Syphilis
Introduction
Syphilis is a bacterial infection that is usually passed on through having sex with someone who is infected. It can also be passed from an infected mother to her unborn child and, in rare cases, can be caught through injecting drugs.
It is extremely rare to catch syphilis through a blood transfusion in the UK as blood donors are carefully screened.
Three stages of disease
Stage 1 (primary syphilis). Symptoms of syphilis begin with a painless but highly infectious sore on the genitals or sometimes around the mouth. If somebody else comes into close contact with the sore, typically during sexual contact, they can also become infected. The sore lasts two to six weeks before disappearing.
Stage 2 (secondary syphilis). Secondary symptoms, such as a skin rash and sore throat, then develop. These symptoms may disappear within a few weeks, after which you experience a latent (hidden) phase with no symptoms, which can last for years. After this, syphilis can progress to its third, most dangerous stage.
Stage 3 (tertiary syphilis). At this stage, it can cause serious damage to the body.
The primary and secondary stages are when you are most infectious to other people. In the latent phase (and usually around two years after becoming infected), syphilis cannot be passed onto others but can still cause symptoms. See Symptoms of syphilis for more information on the stages of the disease.
How common is it?
The number of diagnoses of syphilis has risen substantially in the past decade in the UK. There have been a number of local outbreaks across England, the largest of which was in London between 2001 and 2004. Rates are highest among gay men.
However, syphilis still remains one of the less common sexually transmitted infections in the UK. Between 2007 and 2008, there was a slight decline in diagnoses in the UK.
Outlook
If diagnosed early, syphilis can be easily treated with antibiotics, usually penicillin injections (see the Treatment section for more information).
However, if it is not treated, syphilis can progress to a more dangerous form of the disease and cause serious conditions such as stroke, paralysis, blindness or even death.
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Symptoms
The symptoms of syphilis are the same for men and women and can be difficult to recognise. They are often mild, which means you can pass on the infection without knowing you have got it.
The symptoms develop in three stages:
- primary syphilis
- secondary syphilis
- tertiary syphilis
Primary syphilis
The initial symptoms of syphilis can appear any time from 10 days to 3 months after you have been exposed to the condition.
The most common symptom is the appearance of a small, painless sore or ulcer (called a chancre). The sore will appear on the part of your body where the infection was transmitted, typically the penis, vagina, anus, rectum, tongue or lips. Most people only have one sore, but some people have more.
You may also experience swelling in your lymph glands (small organs found throughout the body, such as in the neck, groin or armpit).
The sore is painless and may be overlooked, so the condition can be spread without you realising there is an infection.
The sore will then disappear within two to six weeks and, if the condition is not treated, syphilis will move into its second stage.
Secondary syphilis
The symptoms of secondary syphilis will begin a few weeks after the disappearance of the sore.
Common symptoms include:
- a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet
- tiredness
- headaches
- swollen lymph glands
Less common symptoms include:
- fever
- weight loss
- patchy hair loss
- joint pains
These symptoms may disappear within a few weeks, or come and go over a period of months.
Latent phase
Syphilis will then move into its latent (hidden) phase, where you will experience no symptoms, even though you remain infected. Latent syphilis can still be passed on during the first year of this stage of the condition, usually through sexual or close physical contact. However, after a couple of years, you cannot pass the infection to others, even though you remain infected.
The latent stage can continue for many years (even decades) after you first become infected.
Without treatment, there is a risk that latent syphilis will move on to the most dangerous stage: tertiary syphilis.
Tertiary syphilis
The symptoms of tertiary syphilis can begin years or even decades after initial infection.
The symptoms of tertiary syphilis will depend on what part of the body the infection spreads to. For example, it may affect the brain, nerves, eyes, heart, bones, skin or blood vessels, potentially causing any of the following symptoms:
- stroke
- dementia
- loss of coordination
- numbness
- paralysis
- blindness
- deafness
- heart disease
- skin rashes
At this stage, syphilis can be dangerous enough to cause death.
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Causes
Syphilis is caused by the bacterium Treponema pallidium. The bacteria can enter your body if you have close contact with an infected sore, normally during vaginal, anal or oral sex or by sharing sex toys.
It may also be possible to catch syphilis if you are an injecting drug user and you share a needle with somebody who is infected.
Pregnant women can pass the condition on to their unborn babies, which can cause stillbirth or death of the baby shortly after labour.
It is extremely rare for syphilis to be spread through blood transfusions as all blood transfusions in the UK are routinely screened (tested) for syphilis.
Myths
The bacteria causing syphilis cannot survive for long outside the human body. Because of this, syphilis cannot be spread from using the same toilet, clothing, cutlery or bathroom as an infected person.
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Diagnosis
If you suspect you may have syphilis you should see your sexual health clinic, GP or local genito-urinary medicine (GUM) clinic without delay. The earlier syphilis is treated, the less chance there is of serious complications.
All diagnosis and treatment is free and confidential.
Examination
The doctor or nurse will examine your genitals. For men, this involves looking at the penis, foreskin and urethra (the hole at the end of the penis where urine comes out). For women, it involves an internal examination of the vagina. Both men and women may also have their anus examined.
Tests
After the examination, you will have a blood test for syphilis (see below). You should also have tests for other sexually transmitted infections, including HIV. The results should be available in 7 to 10 days.
Blood test
If you are infected with syphilis, your body produces antibodies (proteins released as part of your immune response) against the syphilis bacteria.
Therefore, one way to determine whether you have syphilis is to have a sample of your blood tested for the presence of these antibodies.
- A positive result (antibodies present) indicates that you either have the infection or you used to have it (because the antibodies can remain in your body for years, even after a previous infection was successfully treated).
- A negative result does not necessarily mean that you do not have syphilis as the antibodies may not be detectable for up to three months after infection. You may be advised to repeat the test in three months' time.
Every pregnant woman should have a blood test for syphilis as the infection can kill unborn or newborn babies. The blood test is usually done during an antenatal appointment at weeks 11-20 of pregnancy. If the test is positive, treatment for both the mother and baby can begin.
Swab
If sores are present, a swab (like a cotton bud) will be used to take a small sample of fluid from the sore. This is then either looked at under a microscope in the clinic or sent to a laboratory for examination.
Other STIs
You should also be routinely tested for the presence of other sexually transmitted infections (STIs), such as HIV, chlamydia and gonorrhoea, as it is possible to have more than one STI at a time.
What happens at a GUM clinic?
- Some clinics are walk-in clinics, while others may need you to book an appointment. Ring first to find out or look on their website.
- When you attend a clinic, you will be asked for your name, date of birth and contact details and you will be registered as a patient. These details are confidential and will not be passed to your GP unless you request it.
- The clinic doctor or nurse will ask why you have attended the clinic.
- You will be asked for a sexual history, which will include questions such as when you last had sex, whether you used condoms, whether you have had an STI before, and if you are on any medication.
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Treatment
Antibiotics
Primary and secondary syphilis can be successfully treated with a single dose of penicillin (which is given as an injection into your buttock). You will be prescribed another antibiotic (in tablet form) if you are allergic to penicillin.
Later stages of the disease need to be treated with three penicillin injections, which are given at weekly intervals.
Some of the antibiotics used to treat syphilis can adversely affect methods of contraception that contain the hormones oestrogen and progestogen, such as the combined pill or contraceptive patch. Tell your doctor or nurse if you are using these methods of contraception so they can advise you on additional contraceptive methods to protect you from pregnancy.
Refrain from any kind of sexual activity or close physical contact with another person until your treatment is complete and your sexual partner has been tested and treated.
Jarisch-Herxheimer reaction
A small number of people experience a reaction to the antibiotics known as the Jarisch-Herxheimer reaction. It is thought that the reaction is triggered by the toxins released when a large amount of bacteria are killed after antibiotic treatment.
The Jarisch-Herxheimer reaction causes flu-like symptoms such as fever, headaches and muscle and joint pain. These normally only last 24 hours, are nothing to worry about and cause no serious problems. The symptoms can be treated with paracetamol, although contact your GP or the GUM clinic if the symptoms are severe or do not settle down.
Follow-up test
Once the course of antibiotics has finished, you will be asked to return to the GUM clinic so a follow-up blood test can be carried out to check that the infection has gone.
You can still catch syphilis again, even after you have been successfully treated for it.
Tertiary syphilis
Treatment of tertiary syphilis requires longer courses of antibiotics and may need intravenous treatment (administered directly into the vein). While treatment can stop the infection, it cannot repair any damage that has already been caused by the tertiary syphilis.
Telling your partner
If you have syphilis, it is important that your current sexual partner, or any sexual partner you have had since being exposed to infection, is tested and treated.
Some people can feel angry, upset or embarrassed about discussing syphilis with their current or former partner(s). Do not be afraid to discuss your concerns with the clinic staff or your GP. They can advise you about who should be contacted and the best way to contact them.
The clinic can give you a 'contact slip' to give to your partner or partners. This slip explains to that person that they may have been exposed to syphilis and that they should go for a check-up. The slip does not have your name on it and your details will remain totally confidential.
If you would prefer, the clinic can contact your recent partner(s) for you. This is usually done by phone or letter. Again, your details will remain totally confidential and your partner(s) will be given no information about you without your consent.
Nobody can force you to tell any of your partners about your syphilis, but it is strongly recommended. If it is left untested and untreated, syphilis can lead to death.
Avoiding sex
Do not have vaginal, anal or oral sex and avoid any kind of skin contact with your partner until you have finished treatment. Otherwise, you could be reinfected or pass the infection on to someone else.
Pregnancy
Syphilis in pregnancy can be successfully treated using antibiotics. There are no risks to your unborn baby from the antibiotics. It is vitally important that pregnant women receive treatment for syphilis as, if it is left untreated, it can cause serious birth defects, miscarriage or stillbirth.
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Prevention
The only guaranteed way to prevent a syphilis infection is to avoid sexual contact or to only have sexual contact with a faithful partner who has been tested and is clear from the infection.
Condoms can reduce your risk of catching syphilis, but cannot prevent it altogether. You can still catch syphilis if your mouth makes contact with a sore on an infected person's anus or vagina, for example.
It is important to not only use a condom during vaginal, oral and anal sex, but also consider using a dental dam (square of plastic) when your mouth makes contact with your partner's vagina or anus. This will reduce your risk of any sexually transmitted infection, not just syphilis.
Avoid sharing sex toys. If you do share them, wash them or cover them with a condom before each use.
Sexual penetration or ejaculation does not need to take place for syphilis to spread.
If you are an injecting drug user, do not use other people's needles. Many pharmacies and local authorities offer needle-exchange programmes, where used needles can be exchanged for clean ones. Your GP or drug counsellor should be able to provide more information.
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