Patient education: Syphilis (The Basics)

What is syphilis? — 

This is an infection you can get from having sex. Infections that can spread through sex are called "sexually transmitted infections." It is also possible for a pregnant person to give syphilis to their baby.

Syphilis has different stages:

●Primary syphilis

●Secondary syphilis

●Tertiary syphilis

In some people, the infection can spread to the brain, ears, or eyes. This can happen in any of the stages.

In some cases, a person might not have any symptoms. This is called "latent" syphilis.

What are the symptoms of primary syphilis? — 

Primary syphilis is the first stage of infection. Symptoms start 2 to 3 weeks after the person becomes infected. At that time, they usually get a raised red bump on the spot where the infection first entered the body. The bump is usually painless. Eventually, it turns into a small sore (or ulcer) with a raised edge.

The sores caused by syphilis usually form on the penis or around the vagina or anus. But they can also form in places that are hard to see, such as the back of the throat or inside the vagina or rectum.

Sores caused by primary syphilis usually heal on their own within a few weeks. Since they usually don't hurt, many people don't see them or get treatment.

After the first sores heal, some people develop secondary syphilis.

What are the symptoms of secondary syphilis? — 

Secondary syphilis usually starts weeks or a few months after primary syphilis. It happens in 1 in 4 people who don't get treatment for their primary syphilis.

Symptoms of secondary syphilis include:

●A widespread rash

●Large, raised, gray or white patches on warm, moist areas of the body (such as the mouth and genitals)

●Fever

●Headache

●Sore throat, muscle aches, and other flu-like symptoms

●Swollen lymph nodes in the neck, armpit, and groin area (lymph nodes are bean-shaped organs scattered throughout the body that store infection-fighting cells)

What are the symptoms of tertiary syphilis? — 

People with tertiary syphilis usually develop symptoms years after getting infected. This happens in a small number of people who do not get treatment.

People with tertiary syphilis can have damage to the heart, skin, brain, and other organs.

What is latent syphilis? — 

This is a period of time when syphilis is not causing any symptoms. It is divided into:

●"Early latent" syphilis – This is when the person got infected within the last year.

●"Late latent" syphilis – This is when the person has been infected for more than 1 year.

Sometimes, a person might not know exactly when they got infected. People with latent syphilis can have the infection for years without knowing it.

What is neurosyphilis? — 

This is when syphilis infection has moved into the brain, the spinal cord, or the tissues that surround both. Neurosyphilis can happen during any of the stages of syphilis. Symptoms include:

●Headache

●Confusion

●Nausea and vomiting

●Stiff neck

If your doctor suspects you have neurosyphilis, you might need a test called a "lumbar puncture," sometimes called a "spinal tap." The doctor takes a small sample of fluid from the space around the spinal cord. Then, the fluid is tested for the bacteria that cause syphilis.

What are ocular syphilis and otosyphilis? — 

"Ocular syphilis" is when the infection affects the eyes. "Otosyphilis" is when it affects the ears. If syphilis involves the eyes or ears, it can cause vision or hearing problems. This can happen in anyone with syphilis, but might be more common in people who also have HIV infection.

Is there a test for syphilis? — 

Yes. Your doctor can order blood tests to find out if you have syphilis.

How is syphilis treated? — 

It is usually treated with an antibiotic called penicillin. How long a person must take it depends on their stage of infection. Most people can get a penicillin shot, but some need to get the medicine through a thin tube that goes into a vein, called an "IV." People who are allergic to penicillin usually get a different antibiotic.

If you have syphilis, tell anyone you recently had sex with. They might also be infected (even if they have no symptoms) and need treatment. Your doctor or nurse will help you figure out which partners to tell.

After finishing treatment, most people need follow-up testing to make sure they are cured. Some people need to get multiple blood tests over a few years.

How can I help prevent getting syphilis? — 

You can reduce your chances if you:

●Use a latex condom correctly every time you have sex (figure 1).

●Avoid having sex when you or your partner has any symptoms that could be caused by an infection.

●Do not share sex toys.

●Do not have sex.

Some people can take an antibiotic pill after sex to help lower their risk of getting syphilis. This is called "post-exposure prophylaxis," or "PEP." It has only been studied in specific groups of people, including:

●Men who have sex with men

●Transgender women

If you are in 1 of these groups and at increased risk for syphilis, PEP might be an option. Your doctor can talk to you about the medicine and help you decide.

If you decide to take PEP, start taking it as soon as possible after having unprotected sex, and within 3 days. While PEP helps lower your risk of getting syphilis, it is still possible to get infected. The medicine can also cause side effects, such as stomach upset.

What if I want to get pregnant? — 

If you think you might have syphilis, it's important to get tested and treated if you are pregnant or want to get pregnant. Syphilis during pregnancy can cause problems if it is not treated.

Having syphilis while you are pregnant increases your risk of pregnancy loss (miscarriage) or stillbirth. A stillbirth is when the baby dies before it is born. You can also pass the infection on to your baby during pregnancy. This can cause serious health problems for the baby.

When should I see a doctor? — 

Call your doctor or nurse if:

●You have symptoms of syphilis.

●Any of your sex partners have been diagnosed with syphilis.

●You want to learn more about starting PEP to lower the risk of getting syphilis.

More on this topic

Patient education: Syphilis blood test (The Basics)
Patient education: Congenital syphilis (The Basics)
Patient education: Sexually transmitted infections (The Basics)
Patient education: Barrier and pericoital methods of birth control (The Basics)

Patient education: Barrier and pericoital methods of birth control (Beyond the Basics)