🔴 Men's Health
Syphilis in Nigeria
The 'great imitator' is back: rising rates and what you need to know
Syphilis: caused by Treponema pallidum: was nearly eliminated globally in the 1980s but has resurged dramatically worldwide, including in Nigeria. Syphilis is called 'the great imitator' because it mimics many other diseases across its stages. It is easily treated with penicillin, but devastating if left to progress to tertiary syphilis (heart damage, stroke, dementia, blindness). Congenital syphilis (mother to baby) causes stillbirth and infant disability.
Signs and Symptoms
✓ Primary syphilis (2–3 weeks after exposure): a painless genital, oral, or anal ulcer (chancre), often missed
✓ Secondary syphilis (6–8 weeks later): generalised rash including palms and soles; flu-like illness; mouth sores; lymph node swelling
✓ Latent syphilis: no symptoms: only detected by blood test
✓ Tertiary syphilis (years later): gummas (destructive granulomas); cardiovascular syphilis (aortic aneurysm); neurosyphilis (stroke, dementia, blindness, tabes dorsalis)
✓ Congenital syphilis: stillbirth; jaundice; bone abnormalities; snuffles (nasal discharge) in newborns
Risk Factors
- Multiple sexual partners
- Men who have sex with men (MSM)
- HIV infection: syphilis and HIV potentiate each other
- Inconsistent condom use
- Sex worker clients and sex workers
- Not being tested during pregnancy (antenatal syphilis screening is mandatory but often missed)
When to Seek Help
Any genital, oral, or anal ulcerA painless ulcer is syphilis until proven otherwise. Seek assessment within 48–72 hours.
Unexplained rash involving palms and solesSecondary syphilis is a classic: do not wait to 'see if it resolves'.
Pregnant women: as part of antenatal bookingAntenatal syphilis screening (RPR or VDRL) is mandatory in Nigeria, universal screening prevents congenital syphilis.
Neurological symptoms in a patient with past STI historyNeurosyphilis must be excluded: a treatable cause of dementia, stroke, and blindness.
Tests & Diagnosis
🧪 RPR (Rapid Plasma Reagin) or VDRL
Non-treponemal screening test: sensitive but not specific. Used for screening and monitoring treatment response.
🧪 TPHA or FTA-ABS (treponemal test)
Specific confirmatory test: stays positive for life even after treatment.
🧪 Rapid syphilis test (point-of-care)
Treponemal rapid test: available in many Nigerian clinics. Confirms current or past infection.
🧪 CSF analysis (lumbar puncture)
Required if neurosyphilis is suspected: CSF VDRL and cell count.
🧪 HIV test
Always test for HIV alongside syphilis: co-infection is common and affects management.
Treatment Options
1
Primary, secondary, and early latent syphilis
Benzathine penicillin G 2.4 million units IM as a single dose. For penicillin allergy: doxycycline 100 mg twice daily for 14 days.
2
Late latent syphilis
Benzathine penicillin G 2.4 million units IM weekly for 3 doses.
3
Neurosyphilis
Aqueous crystalline penicillin G IV for 10–14 days, requires hospitalisation.
4
Congenital syphilis
Aqueous penicillin IV or procaine penicillin IM, dose and duration guided by stage.
5
Jarisch-Herxheimer reaction
Fever, chills, and worsening rash within 24 hours of first penicillin dose, a normal immune response to dying bacteria, not an allergy. Managed with paracetamol. Do not stop treatment.
6
Partner treatment
All sexual partners within the relevant time period must be tested and treated.
Frequently Asked Questions
Is syphilis curable?
Yes, completely curable with penicillin in all stages. Tertiary complications already established (e.g., aortic aneurysm, dementia) cannot be reversed, but treatment prevents further progression. Early treatment prevents all complications.
Can syphilis kill you?
Yes, untreated syphilis causes cardiovascular syphilis (aortic aneurysm rupture), neurosyphilis (dementia, blindness, stroke), and significantly increases HIV transmission risk. Congenital syphilis causes stillbirth and infant disability. It is a serious disease that has become trivialised in public health messaging.
Is syphilis increasing in Nigeria?
Yes, syphilis rates have risen significantly in Nigeria, including among pregnant women (with resulting increases in congenital syphilis). Reduced condom use, HIV co-infection, and gaps in antenatal screening contribute to the resurgence.
How is syphilis transmitted?
Primarily through direct contact with a syphilitic sore (chancre) during vaginal, anal, or oral sex. Condoms significantly reduce but do not eliminate risk (sores can be in areas not covered). Mother-to-child transmission during pregnancy causes congenital syphilis.
Do I need to tell past partners?
Yes, partner notification is ethically required and legally important in many contexts. Sexual health clinics can offer partner notification services. Notifying partners allows them to be tested and treated, breaking the chain of transmission.
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💬 Book on WhatsAppLast updated 16 October 2026.