Patient Basics: Syphilis

Originally published by Harvard Health.

What Is It?

Syphilis is a sexually transmitted disease (STD) caused by a type of bacteria called Treponema pallidum. In its earliest stage, syphilis produces an open sore (ulcer) that leaks fluid filled with syphilis bacteria. Syphilis can be transmitted by contact with this ulcer or other infectious sores that form later in the disease, usually during vaginal, oral or anal sex. If untreated, syphilis moves through a series of stages that affect different parts of the body, although the stages can overlap:

• Primary syphilis — In this first stage, syphilis causes a painless ulcer called a chancre, usually in the genital area where syphilis bacteria enter the body. This stage begins 10 to 90 days (average three weeks) after a person has been exposed to someone with syphilis. The sore goes away without treatment in about four to eight weeks.
• Secondary syphilis — In this stage, syphilis bacteria spread throughout the body. This usually causes a rash over most of the body along with fever, aches and pains, and other symptoms. This stage begins six to eight weeks after a person is exposed to syphilis, and it lasts up to one year.
• Latent syphilis — This stage begins when the secondary stage ends. Although there are no symptoms, the person remains infected. This stage can last for many years, even for the rest of a person’s life. About one-third of cases of latent syphilis progress to tertiary syphilis.
• Tertiary syphilis — In this stage, syphilis bacteria can cause severe damage to many different internal organs, including the brain and spinal cord. It usually begins within 10 years of infection and can end in death.

Pregnant women with syphilis can pass the bacteria to their babies, causing a condition known as congenital syphilis. Congenital syphilis causes a variety of skin and organ problems in infants, and it can be deadly. Pregnant women with syphilis also have about a 40% chance of having a baby that is stillborn.

If you are infected with syphilis, it may be easier for you to become infected with HIV. If you already have HIV, a syphilis infection may make you more likely to spread HIV to others.

Symptoms

The symptoms of syphilis vary depending on the stage of the illness:

Primary syphilis — Usually, a single ulcer (chancre) appears at the site where the bacteria entered the body. The genitals are the most common location for chancres to develop, but these ulcers also can form around the mouth or anus. The chancre is firm and painless, and it oozes fluid that contains syphilis bacteria. Sometimes, lymph nodes near the ulcer become enlarged, but remain painless. The chancre of primary syphilis usually heals after one to five weeks, although the person remains infected.

Secondary syphilis — Typical symptoms of secondary syphilis are:

• A rash, which may look like rough “copper penny” spots or fine red dots on the palms of the hands and soles of the feet
• A skin rash on the arms, legs, and trunk — The rash can take a variety of forms, such as small blotches or indented circles; small blisters filled with pus; thick gray or pink patches
• White patches inside the mouth and other mucous membranes.

Without treatment, rash symptoms usually go away after two to six weeks.

Other symptoms can include:

• Enlarged lymph nodes (swollen glands)
• Fever
• Headaches
• Muscle aches
• Sore throat
• Poor appetite
• Weight loss
• Feeling extremely tired

Without treatment, these other symptoms generally last about one year.

Latent stage — This stage does not cause any symptoms.

Tertiary syphilis — In this stage, syphilis causes symptoms related to severe organ damage. These symptoms can include:

• Destructive tumors, called gummas, in the mouth, nose, tongue, bones, skin, liver or other organs
• Chest pain or breathing difficulties related to heart valve damage or damage to the wall of the aorta (the major blood vessel bringing blood from the heart to the rest of the body)
• Joint pain
• Paralysis, coordination problems, loss of sensation, blindness, deterioration of intellectual function, personality changes and impotence due to nerve or brain damage

Diagnosis

If your doctor suspects that you have syphilis, he or she will look for any of the typical symptoms of the disease, especially for a chancre in the genital area. Your doctor can diagnose syphilis by taking a sample of fluid from a suspicious ulcer and having that fluid examined under a microscope for the presence of syphilis bacteria.

Your doctor also may order blood tests to check for certain antibodies that are present in people with syphilis. However, in some cases, people without syphilis test positive for these antibodies. A positive test may have to be confirmed with a second blood test.

Because of the high risk of HIV infection in people with syphilis, public-health officials recommend that all people infected with syphilis should be tested for HIV infection.

Expected Duration

Unless treated, syphilis is a lifelong illness.

Prevention

A person who has symptoms of primary or secondary syphilis can pass a syphilis infection to his or her sex partner. During sexual intercourse, the bacteria can pass from sores to the uninfected sexual partner through tiny breaks in the skin. To prevent this from happening, a person infected with syphilis (and his or her sexual partners) should abstain from sexual activity until after the completion of treatment for the infection. Every pregnant woman should have a blood test for syphilis to prevent passing the infection to her baby.

Treatment

People with primary syphilis can usually be cured with a single injection of a long-acting penicillin. People in later stages require longer treatment with penicillin. Other antibiotics, including doxycycline, azithromycin or ceftriaxone may be effective for people who are allergic to penicillin. All sex partners of people with syphilis should be treated as well. Babies born with congenital syphilis should be treated with a course of penicillin.

When To Call a Professional

Contact doctor if you develop any of the symptoms of syphilis, especially if you are pregnant. If you have a sex partner who is diagnosed with syphilis, contact your doctor immediately so that you can be treated for syphilis.

Prognosis

With proper antibiotic penicillin treatment, early syphilis infection can be cured without causing permanent damage. Although later stages of syphilis also respond to antibiotics, treatment will not repair any organ damage caused by the disease. Without treatment, about one-third of patients with latent syphilis develop tertiary syphilis, and these patients risk severe organ damage and death.

Additional Info

CDC National Prevention Information Network (NPIN)
National Center for HIV, STD and TB Prevention
P.O. Box 6003
Rockville, MD 20849-6003
Toll-Free: 1-800-458-5231
Fax: 1-888-282-7681
TTY: 1-800-243-7012
http://www.cdcnpin.org/

American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Phone: 919-361-8400
Fax: 919-361-8425
http://www.ashastd.org/