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Syphilis

What is syphilis? 

Syphilis is a sexually transmissible bacterial infection. In Australia, cases of Syphilis have been steadily increasing in recent years.

Syphilis is easily treated with antibiotics. Without treatments, serious health problems can occur. The infection has different stages: primary syphilis, secondary syphilis, latent syphilis, and tertiary or late syphilis.  

How do you catch syphilis?

  • Syphilis is passed on through skin-to-skin contact. You can catch it by having oral, vaginal, or anal sex with someone who has syphilis.  
  • It is highly infectious when symptoms (sores or rashes) are present.  
  • Syphilis can also be transmitted from mother (or pregnant person) to baby during pregnancy, and this can have severe effects on the baby.  

What are the symptoms?  

Not everyone who has syphilis will have symptoms, so you may not know you have it unless you get tested. 

There are four stages of syphilis, and if you do experience symptoms, they will vary depending on the stage. 

Stages of syphilis

Primary syphilis 

  • A hard, painless sore (ulcer) appears most often on the genitals; however, it can occur elsewhere, such as the mouth or anus.  
  • The sore usually appears about 3 to 4 weeks after infection but can appear up to three months later.  
  • Because these sores are usually painless, you may not notice it, especially if it is in a part of the body not easily seen, like the anus or cervix. These sores are highly infectious.  
  • The sore usually heals after 2-6 weeks, but the infection remains in your body if you have not had treatment. You can still pass the infection on to others when the sore has healed.  

Secondary syphilis

  • Symptoms of secondary syphilis occur about 2 to 4 months after infection if you have not had treatment.  
  • The most common symptom at this stage is a red rash on your chest, back, hands, and feet, including palms and soles. When the rash is present, syphilis is highly infectious.  
  • You may also have flu-like symptoms, such as swollen lymph nodes in the groin and armpits, tiredness, hair loss, and a genital rash. If you do not have treatment, these symptoms can come and go for up to two years.  

Latent syphilis

  • If syphilis is not treated in the primary or secondary stage, it then becomes latent. In latent syphilis, there are no symptoms. 
  • Latent syphilis is infectious in the first 12 to 24 months. After this, it is less infectious.  
  • If syphilis is diagnosed and treated early in this latent phase, there are usually no problems, but you may need further tests and longer treatment 

Tertiary syphilis  

  • If syphilis is not treated, it can progress to tertiary syphilis in about a third of infected people.  
  • Tertiary syphilis can cause severe problems in almost any part of the body, but mainly in the heart and brain, and can be fatal.  
  • Tertiary syphilis is no longer infectious and can still be treated.

Syphilis and pregnancy 

If an unborn baby gets syphilis during pregnancy, the infection can be severe, disabling or life threatening. Syphilis can cause serious birth defects, premature birth and stillbirth. 

This is why regular syphilis testing during pregnancy is so important. The earlier syphilis is treated, the lower the risk to your baby. 

How can I avoid getting syphilis? 

You can avoid getting syphilis by using condoms or dams correctly every time you have sex.  

For valuable tips on condom use, check out our condom fact sheet. 

How do you test for syphilis?

  • The test for syphilis is a blood test.  
  • Sometimes more than one test is needed. Blood tests are also used to check your response to treatment if you are diagnosed with syphilis. 
  • If a sore or a rash is present, swabs can be collected to look for the presence of the bacteria.  
  • Blood tests which are done routinely during pregnancy include a test for syphilis.  

How is syphilis treated? 

  • Syphilis is treated with penicillin given as an injection.  
  • Latent syphilis may require a longer course of treatment than the other stages.   
  • If someone with syphilis has a penicillin allergy, other antibiotic treatment is available. 

Some people, especially those in the early stages of infection, are likely to experience a flu like illness when they are treated. If this occurs it usually does so within 24 hours after treatment.  

Symptoms may include fever, headache, sweats, and joint pain. It lasts for several hours, and simple supportive treatment of analgesia such as paracetamol, fluids, and rest is usually all that is needed.   

After treatment, you will need to avoid any sexual contact until the rash or skin lesion has healed and until at least one week after your treatment has finished. 

Your partner/s may need treatment, and it is essential to wait for one week after they finish their treatment before having any sexual contact, so you don’t become re-infected.  

 Follow up blood testing at 3 and 6 months (and sometimes 12 months) is usually recommended to ensure the effectiveness of your treatment.   

Do I need to let my sexual partners know?

If you have been diagnosed with syphilis, you will need to inform your sexual partners so they can be tested and treated. Your nurse or doctor will discuss with you the time frame, which may be up to 12 months, depending upon the stage of infection you have.

If your partners do not have treatment, they could end up with severe problems and may also re-infect you. There are websites that you can use to help contact your partners: www.letthemknow.org.au or http://www.thedramadownunder.info/   

Taken from SYPHILIS | Contact Tracing guidelines:

“According to sexual history and clinical stage of infection:

  • Primary syphilis — 3 months plus duration of symptoms or last negative test;
  • Secondary syphilis — 6 months plus duration of symptoms or last negative test;
  • Early latent syphilis — 12 months or most recent negative test
  • Late latent/tertiary syphilis: Test current partner/s. If any doubt as to whether the patient has early latent or late latent syphilis, contact trace as for early latent syphilis.

If the stage of syphilis is unclear, contact your local specialist service for advice”

Syphilis and HIV

The presence of syphilis can make HIV transmission more likely, and if you have been diagnosed with syphilis, you may want to consider using HIV pre-exposure prophylaxis (PrEP) if you are in a risk group. Talk to your sexual health doctor about this.  Testing for syphilis and HIV is usually done at the same time or during the follow-up after treatment.  

References 

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