Syphilis remains a significant public health issue in Indonesia, with 76,923 new cases reported in 2020. High-risk groups, including sex workers, men who have sex with men, people who inject drugs, and pregnant women, are most affected. While antenatal care has helped reduce congenital syphilis, challenges persist, particularly in rural areas with limited healthcare resources and social stigma. Indonesia has expanded syphilis screening, especially for pregnant women, with targets to reduce syphilis incidence to 6 per 100,000 in men, 5 per 100,000 in women, and fewer than 50 cases of congenital syphilis per 100,000 live births. The SITE (Syphilis Interventions Towards Elimination) model is used to simulate syphilis transmission and assess the impact of various interventions, guiding national efforts in screening, treatment, and prevention.

Syphilis spreads primarily through direct contact with syphilitic sores during vaginal, anal, or oral sex. These sores, called chancres, appear at the infection site and are highly contagious during the early stages. Syphilis can also be transmitted from mother to child in utero, known as congenital syphilis, which can lead to severe complications in infants, including birth defects or stillbirth. Unlike some STIs, syphilis cannot spread through casual contact, shared eating utensils, or surfaces. The infection is most common among sexually active individuals who may not use protection consistently. Safe sex practices, including condom use and regular STI testing, are essential for preventing transmission.

Syphilis symptoms vary by stage. In the primary stage, a painless sore (chancre) appears at the infection site, typically healing on its own within 3 to 6 weeks. Secondary syphilis may follow occurs 4 to 10 weeks after primary infection, marked by a rash on the body, including palms and soles, flu-like symptoms, and swollen lymph nodes. If untreated, syphilis enters a latent phase, with no visible symptoms, lasting years. In the tertiary stage, untreated syphilis can cause severe complications to the heart, brain, nerves, and other organs, potentially leading to paralysis, blindness, and even death. Congenital syphilis: Babies born with syphilis may experience stillbirth or death, as well as physical and intellectual disabilities.

Syphilis is diagnosed through blood tests that detect antibodies against Treponema pallidum. Common tests include Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests, which are nontreponemal and commonly used for screening. These tests detect antibodies to damaged bacteria cells but can yield false positives. Treponemal tests, such as TPHA and TP rapid, detect antibodies specific to the bacteria and are used for confirmation, though they remain positive for life. Regular testing is recommended for pregnant individuals and those at higher risk, such as people with HIV and men who have sex with men, as well as anyone with symptoms or known exposure. Ideally, a positive nontreponemal test should be followed by a treponemal test to confirm the diagnosis and assess treatment progress. In resource-limited settings, the TP rapid test offers a quick and easy screening option.

Syphilis is highly treatable, especially in its early stages, with a single injection of benzathine penicillin (BPG). More advanced stages require additional doses. For those allergic to penicillin, alternatives like doxycycline or azithromycin may be used. Tertiary syphilis requires more intensive treatment over three weeks, but organ damage can be difficult to reverse. Early diagnosis and treatment are crucial to prevent complications. Sexual partners of infected individuals should also be tested and treated to prevent reinfection or further spread. Follow-up testing with nontreponemal tests (RPR or VDRL) at 6, 12, and 24 months ensures the infection has cleared. A four-fold drop in titers shows successful treatment, while an increase suggests reinfection or treatment failure.

Preventing syphilis involves practicing safe sex, including consistent condom use and regular STI testing, especially for individuals with multiple sexual partners. Prompt testing and treatment of both partners can prevent transmission and reinfection. For pregnant women, early syphilis screening during prenatal visits is essential to prevent congenital syphilis and protect the baby’s health. Public health initiatives also focus on increasing awareness and education about syphilis, particularly in high-risk populations. Reducing stigma around STIs is crucial for encouraging individuals to seek testing and treatment promptly, which is vital for controlling syphilis spread.