Syphilis in women is a sexually transmitted infection caused by the spirochete Treponema pallidum that can present with distinct genital, systemic, and obstetric complications. Understanding its stages, diagnostic tools, and treatment pathways is essential for protecting female reproductive health and preventing congenital transmission.
Why Women Experience Different Manifestations
Women’s anatomy and hormonal cycles create unique portals for Treponema pallidum to enter and spread. The cervical mucus, vaginal epithelium, and endometrial lining can harbor the bacterium, leading to lesions that are often less painful than the classic chancre seen in men. Studies from the WHO (2023) show that up to 30% of female patients report non‑painful ulcers, which can be mistaken for other dermatologic conditions.
Stages of Syphilis and What They Look Like in Women
Each stage carries its own set of signs, and the timeline may differ from the textbook description.
- Primary syphilis typically presents as a single, painless ulcer on the vulva, cervix, or perineum. The chancre heals on its own within 3-6 weeks, but the infection remains.
- Secondary syphilis brings a rash that may involve the trunk, palms, and soles, as well as mucous patches in the mouth and vagina. Women often notice a gritty feeling in the vagina or abnormal discharge.
- Latent syphilis is asymptomatic but detectable by serologic testing. Without treatment, it can progress to tertiary disease, affecting the heart, brain, and joints.
- Congenital syphilis occurs when a pregnant woman transmits the infection to the fetus. It can cause stillbirth, preterm birth, or severe neonatal disease.
Key Health Risks for Women
Beyond the obvious lesions, untreated syphilis can lead to:
- Infertility due to scarring of the fallopian tubes.
- Increased susceptibility to HIV infection (co‑infection rates are two‑fold higher).
- Pelvic inflammatory disease (PID) that mimics other bacterial infections.
- Adverse pregnancy outcomes such as miscarriage, stillbirth, or neonatal death.
Diagnosing Syphilis in Women
Accurate diagnosis rests on a combination of clinical suspicion and laboratory testing. The CDC (2024) recommends a two‑step serologic algorithm.
| Method | Sensitivity | Turnaround Time |
|---|---|---|
| VDRL / RPR (non‑treponemal) | 85-95% | Same‑day |
| FTA‑ABS / TP‑PA (treponemal) | 98-100% | 1-2 days |
| Dark‑field microscopy | 90-100% (lesion present) | Immediate |
Non‑treponemal tests (VDRL, RPR) are useful for screening and monitoring response to therapy but can yield false‑positives in pregnancy. Confirmatory treponemal assays (FTA‑ABS, TP‑PA) provide definitive proof. When a chancre is present, dark‑field microscopy allows direct visualization of the spirochete.
Treatment Options and What to Expect
The gold standard remains Penicillin G, administered as a single intramuscular dose for early disease or weekly injections for late latent infection. For women allergic to penicillin, doxycycline (100mg twice daily for 14 days) is an alternative, though it is not recommended during pregnancy.
Within 24hours of treatment, many patients experience a Jarisch‑Herxheimer reaction, a feverish flu‑like response caused by rapid spirochete death. The reaction usually resolves within a few hours and does not require additional medication.
Follow‑up serology at 3, 6, and 12 months is essential. A four‑fold decline in non‑treponemal titers indicates successful clearance. Persistent titers may signal reinfection or treatment failure, prompting retreatment per CDC guidelines.
Impact on Reproductive Planning
Women planning pregnancy should undergo mandatory syphilis screening during preconception visits. If infection is detected, immediate penicillin therapy reduces the risk of congenital syphilis to below 2%. During pregnancy, the CDC advises treatment in the second trimester to protect the fetus while minimizing teratogenic concerns.
After successful therapy, women can safely pursue conception. However, couples should both be screened to avoid re‑exposure.
Prevention Strategies Tailored for Women
- Regular STI screening: annual testing for sexually active women, and more frequent testing for those with multiple partners.
- Barrier protection: consistent condom use reduces transmission risk by up to 80%.
- Partner notification: informing all recent sexual partners ensures they receive testing and treatment.
- Vaccination is not available, but hepatitis B immunization can prevent co‑infection complications.
Education campaigns targeting reproductive health clinics have shown a 25% increase in early detection rates, according to recent CDC data.
Related Topics to Explore Further
Understanding syphilis in women intersects with broader public‑health issues. Readers may also want to read about:
- HIV and STI co‑infection dynamics
- Management of other bacterial vaginosis infections
- Maternal‑fetal medicine guidelines for infectious diseases
- Global trends in syphilis prevalence (WHO reports)
Frequently Asked Questions
Can syphilis be transmitted without visible sores?
Yes. During the latent stage, the infection can spread through sexual contact even though no lesions are present. That’s why routine serologic screening is vital for sexually active women.
Is a single dose of penicillin enough for early syphilis?
For primary or secondary syphilis, a single intramuscular injection of benzathine penicillin G (2.4 million units) is the standard and cures >95% of cases when administered promptly.
What should a pregnant woman do if she tests positive for syphilis?
She should receive a full course of penicillin under obstetric supervision, ideally in the second trimester. Follow‑up serology ensures the infection is cleared before delivery.
Are there any long‑term complications if syphilis is missed?
Untreated latent syphilis can evolve into tertiary disease, causing cardiovascular issues, neurosyphilis, and gummatous lesions. In women, scarring of reproductive organs can lead to infertility.
How accurate are rapid point‑of‑care tests for women?
Rapid treponemal tests have sensitivities around 90% and provide results in 15-20minutes, making them useful in community clinics. Positive results should still be confirmed with laboratory serology.
Can oral sex transmit syphilis to women?
Yes, if a partner has a sore in the mouth, the bacterium can be transferred to the vaginal or cervical mucosa during oral‑genital contact.