What is syphilis and how common is it?
Syphilis is a sexually transmitted infection caused by bacteria called Treponema pallidum. It can be acquired from any sexual contact with someone who has syphilis.
Syphilis often has no symptoms, but it can cause serious complications if untreated.
Syphilis is becoming more common. Infections are at the highest level since the Second World War and are increasing each year. It is more common amongst some population groups, especially gay, bisexual or other men who have sex with men (GBMSM), but we are seeing syphilis in heterosexuals (straight people), more than ever before.
It is easy to test for syphilis and it can be treated and cured with antibiotics.
What are the signs and symptoms of syphilis?
The symptoms of syphilis are the same for everyone. Early symptoms may appear on the penis, vulva, around the bottom (anus), or in the mouth. These symptoms can appear from 9-90 days after coming into contact with the bacteria, which means it can be difficult to know exactly when you acquired it.
Syphilis has three stages, primary, secondary and tertiary and the symptoms differ in each stage. Syphilis does not go away on its own, the infection is still there even though the symptoms come and go between stages.
Primary syphilis
This is when syphilis infection is new. Typically, you will develop an ulcer or spot called a ‘chancre’. Chancres are often painless and they will appear in the area where skin-to-skin contact has occurred, so this could be skin in the genitals, anus or the mouth. Because they are painless they can be easy to miss especially if they are out of sight inside the vagina or anus. A chancre will heal and go away on its own within 2-4 weeks even if it is not treated.
Secondary syphilis
Once the bacteria gets into the blood it spreads throughout the whole body, usually about 2-3 months after the early infection. ‘Flu-like’ symptoms for example feeling more tired than usual, fever or swollen glands or a new rash are typical. Syphilis rash can be different to other rashes, it can affect the palms of the hands and soles of the feet and the chest and back, it might be red or brown and blotchy, but not usually itchy. It can also cause patchy hair loss (alopecia). Some people develop ‘warty’ lesions, commonly around the mouth or genitals. All of these symptoms can go on for weeks, but eventually resolve on their own, even if syphilis is not diagnosed or treated.
Late latent syphilis (sometimes called tertiary syphilis)
If you do not notice the earlier signs of syphilis, the infection can become ‘latent’, which means that it is still in your body. The longer syphilis is latent the more likely it is to cause complications. The syphilis bacteria can affect the brain, ears and eyes (‘neuro-syphilis’). Signs of neuro-syphilis could be feeling dizzy or confused, hearing loss or tinnitus (ringing in the ears), loss of vision or seeing ‘floaters’. Rarely you may develop serious complications which can cause heart problems, nerve problems or skin complaints. These symptoms usually get better when treated but may be long-lasting.
If you have latent syphilis for more than two years, it will require longer treatment for an effective cure. The easiest way to avoid latent syphilis is to have regular testing to prevent complications from developing.
How is syphilis transmitted?
Syphilis can be transmitted from any kind of skin-to-skin sexual contact, including oral, vaginal or anal sex as well as intimate touching, sharing sex toys, or even kissing. Using condoms for sexual activity (oral, anal, vaginal sex) will reduce the chance of acquiring syphilis.
Screening for syphilis is a routine test during pregnancy. If you have the infection, it will be treated to prevent passing it to your unborn child. Infection passed on during pregnancy is called “congenital syphilis” which is rare. Syphilis can also increase the risk of miscarriage or still birth if you don’t know about it.
You can acquire syphilis from sharing needles to inject drugs with someone who has syphilis.
Syphilis is not passed on through:
- sharing towels
- baths and swimming pools
- toilet seats
- saunas and steam rooms
Having had syphilis before, does not protect you from catching it again.
Testing for syphilis
There are a number of ways to test for syphilis and get a diagnosis at a sexual health clinic. If you have symptoms, you will be examined. If we see a chancre, a swab will be taken for laboratory testing. The swab test involves a clinician running a small cotton bud over the chancre. If the skin is dry or the chancre has healed, this test can miss syphilis. Sometimes we can use some fluid from the chancre to look under the microscope to be able to see the bacteria. If you have a rash which looks typical for syphilis you may be offered treatment on the day. If you show signs of neuro-syphilis you will be examined by a doctor. If you know you have been in contact with syphilis we will often offer you treatment.
The blood test for syphilis can take up to 90 days to detect the infection which is known as the ‘window period’. You may be advised to test again to cover this. If you have had syphilis before, antibodies will continue to show as positive on a syphilis blood test. There is a second part of the test which shows if there the syphilis infection is active. It is helpful for you to know what your last syphilis result was and when you had the test.
There are options to test for syphilis from home or in some community settings, they generally use a small sample of blood from your finger but may not be able to tell the difference between syphilis which has been treated and a new infection. If you have had syphilis before, you may be advised to come into a clinic for a blood test rather than using a home test kit.
You should also have a sexual health screen to look for any other sexually transmitted infections.
Syphilis treatment
Syphilis can be cured with antibiotics. For most people this will be penicillin, but if you have an allergy we might use something else. How much treatment you need depends on how long you have had syphilis for and what your symptoms are.
Treatment for Primary and Secondary syphilis
In these stages syphilis is treated with a one-off injection of penicillin or a two week course of doxycycline tablets if you have an allergy to penicillin.
Treatment for latent syphilis
If it is possible that you have had syphilis for more than two years, we will give longer treatment. This will either be three doses of penicillin, spread over three weeks, or an extended course of doxycycline tablets over one month.
Treatment for neuro-syphilis
If we are worried about neurological symptoms, or symptoms affecting other parts of the body we will suggest treatment every day for 7, 10 or 14 days, using antibiotics and sometimes steroids. A doctor will make this decision.
Are there any side effects to the treatment for syphilis?
It is possible to have side effects from antibiotics and we will speak to you about this when we plan your treatment. Let us know if you are allergic to penicillin. Injections can make the area sore, and you may notice some bruising. Paracetamol and ibuprofen may help with this if needed.
As the antibiotics work some people experience the Jarisch Herxheimer reaction (JH reaction) within 24 hours. This can include headaches, fever, muscle aches, chills and shivering. This can be treated with paracetamol and should stop by itself. This is due to your immune system clearing the infection. It is not an allergic reaction.
Penicillin injections can rarely cause a feeling ‘impending doom’ with hallucinations, agitation and feeling scared, it wears off quickly and we will look after you if this occurs.
What follow up is required after treatment for syphilis?
If you are treated for syphilis it is important to come back for follow up testing (test of cure). You may need further blood tests at 3-months, 6-months and 12-months after treatment depending on the stage of syphilis.
You should not have sexual and intimate contact for 2 weeks after treatment.
Current and previous sexual partners should be contacted to let them know about the infection (you may need to go back as far as the last time you had a syphilis test). The health advisers will discuss partner notification with you and can help with this. Make sure any partners have completed treatment before you have sex with them again.
If you have symptoms, you may be advised to come back and have a review with a doctor, especially if you have had neuro-syphilis.