Syphilis

The symptoms of syphilis are similar for men and women. They’re often mild and difficult to recognise, so you may pass on the infection without knowing you have it.

The symptoms also tend to change over time and may come and go.

Even if the symptoms do improve, there’s still a risk you could pass the infection on or develop serious problems if you don’t get treatment.

The first symptoms of syphilis usually develop around two or three weeks after infection, although they can take up to 3 months to appear.

• the main symptom is a small, painless sore or ulcer (called a chancre) that you might not notice
• the sore will typically be on the penis, vagina, or around the anus, although they can sometimes appear in the mouth or on the lips, fingers or buttocks
• most people only have one sore, but some people have several
• you may also have swollen glands in your neck, groin or armpits

These symptoms usually pass within two to eight weeks. But if the infection isn’t treated, further symptoms may develop a few weeks after the initial symptoms have passed:

• a blotchy red rash that can appear anywhere on the body, but often develops on the palms of the hands or soles of the feet
• small skin growths (similar to genital warts) – on women these often appear on the vulva and for both men and women they may appear around the anus
• white patches in the mouth
• flu-like symptoms, such as tiredness, headaches, joint pains and a high temperature (fever)
• swollen glands
• occasionally, patchy hair loss

Without treatment, a syphilis infection can last for years or decades without causing any symptoms.

Eventually, it can spread to parts of the body such as the brain or nerves and cause serious and potentially life-threatening problems.

People at this stage may experience:

• meningitis
• strokes
• dementia symptoms
• loss of co-ordination
• numbness
• vision problems or blindness
• heart problems

Syphilis is still treatable at this stage, but it’s sometimes not possible to reverse any damage that’s already been done.

The only way to find out if you have syphilis is to get tested.

You should get tested for syphilis if:

• you’re worried you might have it
• a sexual partner has been diagnosed with syphilis
• you have symptoms of syphilis

To diagnose syphilis, you’ll usually have a:

• blood test – this can show whether you have syphilis or have had it in the past; repeating the test a few weeks later may be recommended if it’s negative, in case it was too early to give an accurate result
• physical examination –your genitals (and inside the vagina for women) or other parts of your body will need to be examined to look for growths or rashes that may be caused by syphilis
• swab test – a swab (similar to a cotton bud) is used to take a small sample of fluid from any sores, so it can be checked for syphilis

You should also be tested for other STIs, such as chlamydia and gonorrhoea, as it’s possible to have more than one STI at a time. Some results may be available the same day, while others may take a week or two to come back.

It’s important to get it treated because it won’t normally go away on its own and it can cause serious problems if left untreated.

Syphilis is usually treated with either:

• an injection of antibiotics into your buttocks – most people will only need one dose, although three injections given at weekly intervals may be recommended if you’ve had syphilis for a long time
• a course of antibiotics tablets if you can’t have the injection – this will usually last two or four weeks, depending on how long you’ve had syphilis

You should avoid any kind of sexual activity or close sexual contact with another person until at least two weeks after your treatment finishes. This includes vaginal, anal and oral sex, as well as close skin contact. If you have sex during treatment, you could become infected again or you could pass the infection on to someone else.

Your current and previous sexual partners should be tested and treated for syphilis as well, as leaving the infection untreated can lead to serious problems.

You can choose to either notify your previous sexual partners yourself, with support and advice from clinic staff, or the clinic can contact them by letter or phone and advise them to go for a check-up.

If the clinic contacts your previous sexual partners for you, your details will remain totally confidential and no information about you will be given out without your consent.

If a woman becomes infected while she’s pregnant, or becomes pregnant when she already has syphilis, it can be very dangerous for her baby if not treated. Infection in pregnancy can cause miscarriage, stillbirth or a serious infection in the baby.

All pregnant women are offered a blood test to check for syphilis, usually at around 8-12 weeks of pregnancy. The test can be repeated if there’s a risk you may have been exposed to syphilis later in your pregnancy.

Pregnant women with syphilis can be safely treated with antibiotics.

The treatment you need depends on how long you’ve had syphilis and how far along in your pregnancy you are.

• Pregnant women who’ve had syphilis for less than two years are usually treated with an injection of penicillin into the buttocks (if treated during the first or second trimester) or two injections given a week apart (if treated during the third trimester).
• Pregnant women who’ve had syphilis for more than two years are usually treated with three penicillin injections into the buttocks given at weekly intervals.

A short course of antibiotic tablets may be needed if you can’t have penicillin.