Syphilis is a complex sexually transmitted infection caused by the bacterium Treponema pallidum. The disease is known for its ability to mimic other conditions and progress through distinct stages if left untreated. While abdominal discomfort is not a common symptom during the initial, highly infectious phases, stomach pain may arise from systemic involvement in the later stages, indicating the infection has spread throughout the body. The possibility of gastrointestinal involvement highlights the need for early diagnosis and treatment.
Syphilis and Gastrointestinal Manifestations
The bacterium Treponema pallidum has the capacity to travel through the bloodstream and reach nearly any organ system, including the gastrointestinal (GI) tract. When the bacteria colonize this area, they can cause inflammation and tissue damage, which may result in abdominal discomfort. Such manifestations are considered rare and are often associated with the late or tertiary stage of syphilis.
One specific condition is syphilitic gastritis, which is an inflammation of the stomach lining caused by the bacterial presence. This can lead to symptoms like upper abdominal pain, nausea, and vomiting, because the inflammation interferes with normal digestive function. In some cases, the infection can cause syphilitic hepatitis, where the liver becomes inflamed, often presenting as pain in the upper right quadrant of the abdomen.
The lower GI tract may also be affected, resulting in proctitis, which is the inflammation of the rectum and anus. Syphilitic proctitis can cause lower abdominal pain, rectal pain, bleeding, and painful bowel movements. Because these GI symptoms are nonspecific, they can easily be mistaken for more common conditions, often delaying the correct diagnosis. The presence of abdominal pain in the context of syphilis suggests a significant, systemic infection that requires prompt medical attention.
Typical Stages and Symptoms of Syphilis
Syphilis progresses through four distinct stages—primary, secondary, latent, and tertiary—each characterized by different signs and symptoms. The first stage, primary syphilis, begins with the appearance of a chancre.
This is a small, firm, and typically painless sore that develops at the site where the bacteria entered the body. The sore usually appears between 10 and 90 days after exposure. While it may heal on its own within three to six weeks, the infection remains in the body.
If the infection is not treated, it moves into the secondary stage, which is usually marked by a widespread, non-itchy rash that frequently appears on the palms of the hands and the soles of the feet. During this time, a person may also experience flu-like symptoms, including fever, sore throat, muscle aches, fatigue, and swollen lymph nodes. Wart-like sores, known as condyloma lata, may also appear in moist areas of the body.
The latent stage follows the secondary stage and is a period where there are no visible signs or symptoms of the infection. This asymptomatic stage can last for many years, but the bacteria are still present and can eventually progress to the final stage. Tertiary syphilis can develop years after the initial infection and is characterized by severe damage to multiple organ systems. This late stage can affect the heart, blood vessels, brain, and nervous system, leading to cardiovascular and neurological problems.
Diagnosis and Treatment Pathway
If there is any suspicion of syphilis, regardless of the presenting symptoms, seeking immediate medical evaluation is necessary. The diagnostic process typically begins with a blood test to check for antibodies, which are proteins the immune system produces to fight the infection.
Initial screening is often done using nontreponemal tests:
- Rapid Plasma Reagin (RPR)
- Venereal Disease Research Laboratory (VDRL) tests
If a screening test is positive, a second, more specific treponemal test is used for confirmation:
- Fluorescent Treponemal Antibody Absorption (FTA-ABS)
- T. pallidum Particle Agglutination (TP-PA) test
In cases where there are neurological symptoms or suspicion of neurosyphilis, a sample of cerebrospinal fluid may be collected via a spinal tap to check for the presence of the bacteria.
Syphilis is curable, and the preferred treatment for all stages is the antibiotic penicillin G. The dosage and duration of treatment depend on the stage of the infection. Early-stage syphilis is often treated with a single intramuscular injection of long-acting penicillin. Late-stage or tertiary syphilis requires multiple weekly injections, and neurosyphilis requires intravenous penicillin for a longer period. Early detection and completion of the full treatment course are paramount to prevent systemic damage.