Syphilis

Syphilis is a bacterial infection transmitted through contact with mucous membranes and lesions of the mouth, anal and genital area. Syphilis is a serious infection. If untreated, it can lead to serious health problems over time including irreversible damage to the brain, eyes, nerves, heart and other organs. About half of people with syphilis infection don't know they have it because they don't have any symptoms. Because of this it is very important to get tested and treated as soon as possible.

Syphilis is very infectious and easy to catch. It is picked up from someone who has it during any type of sex (oral, anal or vaginal) or even just very close skin-to-skin or genital contact.

Syphilis can also be passed from a pregnant person to their baby during pregnancy. This is called congenital syphilis. If syphilis is treated before pregnancy, it will not harm a future baby. If it is transmitted during pregnancy or left untreated, it can cause miscarriage, stillbirth, or serious health problems for the baby. Early diagnosis and treatment during pregnancy greatly reduce this risk.

Syphilis is not passed on by hugging, sharing baths, towels, toilet seats, swimming pools, cups, plates or cutlery.

Syphilis is sometimes called 'the great pretender' because many people have no symptoms, or symptoms that can look like other illnesses. Symptoms can also come and go, even though the infection is still present.

Syphilis happens in stages; primary, secondary, latent and late.

Primary stage syphilis

The first sign is usually a single painless sore, called a chancre, at the site of contact. This may be on the genitals, anus, mouth, or cervix. Because it does not hurt and may be hidden, it can easily be missed.

Primary syphilis:

• Usually appears about 3 to 4 weeks after infection, although it can appear later
• May be accompanies by swollen glands
• May heal on its own after a few weeks, but the infection remains
• Is highly infectious.

Any genital, anal, or oral sore should be checked by a doctor or nurse, even if it is painless or starting to heal.

Secondary syphilis

Weeks later, a rash may appear. It is often on the body and can include the palms of the hands or soles of the feet.

Other symptoms may include:

• Sore throat or mouth ulcers
• Fever
• Swollen glands
• Patchy hair loss
• Tiredness
• Flat, wart-like sores around the genitals or anus.

These symptoms may be mild and can go away without treatment, but the infection is still present and people are still very infectious at this stage.

Latent and late syphilis

After symptoms disappear, syphilis can become latent, which means it is still in the body but causes no symptoms. If it is not treated, late syphilis can develop years later and may cause permanent damage to organs such as the brain, nerves, heart, eyes, or blood vessels. After about 2 years, syphilis is usually no longer sexually infectious, but it can still be passed to a baby during pregnancy.

Syphilis can go on to cause serious life-threatening conditions years later if it is left untreated. One in three people who have contracted syphilis and remain untreated will suffer serious damage to the nervous system, heart, brain, or other organs, and death may result.

In pregnancy

If syphilis is diagnosed and fully treated before pregnancy, it will not harm a future baby.

If a person contracts syphilis during pregnancy, the infection can be passed to the baby. This is called congenital syphilis. Babies with congenital syphilis can become very unwell, with lifelong physical and developmental problems

Untreated syphilis in pregnancy can also cause miscarriage or stillbirth.

Treatment during pregnancy, especially if given early, greatly reduces the risk and helps protect both mother and baby.

A blood test is the only way of knowing if you have syphilis. Many people who get syphilis have no symptoms and do not know they have it.

If you were exposed recently, your first blood test may not show syphilis yet. You may need repeat testing, and sometimes treatment is recommended even before a blood test becomes positive.

Syphilis is easily cured with antibiotics if it is treated early, usually with penicillin injections. Other treatment options are available for people who are allergic to penicillin, depending on the situation. It is important to complete all treatment exactly as advised.

Some people feel flu-like for a few hours after treatment, with fever, aches, headache or chills. This reaction usually settles on its own, but ask your clinician what to expect and what to do if you feel unwell.

You should avoid sex until at least 7-14 days after treatment is finished and any sores or rashes have healed so you don't pass syphilis onto anyone else. Your clinician will advise what is appropriate for you depending on your circumstances.

After treatment, follow-up blood tests are important for at least 12 months to make sure the treatment has worked properly. A repeat sexual health check at around 3 months is also sensible, especially to check for reinfection and review partner treatment.

Tell your doctor, nurse or midwife if you are pregnant, could be pregnant, or are planning pregnancy. Syphilis in pregnancy needs prompt specialist advice and treatment.

Condoms reduce the risk of syphilis, but they do not cover all skin. If a sore or rash is outside the area covered by a condom, syphilis can still be passed on. Regular blood testing is important, especially if you have new or multiple partners.

If you are diagnosed with syphilis, recent sexual partners will need to be told, assessed, tested, and sometimes treated. Exactly how far back this goes depends on the stage of syphilis and your sexual history, so your doctor, nurse, or sexual health clinic will guide you. Partner notification is important to prevent reinfection and reduce transmission. You can ask for help from your doctor, nurse or sexual health clinic to notify a previous sexual partner or if you want the notification to be anonymous.

Avoid sex until:

• Treatment has been completed
• Any sores or rashes have completely healed
• Your clinician says it is safe.

This helps prevent passing syphilis on or getting it again.