What is Syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.


How Do They Test for Syphilis?

There are two ways medical professionals can test for syphilis. The first is by collecting a sample from a syphilis sore. However, syphilis sores only occur within the primary stage of the infection. (More on that below.) After a few weeks, the sores will disappear, but syphilis will remain in the body if left untreated. Many people may not notice these sores either. Some may appear on or within the genitals, anus, or mouth.

The other way to test for syphilis is through a blood test. Urine tests are not sufficient to detect syphilis. Note also that it usually takes one-to-two weeks for STD blood tests to function properly. A blood test taken the day after a person contracts the infection may yield a false negative.


syphillis under microscope


How Does a Syphilis Blood Test Work?

Shortly after syphilis infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

STD blood testing is not painful, and it’s a straightforward process. Patients can expect to receive their blood test results a few days after the test. Sometimes, complications arise in the testing process, and it may take as long as two weeks to deliver a definitive test result. In general, we strive to provide our patients with results two-to-five days after an STD test.


How Common is Syphilis?

Syphilis is a fairly common STD. According to the CDC, over 100,000 new cases of syphilis were diagnosed in 2017. However, not all of those cases are “new.” Since syphilis can exist within the body for decades if left untreated, researchers tend to focus on syphilis infections identified in either the primary or secondary stages (within a year of contraction). Of the 100,000 cases in 2017, 30,000 were P&S. P&S syphilis rates rose 10% from 2016 to 2017 and 72% from 2013 totals.

Anyone can get syphilis. Young, old, gay, straight, man, woman –– all sexually active individuals can contract syphilis through sexual contact with an infected person. However, men who have sex with men have the highest risk of getting syphilis. Indeed, gay, straight, or bisexual men comprise almost 60% of those diagnosed with P&S syphilis. Lastly, individuals who have had an STD in the past are also more likely to contract an STD again.


How do People Get Syphilis?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.


What Are the Signs and Symptoms of Syphilis?

Many people infected with syphilis do not have any symptoms for years, yet they remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores go unrecognized. Thus, transmission may occur from persons who are unaware of their infection.

Primary Stage

The primary stage of syphilis is usually marked by the appearance of a single sore, known as a chancre, but there may be multiple sores later. The time between initial infection and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts three-to-six weeks, and it heals without treatment. However, if treatment is not administered, the infection will progress to the secondary stage.

Secondary Stage

Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. Secondary syphilis rashes may appear as rough, red, or reddish brown spots on the palms of the hands and/or the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body; sometimes they resemble rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of the disease.

Late and Latent Stages

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis develop in about 15% of people who have not been treated for syphilis and can appear ten-to-twenty years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.


What is the Link Between Syphilis and HIV?

Genital sores caused by syphilis make it easier to transmit and acquire HIV through sexual contact. There is an estimated two-to-five-fold increased risk of acquiring HIV if exposed when syphilis is present.

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes –– such as syphilis –– disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, they increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for getting infected with HIV because STDs are a marker for behaviors associated with HIV transmission.


What is the Treatment for Syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important for all sexually active individuals to get screened for syphilis on a regular basis.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must also notify their sex partners so that they also can be tested and receive treatment if necessary.


Can Syphilis Come Back?

Having syphilis once does not protect a person from getting it again. Following successful treatment, people may still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a healthcare provider will help to determine the need to be re-tested for syphilis after being treated.


How Can Syphilis be Prevented?

The surest way to avoid transmission of sexually transmitted diseases –– including syphilis –– is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be STD-free.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to high-risk sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs, so that preventive action can be taken.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention. Transmission of an STD, including syphilis, cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to go get tested immediately. 

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