Primary stage
One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:
- on the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
- on the penis in men.
- around the anus and mouth (both sexes).
The ulcers take between 2 and 6 weeks to heal.
If the infection is not treated at this point then it will progress to the secondary stage.
Secondary stage
If the infection has not been treated, the secondary stage will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:
- a flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months).
- a non-itchy rash covering the whole body or appearing in patches.
- flat, warty-looking growths on the vulva in women and around the anus in both sexes.
- white patches on the tongue or roof of the mouth.
- patchy hair loss.
During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will usually clear up within a few weeks, but may re-occur for years.
Treatment at any time during the first two stages of syphilis will cure the infection.
Latent and tertiary stages
If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test.
If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system.
If treatment for syphilis is given during the latent stage then the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.
How syphilis is passed on
Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:
- by having vaginal, anal or oral sex with someone who has the infection.
- from a mother to her unborn baby.
Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.
Where to go for help
If you have any symptoms or you are worried you may have been infected with syphilis, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can. Some countries also have specific sexual health clinics that can help you directly.
The diagnosis of syphilis
To find out if someone has syphilis, a doctor will usually carry out the following examinations and tests:
- a blood sample is taken and sent to an STD testing laboratory.
- a specimen of fluid is taken from all sores using a cotton swab and examined under a microscope.
- the genital area is examined for any primary signs of syphilis. The rest of the body is also checked.
- women are given an internal examination to check for sores.
- a sample of urine is taken.
None of the examinations should be painful, but they may be slightly uncomfortable. The blood samples taken by the doctor are examined in a laboratory under a microscope to confirm a diagnosis. Various tests can be used on the blood sample. The most common and least expensive looks for antibodies.
The examinations and tests can be done as soon as a person thinks they might have been in contact with syphilis. However, if the result is negative then it is usually recommended that the person retests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test.
Treatment
If the patient has syphilis, the doctor or sexual health adviser will talk about the STD and answer any questions. The patient will be asked about their sexual partners as it is important they are informed and tested as soon as possible.
It is strongly advisable to avoid any oral, vaginal or anal sex whilst having treatment, especially if the patient is in the early infectious stages of syphilis. Contact with any sores or rashes carries a risk of syphilis transmission.
Treatment of syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules. If the patient has had syphilis for less than a year then fewer doses will be needed.
If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternative medication can be prescribed.
It is important that the full course of treatment be completed. If treatment is interrupted then it may be necessary to start again from the beginning.
After the treatment is completed, the patient will be asked to attend the clinic at regular intervals for blood tests to check that the syphilis has gone.
Once a person has been treated and confirmed cleared of syphilis, any future blood tests (e.g. for immigration reasons) will still be positive, because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis.
Treatment is only capable of killing the syphilis bacteria and preventing further damage. It cannot repair damage already done to organs, or prevent re-infection if the person is exposed to the bacteria again.
Prevention
Although using a condom reduces the chances of becoming infected with syphilis, it is not entirely effective. A condom may not cover all of the sores or rashes in the affected areas, and direct skin contact may result in transmission.
If a person has sex regularly with multiple partners, then it is advisable for them to get frequent STD check-ups.
A person can become re-infected with syphilis even if they have had effective treatment for a previous infection. Past infection with syphilis does not make a person immune.
Congenital syphilis
Syphilis can infect a baby in the womb if the mother's infection is not treated. This is know as congenital syphilis. If a baby becomes infected then there is a high risk of stillbirth or miscarriage.
A newborn baby may not display any obvious symptoms of syphilis, but may develop serious complications within weeks if the disease is not treated.
In many countries, blood tests for syphilis are given to all pregnant women when they visit antenatal clinics. Women may also be offered other tests for other STDs, such as an HIV test when pregnant.
If a woman is found to be infected with syphilis, treatment can safely be given during pregnancy with no risk to the unborn baby.
