Syphilis

What is syphilis?

Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if left untreated. However, it’s easy to cure if found early.

In Australia, rates of syphilis are higher among:

• men who have sex with men
• Aboriginal and/or Torres Strait Islander people living in remote places

However, in recent years rates of syphilis have also been going up in:

• heterosexual males
• females

What are the symptoms of syphilis?

Some people with syphilis have no symptoms. This is why it’s important to be tested regularly.

The symptoms of syphilis depend on the stage of infection. There are 4 stages of syphilis infection:

1. primary syphilis
2. secondary syphilis
3. latent syphilis
4. tertiary syphilis

Primary syphilis (10 to 90 days after infection)

Symptoms include:

• a painless sore or sores in or on your mouth, anus, penis, vagina or cervix
• the sore is a roundish area of broken skin — the centre may be weepy and have pus coming from it
• the sores usually go away by themselves after 2 to 6 weeks

It’s easy for sores to go unnoticed because they are usually painless. They may also be hidden from view in your rectum or on your cervix.

However, even when the sore goes away, you are still infectious and can pass the infection on to others.

Secondary syphilis (7 to 10 weeks after infection)

Symptoms include:

• a red rash on the palms of your hands, soles of your feet, chest or back — the rash is slightly lumpy, but not itchy or painful
• fever
• enlarged glands in your armpits and groin
• hair loss
• headaches
• tiredness

These symptoms can often go unnoticed.

Latent syphilis

There are generally no obvious symptoms and infection is only found with blood tests.

If syphilis is not treated at this stage, it can remain latent or turn into tertiary syphilis.

Tertiary syphilis

Tertiary syphilis develops in about 1 in 3 people with untreated latent syphilis.

The bacteria can damage almost any part of your body including your:

• heart — causing heart disease
• brain — causing mental illness
• spinal cord — causing neurological problems
• eyes — causing blindness
• bones

This can happen many years after your original infection.

What causes syphilis?

Syphilis is caused by a bacteria called treponema pallidum.

How is syphilis spread?

Syphilis is usually spread through skin-to-skin contact during vaginal, anal or oral sex.

Syphilis is highly infectious when there is an open sore or rash present.

Syphilis can also be passed on:

• before people have symptoms
• by people who don’t have any sores

Syphilis can occasionally be spread by blood contamination, via needle-stick injury or sharing injecting equipment.

The risk of getting syphilis through a blood transfusion is very low, due to:

• the screening of donors
• the way the blood is stored

During pregnancy, syphilis can passed on to the baby. This is called congenital syphilis.

Who is at risk?

In Australia, groups at particular risk of syphilis include:

• men who have sex with men
• females of child-bearing age
• those living in outbreak areas, including Aboriginal and Torres Strait Islander Communities

When should I see my doctor?

If you think you may have syphilis, it’s important to see a doctor as soon as possible. Your doctor will confirm the diagnosis with testing and start treatment if required.

How is syphilis diagnosed?

Your doctor will talk with you and examine you. They will need to do a blood test to confirm a diagnosis of syphilis.

The blood test finds the antibodies that your body makes to fight the infection. A positive test shows that you have a current or past infection. It can take 3 months to develop antibodies, so the tests may be negative early on.

Your doctor may also do a swab test from a sore. When syphilis is diagnosed your doctor will report it to the local health authorities, as syphilis is a notifiable disease.

Syphilis is routinely tested for in pregnancy.

You may also want to be tested for other sexually transmitted infections such as:

• chlamydia
• gonorrhoea
• HIV

Notifying sexual partners

It’s very important that you tell people who you’ve had sex with that you have syphilis. This helps to stop you being re-infected and reduces the spread of syphilis. They can then be tested and treated if infected.

Your doctor will help you decide who you need to tell and how to tell them.

The Let Them Know website can give advice on how to tell your partner(s). They also have sample emails and SMSs you can send personally or anonymously.

How is syphilis treated?

Syphilis is usually treated with penicillin. It’s given by an injection into your muscle. There are other treatments if you are allergic to penicillin.

After treatment with penicillin, you may feel like you have the flu for 24 hours. This will soon go away, without any extra treatment. Rest and drink plenty of fluids.

Do not have sex, even with a condom, until your doctor tells you your treatment has worked.

You will need to have follow-up blood tests to make sure the infection is gone.

What if I have syphilis and am pregnant?

Untreated syphilis during pregnancy can cause you to pass the infection to your baby before birth — congenital syphilis.

This can cause:

• miscarriage
• stillbirth
• premature birth
• low birthweight
• death shortly after birth

Babies born with syphilis can have serious health problems, such as permanent brain damage. If syphilis is found you can be treated. This stops the disease being passed on to your baby.

If you have a high risk of syphilis infection, you will also be tested at:

• 28 and 36 weeks
• the time of birth
• 6 weeks after birth

Can syphilis be prevented?

Practising safe sex is the best way to prevent syphilis infection.

It is safest to:

• always use condoms with water-based lubricant during sex
• always use dental dams for oral sex
• avoid sexual activity if you or your sexual partner are unwell, especially if they have symptoms of syphilis
• have regular STI check-ups

Complications of syphilis

If left untreated, syphilis can cause:

• meningitis (brain infection)
• dementia
• lung failure
• heart failure
• blindness
• death

Syphilis can also be passed to your baby during pregnancy. This can be very serious — see the What if I have syphilis and am pregnant? section above.