (see fig. 4). Timely treatment can stop the infection from getting worse, but it cannot reverse damage already done. 

1. Small bumps or growth: 

In the later stages, some people develop small growths called gummas. These can form on the skin, bones, liver, or other organs. Gummas usually go away with treatment. 

2. Nervous System Problems:

Syphilis can harm the brain, spinal cord, and nerves, leading to:

• Headaches
• Stroke 
• Meningitis 
• Confusion, memory loss, or personality changes that affects decision making 
• Paralysis or loss of movement in part of the body
• Erectile dysfunction
• Bladder problem

3. Eye problems:

When syphilis affects the eyes it is called ocular syphilis.

Symptoms may include:

• Eye pain or redness
• Changes in vision
• Blindness

4. Ear problems:

When syphilis affects the ears it is called otosyphilis. Symptoms may include:

• Hearing loss
• Ringing in the ear (tinnitus)
• Dizziness or a spinning feeling (vertigo)

5. Heart and blood vessel problems:

The infection can weaken the heart and blood vessels. It may cause the main artery (aorta) to swell and can also damage the heart valves.

6. HIV Infection:

Syphilis sores on the genitals bleed easily, which makes it easier to catch or spread HIV during sex.

Living with Syphilis: What you need to know

If you're diagnosed with syphilis, do not be afraid. Managing your health carefully is important.

• Take all prescribed medicines on time.
• Avoid sexual contact until your healthcare provider confirms you are cured.
• Inform your sexual partners so they can get tested and treated.
• Attend all follow-up appointments to monitor recovery.
• Seek support to overcome any stigma or emotional challenges.

With proper treatment and support, syphilis can be cured. You can move forward with confidence and good health. Remember, help and support are here for you every step of the way.

Resources and Support in Africa

Many clinics and organisations across Africa offer testing, treatment, and counselling for syphilis. These include: 

• Public and private health centres
• HIV and STI clinics offering integrated services
• Government programs for maternal and child health
• NGOs focused on sexual health education
• Local support groups and counselling services

Reaching out for help and using these resources are important steps in protecting your health.

Conclusion

Syphilis often begins quietly, but with proper care, it does not have to lead to serious complications. Prevention and early treatment can stop severe effects.

If you think you might have syphilis, visit a clinic or hospital as soon as possible. Health workers are there to help you, not to judge you. Pregnant women should attend antenatal care and get tested early to protect themselves and their babies.

By practising safe sex, getting tested, and seeking treatment when needed, you can play an important role in reducing the disease's impact and promoting healthier communities.

Frequently Asked Questions (FAQs)

Q: How do you get syphilis?

A: Syphilis spreads mainly through sexual contact with someone who has syphilis sores. It can also pass from mother to baby during pregnancy.

Q: What are the early signs of syphilis?

A: The first sign is often a painless sore on the genitals, anus, or mouth. Later, a rash and flu-like symptoms might appear.

Q: How soon after exposure can syphilis be detected?

A: Blood tests can usually detect syphilis within 3–6 weeks after exposure. If you suspect an infection, visit a clinic as soon as possible.

Q: Can syphilis be cured permanently?

A: Yes. With proper antibiotics, syphilis is curable permanently. However, organ damage in late-stage syphilis may not be reversible, which is why early diagnosis is important.

Q: Can I get syphilis again after treatment?

A: Yes. Even if cured, you can be reinfected if exposed again. That’s why partner testing and treatment are important.

 

Sources:

1. World Health Organisation (WHO). Syphilis Facts Sheet. [internet.n.d]. Cited September 22, 2025. Available from here

2. Farahani M, Killian R, Reid GA, Musuka G, et al.: Prevalence of syphilis among adults and adolescents in five sub-Saharan African countries: findings from Population-based HIV Impact Assessment surveys. The Lancet Global Health, 2024 September; 13(9), e1413 - e14. Available from here. 

3. CDC. Syphilis. [2025 January 2} Cited September 22, 2025. Available from here

 

Related:

How to prevent sexually transmitted infections (STIs)

Common sexually transmitted infections in Africa

Tips on Safe Sex Practice for African Adolescents and Young Adults

Common Causes of Miscarriage in Nigerian Women

HIV/AIDS in women of reproductive age in sub-Saharan Africa; An Overview

How to Improve Reproductive Health Wellbeing: Advice for African Adults

 

 

Published: October 20, 2025

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