Syphilis

Syphilis

Syphilis is a bacterial infection. It’s hard to detect and is one of the most easily caught sexually transmitted infections (STIs).

Symptoms of syphilis

Most people with syphilis don’t notice any symptoms and don’t know they have it. Symptoms change over time and may come and go.

Syphilis usually has 3 stages.

The first stage (primary syphilis)

Ten days to 3 months after infection, you may notice a small, painless sore or ulcer.

This is typically on either the:

• penis
• vagina
• anus
• rectum
• tongue
• lips

You might only have 1 sore, but can have more.

Swelling in your lymph glands (such as in the neck, groin or armpit) often happens with the ulcers.

The sore will then disappear within 2 to 6 weeks. If left untreated, syphilis will move into its second stage.

The second stage (secondary syphilis)

Symptoms of secondary syphilis begin a few weeks after the original sore disappears.

Common symptoms of secondary syphilis include:

• a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet
• tiredness
• headaches
• swollen lymph glands

Less common symptoms include:

• fever
• weight loss
• patchy hair loss
• joint pains

These symptoms may disappear within a few weeks, or come and go for a few months.

Syphilis will then move into a stage where you will experience no symptoms. You’re still infected during this stage. This is called ‘latent syphilis’. You can still pass it on during the first year of this stage. After a couple of years, you can’t pass the infection to others, even though you remain infected. However, during this stage, the infection can be passed on from a mother to an unborn child during pregnancy.

The latent stage can continue for many years (even decades) after you first become infected. Without treatment, there is a risk that latent syphilis will move on to the more serious stage –tertiary syphilis.

The third stage (tertiary syphilis)

The symptoms of tertiary syphilis can begin years or even decades after the initial infection. 1 in 3 people who are not treated for syphilis develop serious symptoms eventually.

The symptoms of tertiary syphilis will depend on what part of the body the infection spreads to. For example, it may affect the brain, nerves, eyes, heart, bones, skin or blood vessels, potentially causing any of the following symptoms:

• stroke
• dementia
• loss of co-ordination
• numbness
• paralysis
• blindness
• deafness
• heart disease
• skin rashes

At this stage, syphilis can be dangerous enough to cause death.

Testing for syphilis

If you think you might have syphilis, get tested for free by:

• booking an appointment at your local sexual health service
• contacting your GP practice for an appointment

What does a syphilis test involve?

The only reliable way to tell if you have syphilis or not is to have a blood test. This is usually sent to the lab for analysis. However, in some sexual health services, a same day test can be done if you have symptoms.

Treatment for syphilis

Antibiotics will treat the syphilis infection, even during pregnancy. These are given by injection, tablets or capsules.

Treatment may be started before your test result is known. You may be given one or more doses, depending on the stage of infection.

You’ll need to go back to your GP practice or sexual health clinic 6 and 12 weeks after starting treatment to be retested.

You should avoid having sex until you and your partner (s) have finished treatment and your tests have shown treatment has worked. This includes oral sex and sex using a condom.

Your partner should also get tested for syphilis. It can be hard to spot in its early stages and they might not realise they have it. They will generally be offered treatment regardless.

Syphilis and pregnancy

In Scotland, pregnant women are tested for syphilis as part of their antenatal checks.

If you’re pregnant and have syphilis, you can pass it on to your baby before they’re born. This is known as congenital syphilis.

Having syphilis during pregnancy can increase the risk of:

• miscarriage
• premature birth
• stillbirth

How syphilis is passed on

You can get syphilis by having unprotected vaginal, anal or oral sex (sex without a condom). Around one third of all people who get syphilis do so through having unprotected oral sex with no other vaginal or anal sex involved. It can also be passed by coming into contact with an ulcer on your partners penis, vagina, anus or inside their mouth.

Syphilis can be passed on:

• to an unborn baby during pregnancy (congenital syphilis)
• by injecting drugs with a needle that’s been used by someone who has syphilis
• during a blood or organ transplant (this is extremely rare as all blood and organ donations in the UK are checked for syphilis)

Syphilis also makes HIV easier to pass on and catch.

The number of people getting syphilis in Scotland has greatly increased over the last 5 years. You could be at higher risk if you:

• are a man who has sex with men
• have had sex overseas
• have had multiple sexual partners

How to prevent syphilis

The best way to reduce your risk of STIs is to practice safer sex. This means using a condom for vaginal, anal and oral sex.

Other STIs

If you have been diagnosed with syphilis you should get tested for all STIs including:

• HIV
• chlamydia
• gonorrhoea