Epidemiology

Frequently Asked Questions (FAQ)

Full PDF of the Syphilis FAQ (Revised June 2021)

What is syphilis?

Syphilis is a sexually transmitted infection caused by bacteria. If syphilis goes untreated, it can cause serious health problems. Syphilis is divided into multiple stages (primary, secondary, latent and tertiary). Each stage has its own signs and symptoms to look out for.

How is syphilis spread?

You can get syphilis by having direct contact with a syphilis sore, known as a chancre, during vaginal, anal or oral sex. Sores can be found on or around external genitalia, in the vagina, around the anus, in the rectum, on the lips or in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

How quickly do symptoms appear after infection?

The average time between exposure and onset of the first symptom is 21 days, but can range anywhere from 10-90 days.

Signs and symptoms?

Syphilis presents like many other diseases, but it typically follows a progression of stages that can last for weeks, months, or even years:

Primary Stage

A syphilitic chancre is the classic marker for the primary stage of syphilis. It can present as a single sore but also you could have multiple. The chancre is usually (but not always) firm, round, and can be painless. The chancre will appear at the site of infection, where the bacteria entered the body. The chancre will last usually 3 to 6 weeks and will heal regardless of being treated or not. However, if the infected person does not receive the appropriate treatment, the infection will progress to secondary syphilis.

Secondary Stage

The classic sign of this stage is the appearance of skin rashes, and/or mucous membrane sores. The rash will commonly present in one or multiple areas and is usually not itchy. The rash can be red or reddish brown and appear like rough spots. The most common location is on the palms of the hands or soles of the feet but the rash can appear in other locations, which makes it resemble other diseases. Sometimes, the rash may be so subtle that it goes unnoticed. Another sign is large, raised, gray or white lesions that may develop in warm, moist areas like the mouth, underarm, or groin. The lesions are known as condyloma lata. Other signs seen during secondary syphilis are fever, sore throat, swollen lymph nodes, hair loss, headaches, weight loss, muscles aches and fatigue. The symptoms will also go away with or without treatment but if not treated the infection will progress to the latent and possibly tertiary stage.

Latent Stage

During this stage, there are no visible symptoms but the individual is still infected with syphilis and needs treatment to prevent the transition to the tertiary stage. Note: Latent syphilis can last for years before progressing to the tertiary stage.

Tertiary Stage

This stage is rare and develops because of untreated syphilis infections and appearing usually 10-30 years after the infection was acquired. This stage can affect multiple organ systems (brain, nerves, eyes, heart, blood vessels, liver, bones, and joints) and can be fatal.

Neurosyphilis and Ocular Syphilis

Syphilis can invade the nervous system at any stage of the infection, this I known as neurosyphilis. Symptoms include headaches, altered behavior, difficulty coordinating movements, paralysis, sensory deficits and dementia.

Ocular syphilis also can occur at any stage and can affect any eye structure but the most commonly affected are the posterior uveitis and the panuveitis. Symptoms include vision changes, flashes of light, decrease visual acuity and permanent blindness.

How can I reduce my risk of getting syphilis?

The only way to avoid STI’s is to not have vaginal, anal or oral sex.

If you are sexually active, you can do the following to reduce your chances of getting syphilis:

• Being in a long-term monogamous relationship with a partner that has been tested and does not have syphilis.
• Using latex condoms properly every time you have sex. Condoms prevent transmission by preventing contact with the syphilitic sore. Sometimes the sore is in a location not covered by the condom and contact with these sores can still transmit syphilis.

Am I at risk for syphilis?

Anyone who is sexually active can get syphilis through unprotected vaginal, anal and oral sex.

• Pregnant women should be tested for syphilis at their first prenatal visit.
• You should get tested regularly if you are sexually active and
  • Are a man who has sex with men
  • Are living with HIV and are sexually active
  • Are taking PREP for HIV prevention
  • Have had sex with someone known to have tested positive for syphilis
  • Have anonymous sex partners
  • Have multiple sex partners
  • Have had a past STI and are sexually active
  • Have sex while intoxicated or high

Syphilis and Pregnancy?

If you are pregnant and have syphilis, you can spread the infection to your unborn baby. Having syphilis can lead to babies with a low birth weight, having a premature delivery or having a stillborn baby. To protect your baby, you should be tested for syphilis at least once during your pregnancy and be treated immediately if you test positive.

If a baby is born with syphilis, they may not show any signs or symptoms initially but if they are not treated immediately, the baby may develop serious problems within a few weeks. Health problems like cataracts, deafness, seizures and death can occur if a baby with syphilis is not treated.

How to know if I have syphilis?

A blood test is the most common way to test for syphilis. Sometimes a provider may diagnose syphilis by testing the fluid in the syphilis sore or rash.

Can syphilis be treated?

Yes, syphilis can be treated and cured with the use of the right antibiotics from your health care provider. The antibiotic known for being most effective is Benzathine Penicillin given intramuscularly. The stage of your infection will determine how many doses you will receive.

Persons who receive treatment for syphilis must abstain from sex with new partners until the syphilis sore is completely healed. Person with syphilis should notify their sex partners so that they can be tested and treated if necessary.

I have been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even if you have been successfully treated, you are still at risk of being re-infected. Follow-up testing with your provider is recommended to make sure that your treatment was successful and that re-infection has not occurred. This follow-up testing is recommended to be done around 6 months after your last dose of treatment.

A sore on your partner may not always be obvious as they can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth. Unless you know your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an infected partner.