All Health Topics

Syphilis

Published July 22, 2020
• Reviewed by a UI Health Care Provider
on July 1, 2020

What is syphilis?

It is a bacterial infection most often spread by sexual contact.  It can have very serious complications if it is not treated.

It can affect:

  • Men
  • Women 
  • Babies

Syphilis has 4 stages:

  • Primary
  • Secondary
  • Latent
  • Tertiary

What causes it?

Syphilis is a sexually transmitted infection (STI). It is caused by an organism called Treponema pallidum. It gets into your body through broken skin or mucous membranes. 

How is it diagnosed?

Stage 1

  • It is diagnosed if you have chancres. 
  • Fluid from the chancre may be tested. 

Stage 2, 3, and 4

  • A blood test is needed. 
  • The blood test will not be positive until 5 weeks after the first chancres.

How is it treated?

Syphilis is curable if treated in time. It is treated with penicillin shots. 

  • More than one shot may be needed.
  • Other medicines may be used for people allergic to penicillin.

You must take all the medicines your provider orders.

How does it affect my baby?

During pregnancy, people are tested for syphilis at the first visit. A pregnant person can give syphilis to their unborn baby. It crosses the placenta after 16 to 18 weeks.

A pregnant person with syphilis may:

  • Have a miscarriage
  • Have a stillbirth (death of the baby before birth)
  • Give birth to a child with birth defects

Untreated babies with syphilis may have:

  • Blindness
  • Deafness
  • Brain damage
  • Problems with growth and development
  • Can die

Babies whose mothers have been treated may still have birth defects if they are exposed before their mother was treated.

What are the signs?

Primary (stage 1)

The incubation time is 14 to 21 days. It is contagious in this stage.

Signs are:

  • Small, painless, open, oval shaped sores with hard, raised borders (called a chancre). Chancres are not painful and rarely bleed. They appear 10 to 28 days after sexual contact. They often disappear in 3 to 6 weeks even if not treated.
    • You still need to be treated, even if the sores go away.
  • Chancres can be found on:
    • Genitals (vagina or penis)
    • Mouth
    • Skin
    • Rectum
    • They may not be noticed in women because they can be inside the vagina.
  • Enlarged lymph nodes near the sores

Secondary (stage 2)

This starts 2 weeks to 6 months after the chancre is gone. You can still infect your sexual partners if not treated.

Signs are:

  • A rash on the palms of the hands, soles of the feet, and or on torso
  • Lymph glands swell
  • May have a sore throat
  • Patches appear in the mouth, vagina, or penis
  • Flat bumps that look like warts may be near the genitals and mouth 
    • These bumps are very infectious.
  • Hair loss
  • Vision changes
  • Loss of appetite
  • Constipation (not able to have a bowel movement)
  • Nausea (feel like you need to vomit)
  • A low-grade fever
  • Muscle, joint, or bone pain

These signs may last 2 to 6 weeks.

Latent (stage 3)

This stage starts when you have no signs. It can last for years. Syphilis is not spread through sexual contact at this stage, but it is still in your blood.

Tertiary (stage 4)

You cannot pass syphilis to others at this stage.

1 out of 3 people will develop:

  • Heart problems
  • Skin rashes
  • Bone and joint pain
  • Insanity
  • Slurred speech
  • Senility
  • Paralysis (cannot move an arm or leg)

If syphilis is not treated it may cause death.

Neurosyphilis and ocular syphilis

If syphilis is not treated it can spread to the brain and nervous system (neurosyphilis) or the eye (ocular syphilis). This can happen during any stage. 

Signs of neurosyphilis are:

  • Severe headache
  • Hard to coordinate muscle movements
  • Paralysis (not able to move certain parts of your body)
  • Numbness
  • Dementia (mental disorder)

Signs of ocular syphilis are:

  • Changes in your vision
  • Blindness

Who is at risk? 

Age

Younger people (up to age 29) tend to have more sexual partners which put them at risk.

Sexual partners

  • People are at higher risk as their number of partners goes up.
  • Men who have sex with men.
  • Having a sexual partner who has tested positive for syphilis.

Unprotected sex

  • People who have unprotected vaginal, anal, or oral sex.
  • People who have sex and do not use condoms (rubbers).

HIV

Having HIV puts you at higher risk.

How is it prevented?

  • The only way to avoid syphilis is to not have vaginal, anal, or oral sex.  
  • Have sex with only 1 non-infected partner who has sex only with you.
  • Use protection during sexual activity.
    • Condoms (rubbers), used the right way from start to finish for each sexual contact, are the best protection.
    • Spermicidal foams and jellies and diaphragms are less reliable. These should be used along with condoms, not in place of them.
  • See a doctor right away if you think you have been exposed.
    • Be sure your partner is treated also.
    • Do not have sexual activity until the infection is gone.
    • If you have syphilis, your partner(s) should be tested and treated right away so it does not spread more. Partners can infect and reinfect each other if both are not treated at the same time.

I have been treated for syphilis. Can I get it again?

You can still get it again. Even after you have been treated, you can be re-infected.

Only lab tests can confirm whether you have syphilis. You may need more testing to make sure your treatment worked.

You may not know that a sex partner has syphilis. The sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth. Unless you know your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an infected sex partner.

When may I safely have intercourse again?

  • When you no longer have a chancre or rash.
  • It has been at least 7 days since you started treatment.