Syphilis Disease page

Syphilis is a curable sexually transmitted disease (STD). The initial infection usually causes an open sore at the site of infection. Syphilis infection occurs in four stages, named primary, secondary, latent, and tertiary (late).

Over the past several years, there has been a dramatic increase in the number of new syphilis cases among men who have sex with men (MSM) in various cities and areas, including Chicago, Seattle, San Francisco, Southern California, Miami, and New York City. This new outbreak has been associated, in part, with MSM finding sex partners on the Internet. A study done in San Francisco showed that 23% of the men with new cases of syphilis reported using the Internet to find sex partners.

The increase in the numbers of cases of syphilis also means that unsafe sexual practices are occurring, raising the possibility that potentially deadly HIV transmission can occur. In fact, that is what is being seen. High rates of HIV co-infection are also being found with these new syphilis cases.

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated two- to five-fold increased risk of acquiring HIV infection when syphilis is present. Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, like syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can increase the infectiousness of and susceptibility to HIV.

What are the symptoms of syphilis?

Syphilis has several stages. Symptoms vary with each stage, but often there are no symptoms, even though serious damage may be happening.

Primary Syphilis:
A painless open sore, the chancre, usually appears 3 weeks to 3 months after infection. A chancre may appear almost anyplace on the body. The most common sites are the penis in men, near the vaginal opening or labia in women, or on the anus or in the rectum. Once in a while the chancre appears on the lips or in the mouth. Enlarged glands may also occur near the chancre; for example, if the chancre is on the penis or near the vagina, glands in the groin usually swell up. Both the chancre and any swollen glands usually last 3 to 6 weeks, then clear up. But the infection doesn’t go away; it just continues into the secondary stage.

Secondary Syphilis:
Symptoms of secondary syphilis usually appear 2-3 months after catching the infection. Sometimes they overlap with primary syphilis, but other times the symptoms are delayed up to 6 months. The most common symptom is a spotty skin rash that may occur anywhere on the body and often—unlike most skin rashes—involves the palms of the hands or soles of the feet. The rash usually doesn’t itch. Other common symptoms are swollen glands in various areas of the body, fever, fatigue, patchy hair loss, weight loss, and headache. The symptoms are just like those of many other health problems, so that syphilis has been called "the great imitator". Secondary syphilis symptoms usually last anywhere from 1 to 3 months, but sometimes they last longer, and once in a while the symptoms come and go over a year or two. But even after the symptoms of secondary syphilis clear up, the infection goes on.

Latent Syphilis:
Latent syphilis causes no symptoms. The infection can be detected only by a blood test. If not treated, latent syphilis continues for life. Many of these infections never cause serious problems, but often the disease progresses to the final stage, called tertiary syphilis.

Tertiary (late) Syphilis:
About one-third of untreated people with syphilis experience serious damage to various organs and body systems. Tertiary syphilis can appear any time from a year to 50 years after catching syphilis; most cases occur within 20 years. The brain, heart, liver, and bones are the most commonly involved organs. Tertiary syphilis can cause paralysis, mental problems, blindness, deafness, heart failure, and death.

Congenital Syphilis:
Congenital syphilis happens when a pregnant woman with syphilis passes the infection to her baby in the womb. Congenital syphilis is the most serious form of the disease. Many cases result in miscarriage or stillbirth, and surviving babies may have serious problems of the brain, liver, and other organs; some of these can be fatal or cause lifelong disabilities. Sometimes congenital syphilis is silent at birth but shows up later in childhood or even in the adult years. Congenital syphilis is most likely if the mother has primary or secondary syphilis when pregnant.

What happens to me if I have syphilis?

If syphilis is not treated, the infection will progress through the primary, secondary, latent and perhaps tertiary stages, described above. If an infected woman gets pregnant, her baby may get congenital syphilis. Treatment stops the infection, but if organ damage has already occurred--especially in tertiary syphilis--the damage cannot be repaired and serious health problems may continue.

How is syphilis transmitted?

Syphilis is caught by having sex with someone who has been infected with syphilis less than a year—i.e., someone with primary syphilis, secondary syphilis, or latent syphilis for less than a year. Latent syphilis more than a year old and tertiary syphilis can no longer be transmitted by sex. The syphilis bacteria is very fragile and dies rapidly outside the body, so the risk of nonsexual transmission is very low. Congenital syphilis is transmitted internally, from the blood of an infected woman directly to the baby in the womb.

How do I avoid infection with syphilis?

Abstinence from sexual activity is the surest way to avoid becoming infected with syphilis--not having any anal, oral or vaginal sex.
The next surest way is to limit sex to one uninfected partner who only has sex with you--mutual monogamy.
For those choosing to be sexually active outside longstanding, permanent relationship, condoms should be used correctly and consistently to minimize transmission.
Avoid sex if suspicious symptoms are present. If you think you could have syphilis (or any STD), seek immediate care at a local STD clinic, hospital, or medical practitioner.
Before having sex, talk with your partner (s) about syphilis and other STDs. Work out a risk reduction strategy with them that feels comfortable to both of you.
If you have syphilis (or any STD), notify all sex partners so that they can also seek and obtain treatment.

How do I find out if I have syphilis?

Only a health care provider can diagnose syphilis. Tests for primary and secondary syphilis include blood tests and tests performed on fluid recovered from open chancres. Sometimes a spinal tap is necessary to check for signs of syphilis in the spinal fluid. This is especially important when syphilis has been present more than a year, when previous treatment has failed, or when the health care provider has other reasons to suspect infection of the nervous system.

What is the treatment for syphilis?

Penicillin shots are the main treatment for syphilis. A single shot of long-acting penicillin usually is sufficient for primary or secondary syphilis. Infection for more than a year in duration, or infection of the nervous system, usually requires several doses of penicillin over a 3-week period.

Important: Many common antibiotics do not work against syphilis. Never treat yourself with an antibiotic left over from another prescription.

Sex Partner Management:

The sex partners of persons diagnosed with syphilis must be notified, and most should be treated for possible syphilis even before the results of diagnostic tests are known. Public health works with each patient to make sure all possibly infected partners are examined and treated. This often involves asking persons with syphilis to provide the names of all of their sex partners since the infection began. Public Health does not give this information to ANYONE. Public Health uses the information to let people know that they may have been exposed to syphilis and offer testing and treatment. Public Health does NOT say who might have exposed them to syphilis.

Follow-Up: Even though symptoms always clear up after treatment, sometimes the first treatment doesn't completely cure the infection. It is very important to have several repeat syphilis blood tests to be sure the treatment worked. In most cases, this means repeat blood tests 3 months, 6 months, and a year after treatment.