Syphilis

What causes syphilis?

Syphilis is an infection caused by the bacteria treponema pallidum. This bacteria typically infects the genital area, but can also infect the rectal area, mouth, or throat.

How common is syphilis?

According to the CDC, there were just under 134,000 diagnosed cases of syphilis in the United States in 2020. Around 41,000 of these were primary or secondary cases. This makes syphilis fairly common, although not as common as other STIs like chlamydia and gonorrhea.

How does syphilis spread?

Syphilis spreads through sexual contact with an infected person. Most commonly, it spreads through vaginal or anal sex. However, in some cases, syphilis can spread through oral sex.

Syphilis can also spread from an infected mother to her infant, during vaginal childbirth.

How syphilis cannot spread

Contracting syphilis requires direct contact with a syphilis sore, which commonly appears on the genitals. The CDC notes that syphilis cannot spread through casual contact, like:

• Toilet seats
• Door knobs or handles
• Swimming pools, hot tubs, or bathtubs
• Sharing eating utensils or cups
• Clothing

Who is at risk of getting syphilis?

Anyone who has sex is at risk of contracting syphilis. However, men who have sex with men are diagnosed with syphilis more than any other group, according to the CDC and the Cleveland Clinic.

Signs and symptoms of syphilis

The signs and symptoms of syphilis vary, depending on what stage it is in. There are four main stages in which syphilis is categorized.

Primary syphilis

This is the first sign of syphilis and involves the development of a chancre (“SHANG-kur”) in the infected area. For most people, a chancre is a small sore that is relatively painless. It may develop in an area that is difficult to see such as inside the vagina or rectum.

One or more chancres can develop during primary syphilis and will heal on their own within 3 to 6 weeks according to the Mayo Clinic.

Secondary syphilis

Within weeks of a primary syphilis infection, secondary syphilis will develop. This is a rash that begins on the truck of the body and spreads to cover the entire body. According to the Mayo Clinic, this rash is usually not itchy but may be accompanied by other symptoms like:

• Wart-like sores inside the mouth or around the genitals
• Hair loss
• Muscle aches
• Fever
• Sore throat
• Swollen lymph nodes

This stage of syphilis will usually resolve within a few weeks and may come and go for several months.

Latent syphilis

Untreated syphilis moves into a latent stage (or “hidden” stage). During this stage, there are no symptoms.

This stage may last for years and gives the infection a chance to progress to the tertiary stage, reports the Mayo Clinic.

Tertiary syphilis

According to the Mayo Clinic, around 15-30% of people with untreated syphilis will reach this stage.

In this late stage, the disease may start causing damage to other areas of the body, including:

• The brain
• Nerves
• Eyes
• Heart
• Blood vessels
• Liver
• Bones
• Joints

This stage develops around 10 to 30 years after the primary stage according to the CDC. Tertiary syphilis causes severe damage to internal organs and can result in death.

The good news is that tertiary syphilis is easily preventable by getting treated with antibiotics in the earlier stages.

Complications from syphilis

If left untreated, syphilis can cause a number of serious health complications. Especially if it reaches the tertiary stage.

Gummas caused by syphilis

Gummas are small bumps or tumors that can develop on the skin, bones, or internal organs. According to the Mayo Clinic, Gummas are usually treated with antibiotics and will disappear once treated.

Cardiovascular problems caused by syphilis

The Mayo clinic reports that late-stage syphilis can cause damage to the cardiovascular system, including major blood vessels and heart valves.

Getting a syphilis infection diagnosed and treated properly while in its early stages will prevent these cardiovascular problems in the future.

Neurological problems caused by syphilis

Late-stage syphilis can permanently damage the nervous system. According to the Mayo Clinic, this can cause symptoms such as:

• Recurring headaches
• Stroke
• Meningitis
• Hearing loss
• Vision loss and blindness
• Dementia
• Loss of pain sensation
• Loss of temperature sensation
• Sexual dysfunction in men
• Bladder incontinence

Neurosyphilis

Neurosyphilis is when syphilis spreads to the nervous system or brain.

Getting a syphilis infection diagnosed and treated properly while in its early stages will prevent these neurological problems in the future.

Syphilis during pregnancy and childbirth

According to the CDC, Pregnant women can transmit a syphilis infection to an unborn baby, which can cause serious problems for the infant.

A syphilis infection during pregnancy can cause:

• Premature birth
• Low birth weight
• Stillborn birth

Congenital syphilis

Congenital syphilis is a syphilis infection that is passed from mother to infant. Congenital syphilis can lead to serious complications, including:

• Vision problems
• Deafness
• Seizures
• Death

It is important for pregnant women to be tested for syphilis at least once during their pregnancy. Treatment for syphilis during pregnancy can prevent transmission.

Diagnosis and testing for syphilis

Syphilis is a curable infection when it is found and treated early.

If you are exposed or are at high risk of being exposed to syphilis, it is important to get diagnosed as soon as possible. Early diagnoses will lead to early treatment and prevent the infection from developing into a late-stage disease.

How is syphilis diagnosed?

A healthcare provider will diagnose syphilis by asking about your symptoms and sexual history, as well as a physical exam, and laboratory testing.

The most common types of testing for syphilis are blood tests and culture (“swab”) tests.

Blood tests

According to the Mayo Clinic, a blood test is the most common test used to diagnose syphilis. During a blood test, a blood sample is collected via a venipuncture procedure. The sample is then sent to a laboratory for testing.

Culture (“swab”) tests

If there are any syphilis sores present during testing, your healthcare provider may opt for a culture test. For this test, a cotton-tipped swab is used to collect fluid from the sore. The culture is then sent to a laboratory for testing.

When should I get tested for syphilis?

Because syphilis can lead to serious complications, it is important to get regular sexual health screenings. The CDC recommends getting tested for SDIs at least once a year, if you are sexually active—and more often in certain circumstances like:

• If you are a man who has sex with other men
• If you have multiple sexual partners
• If you exchange money or drugs for sex
• If you are a sex worker
• If you have ever had syphilis or another STI
• If you have sex with anonymous partners
• If you are pregnant or planning to get pregnant

Where can I get a syphilis test?

You can get STI and gonorrhea testing at most healthcare facilities, including:

• Urgent care clinics
• Walk-in clinics
• Primary care clinics
• Gynecological clinics
• Public Health Clinics

You can also order a syphilis test online directly through Solv.

Testing for syphilis at home

There are at-home test kits for several STIs, including syphilis. At-home test kits are available for purchase from many drug store locations, or online.

At-home test kits for syphilis involve collecting a small sample of blood with a finger prick procedure. The sample is then either tested with a test strip at home or sent to a laboratory for testing.

Will I always test positive for syphilis?

Syphilis is a curable infection with the proper treatment from antibiotics. After completing treatment, you will test negative unless you become reinfected by another infected partner.

Getting treated for syphilis

Syphilis is easily treatable with antibiotics. Because treatment prevents serious complications from developing, it is important to seek diagnosis and treatment as soon as possible in accordance with CDC recommendations.

Treating early-stage syphilis

According to the CDC, a single dose of antibiotic, administered by injection, is the most common treatment. The most common antibiotic that is used is a long-acting antibiotic called Benzathine penicillin G.

There are other antibiotics that work well for treating syphilis in people who cannot have penicillin. Some of these antibiotics are:

• Doxycycline
• Tetracycline

Treating late-stage syphilis

A syphilis infection can be treated at any time, however, complications from a late-stage syphilis infection are permanent.

Treating syphilis while pregnant

According to the CDC, Penicillin G is the most effective antibiotic for treating a fetal syphilis infection and preventing congenital syphilis.

Jarisch–Herxheimer reaction

The Jarisch-Herxheimer reaction is a reaction caused by the rapid death of microorganisms in the body during aggressive antibiotic treatment.

This reaction can happen within the first 24 hours of treatment for syphilis or other infections. Symptoms of the Jarisch-Herxheimer reaction are:

• Fever
• Headache
• Fatigue

It is important to note that this reaction is not an allergic or adverse reaction to treatment.

Can I get syphilis again after I’ve been treated?

One infection with syphilis does not make you immune, you can become reinfected if you have sex with an infected partner again, reports the CDC.

The good news is that there are steps you can take to protect yourself from being reinfected, such as:

• Practicing safe sex techniques (proper use of condoms or dental dams)
• Having open and honest communication with your sexual partners about their sexual health and recent screenings

What can happen if syphilis is not treated?

If not treated, a syphilis infection remains in the body and can eventually lead to serious complications. Some of the complications of late-stage syphilis include:

• Tumors on the skin or internal organs known as gummas
• Damage to major blood vessels, including the aorta
• Damage to the heart valves
• Recurring headaches
• Stroke
• Meningitis
• Hearing loss
• Vision loss and blindness
• Dementia
• Loss of pain sensation
• Loss of temperature sensation
• Sexual dysfunction in men
• Bladder incontinence

Preventing syphilis

Safe sex and honest communication with sexual partners can greatly reduce your risk of getting syphilis.

How can I reduce my risk of getting syphilis?

• Use condoms properly during vaginal, anal, and oral sex
• Use dental dams during oral sex
• Ask your sexual partners about their sexual health and recent testing
• Limit the amount of lifetime sexual partners you have