Syphilis

What is syphilis?

Syphilis is an infectious disease caused by a bacterium (germ) called Treponema pallidum. Syphilis is uncommon in the UK, but is more common in other parts of the world.

How do you get syphilis?

Syphilis is a sexually transmitted disease. The infection is passed from person to person through contact with a syphilis ulcer (described below). So, depending where the ulcer is, the infection can be passed on during vaginal, anal, or oral sex.

Syphilis is not spread by toilet seats, door knobs, bath tubs, shared clothing, etc. You need to have close direct contact with an infected person.

If you are pregnant, you can pass on syphilis to your unborn baby (congenital syphilis). This can cause serious problems in the baby.

What are the symptoms of syphilis?

If left untreated, the infection typically follows a pattern of four stages. These stages are called primary syphilis, secondary syphilis, the latent period, and tertiary syphilis.

Primary syphilis

Typically, one small ulcer (sore) develops where syphilis bacteria enter the body. This is commonly on the penis in men, on the vulva or vagina in women, or on the anus. The ulcer usually appears about 2-3 weeks after having sex with an infected person, but it may appear anytime up to three months later.

The ulcer is usually painless, about the size of a small coin. A clear fluid (serum) may come from the ulcer. The ulcer lasts up to six weeks, then heals - but this does not mean the infection has gone. (The ulcer caused by syphilis is sometimes called a chancre.)

When you have a syphilis ulcer, the nearby glands in your groin may swell. These feel like small lumps in your groin at the top of your legs.

Sometimes the primary stage is non-typical. For example:

• You may have more than one ulcer.
• The ulcer may be painful.
• Pus may come from an ulcer.
• The ulcer may be in your mouth (if you catch the infection during oral sex), or in the rectum (from anal sex).
• The ulcer may be on the cervix in women, and is not seen or felt.
• You may have no symptoms, or very mild symptoms that you take little notice of.

Secondary syphilis

If the primary ulcer is not treated, or not noticed, the bacteria may spread to many parts of your body. Symptoms of secondary syphilis may then develop. These tend to appear a few weeks after the ulcer has healed, but may develop whilst the ulcer is healing.

• A rash commonly develops. The rash looks like dark patches that appear on the skin, each about the size of a penny. The rash may occur in many areas of the body, or be only in a few areas. However, the palms of the hands, and soles of the feet are almost always involved. The rash is not usually itchy or painful.
• Wart-like growths may develop around the penis in men, or vagina in women (condylomata lata).
• You may feel generally unwell and feel tired.
• You may have a mild fever.
• Swollen lymph glands may develop in various places in your body.
• Some people develop patchy hair loss.
• Less commonly, inflammation may develop in other parts of your body such as the liver, eyes, brain, or kidneys.

Without treatment, the rash and other symptoms from secondary syphilis usually go after several weeks. However, they may 'come and go' for up to two years.

Latent (hidden) syphilis

After the symptoms of secondary syphilis have cleared, you may not have any symptoms for several years. In this 'latent' period you may think that the disease has gone. In some cases, there is no further development. However, if left untreated, the bacteria can slowly damage various parts of your body, and symptoms of the tertiary (third) stage may eventually appear.

Tertiary syphilis

In time, the infection can have very serious effects on the brain and nerves. The heart, bones, blood vessels, liver, eyes, and skin can also be seriously damaged. Many varied symptoms may develop, years after first being infected. In the days before antibiotics, many people died from tertiary syphilis.

How is syphilis diagnosed?

• A swab (small sample) from the sore can be looked at under the microscope. The typical bacteria can be seen.
• If the ulcer has gone, a blood test can detect if you have syphilis.

What is the treatment for syphilis?

• A course of penicillin injections is the usual treatment. This kills the bacteria and prevents the disease from progressing any further.
• Other antibiotics are sometimes used if you are allergic to penicillin.
• Do not have sex with anyone until the syphilis sores are completely healed.

Treatment during the primary or secondary stages of the disease will usually prevent any permanent long-term damage.

Tell your sex partner(s) so that they can also be tested, and treated if necessary.

Can syphilis be prevented?

If you practice safe sex, and always use a condom, your risk of catching syphilis is very much reduced. However, condoms do not provide complete protection, as syphilis ulcers can sometimes be on areas not covered by a condom.

If you have had syphilis, and had it treated, you can still get it again if you have sex with an infected person. (The antibodies in your blood are not sufficient to protect you from another infection if you come into contact with syphilis again.)

Further help and information

If you suspect that you have syphilis, or any other a sexually transmitted infection, then see your GP or contact your local genito-urinary medicine (GUM) clinic. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital or health authority and ask where the nearest clinic is. It may also be listed in the phone book under 'Genito-Urinary Medicine'. Other resources include:

fpa
Helpline: 0845 122 8690 Web: www.fpa.org.uk
Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)
www.bashh.org
A professional association but their website includes contact details of GUM clinics.