Syphilis

How is it spread?

A person can get infected through condomless oral, vaginal, or anal sex with an infected partner, or through direct sexual contact with bacteria contained in syphilitic sores or rashes. It can also be transmitted from an infected pregnant person to the fetus, and in rare cases from sharing unclean needles to inject drugs. Syphilis increases the risk of transmitting or becoming infected with HIV.

What are the symptoms?

Some people have no symptoms and can pass the infection on to their sexual partner(s) without knowing it.  Syphilis is described by stages.  It is usually infectious for less than one year, during the primary and secondary phases and early in the latent stage.

Primary stage:  During the first or primary stage, 3 days to 3 months after exposure, a small painless sore called a “chancre” develops.  The sore appears where the bacteria first entered the body (i.e., external genitalia, on the cervix, in the vagina, under the foreskin, in the rectum, mouth or throat).   During this stage, people are highly infectious to their sexual partner(s) i.e., they can easily pass it on to other people.  The sore remains for another 3 to 6 weeks, then will heal on its own without treatment.  However, the person is not cured.

Secondary stage:  If primary syphilis is not treated, 3 to 6 weeks after the chancre has healed, a rash may appear anywhere on the body, on the palms of the hands and soles of the feet.  This rash is usually not itchy. Other symptoms may include flu-like symptoms (swollen glands, aching joints, muscle aches, fever), temporary patchy hair loss, and flat, wart-like growths on the genital area.  During this stage, a person is also very infectious to their sexual partner(s).  Secondary symptoms disappear after a few weeks, without treatment, but may return.  Sometimes the rash appears while the chancre is still present.

Latent & Tertiary stages:  A long period with no symptoms follows the secondary stage.  This is called the latent phase.  People may be infectious during the early part of the latent phase.  If untreated, it progresses to the tertiary stage.  Symptoms of this can take from 10 to 30 years to develop.  They can be very serious resulting in damage to the brain, nerves, blood vessels and heart.  This can lead to blindness and even death.    

How is it diagnosed?

Syphilis is diagnosed by combining information from the history, physical examination, and blood tests. It can also be diagnosed at a lab through the detection of syphilis bacteria in secretions from the initial chancre.

How is it treated?

If detected within one year of infection, syphilis is easily treated with penicillin injections, or with antibiotics in pill form for people allergic to penicillin. If syphilis is detected later than one year after infection, longer courses of treatment are needed.

Some people who are treated with penicillin injections for early syphilis may experience fever, muscle aches, chills, and/or headache.  This is known as a “Jarisch-Herxheimer” reaction and is a reaction to the medication killing the bacteria.   This reaction may begin 4-6 hours after treatment and may last for up to 24 hours. The reaction may be quite severe and is NOT due to an allergy to penicillin. The symptoms can be treated with acetaminophen or Ibuprofen. If you experience this reaction, please call the clinic the following day.

After the injections, you should have a seat in the waiting room for 15 minutes in case you have an allergic reaction to the penicillin (hives, difficulty breathing, and/or swelling of the face or mouth).  The risk of developing a severe allergic reaction is extremely rare.  Even if you have had these injections in the past without any problems, you should still remain in the clinic for 15 minutes.

What about my sexual partner(s)?

Your sexual partner(s) need to be told that they may have been exposed to syphilis and should be tested. Your healthcare provider will ask you to inform all partners of the last 3, 6, or 12 months depending on the stage of your infection. You should not have sexual contact during treatment, two weeks following treatment and/or until all symptoms disappear.

Follow-up

Follow-up blood tests for syphilis are very important as they determine if treatment was effective or if you need further treatment.  You will be asked to return for follow-up testing over the next year to confirm that the infection is gone.

It is strongly suggested that persons who test positive for syphilis also consider HIV testing.

Prevention

Using condoms or dental dams can prevent syphilis transmission as long as the sore is covered