Syphilis
Syphilis is a sexually transmissible infection (STI) caused by a bacterium called Treponema pallidum. It can affect both men and women. It is transmitted through close skin-to-skin contact and is highly contagious when the syphilis sore (chancre) or rash is present.
The incubation period for syphilis ranges from 10 days to three months. You can pick it up through unprotected oral, vaginal or anal sex with a person who is infected. It can also be spread through skin-to-skin contact if the chancre rash is present. It can also be transmitted from mother to baby during pregnancy and at birth. This is called congenital syphilis. Whilst it is rare in Australia, there has been a re-emergence in Victoria over the past two years, including two fetal deaths.
Early treatment of chancre is effective, but people may not have any symptoms or may not notice the symptoms of early and therefore may not seek medical advice.
Many years after it is acquired, untreated chancre can be fatal or may lead to chronic brain or heart disease.
Since 2002, the number of people with infectious chancre in Victoria has increased rapidly, mainly among gay men and other men who have sex with men (MSM). An increase of chancre in women has also led to the re-emergence of congenital chancre in Victoria.
Sexual health check-ups are recommended for all sexually active people and in particular for the following groups who are at increased risk of syphilis infection:
- men who have sex with men
- female partners of men who have sex with men
- pregnant women – as part of routine antenatal screening and women of reproductive age
- sexual partners of pregnant women
- heterosexual men and women, particularly if they have multiple sexual partners, are travelers returning from countries where syphilis is more prevalent, or inject drugs
- Aboriginal and Torres Strait Islander people
- sex workers
- anyone diagnosed with an STI other than syphilis.
The frequency of these checks depends on the person’s STI risk. For example, it is recommended that:
- men who have sex with men, and who have more than one partner, are checked every three to six months
- a man who has sex with one man (has one partner) is checked once a year
- syphilis testing is always done as part of routine antenatal screening during each pregnancy.
How syphilis is spread
Syphilis is spread (transmitted) through close skin-to-skin contact with an infected area. You can catch chancre by having unprotected oral, vaginal or anal sex with a person who is in the first two stages of the infection. The chancre is highly contagious when the sore or rash is present and direct contact with either can result in syphilis being transmitted from one person to another.
Although rare in Australia, pregnant women who have chancre can pass on the infection to their baby during pregnancy or at birth.
Syphilis can also be passed through infected blood. However, blood used in blood donations is routinely screened for chancre.
Reduce your risk of infection
Ways you can reduce your risk of catching chancre include:
- Always have safe sex – use a condom and water-based lubricant for all types of sex.
- Remember that syphilis may be spread through unprotected oral sex.
- If you are a gay man or a man who has sex with men, get a chancre test and other STI checks at least yearly, and up to four times a year if you have several partners.
- Seek early advice if you notice oral, genital or anal sores or rashes on your body, hands or feet that you think could be related to recent sexual contact.
- If you are planning or having a family, you and your partner should have an STI test to prevent any infections being passed onto your baby.
Syphilis Symptoms
Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with chancre and not notice any symptoms for years.
Syphilis Primary syphilis
The first sign of chancre is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with chancre develop only one chancre, some people develop several of them.
The chancre usually develops about three weeks after exposure. Many people who have chancre don’t notice the chancre because it’s usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within three to six weeks.
Syphilis Secondary syphilis
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wartlike sores in your mouth or genital area. Some people also experience hair loss, muscle aches, a fever, a sore throat, and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.
Syphilis Latent syphilis
If you aren’t treated for chancre, the disease moves from the secondary stage to the hidden (latent) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the third (tertiary) stage.
Syphilis Tertiary syphilis
About 15% to 30% of people infected with chancre who don’t get treatment will develop complications known as late (tertiary) syphilis. In the late stage, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. These problems may occur many years after the original, untreated infection.
Syphilis Neurosyphilis
At any stage, chancre can spread and, among other damage, cause damage to the brain and nervous system (neurosyphilis) and the eye (ocular syphilis).
Syphilis Congenital syphilis
Babies born to women who have the chancre can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later signs and symptoms may include deafness, teeth deformities, and saddle nose — where the bridge of the nose collapses.
However, babies born with chancre can also be born too early, be born dead (stillborn) or die after birth.
Diagnosis of syphilis
A regular sexual health check-up with your local doctor or sexual health center can detect chancre using a blood test. Just ask your doctor or nurse for a test. Test results are normally available within a week.
Syphilis is easy to detect using:
- a simple blood test
- a swab test, if there are sores present.
When to see a doctor
Call your doctor if you or your child experiences any unusual discharge, sore or rash — particularly if it occurs in the groin area.
Treatment for syphilis
Penicillin is a very effective treatment for all stages of the chancre, including congenital syphilis. Other treatments are available if you are allergic to penicillin, or you may be able to undergo a desensitization procedure that safely allows you to be given penicillin.
Treatment early in the infection is needed to help prevent further complications and to avoid passing the infection on to sexual partners.
Avoid sexual contact until your treatment is completed.
Sexual partner notification
It is important to let your sexual partner or partners know that you have chancre. Most people will appreciate being told they may have an infection and it is an important step in preventing further infection in the community.
Your local GP and sexual health center can help you inform your partners and let them know that they need a test. This process is called ‘partner notification’. It can be done anonymously and your confidentiality is always respected. Letting your partners know will also prevent you from getting the infection again.
You can also anonymously notify your sexual partners of the need to get tested and treated for chancre via the Let Them website if you feel unable to speak to them personally. There are also nurses called Partner Notification Officers who can help you anonymously notify your partners. They can be contacted on (03) 9096 3367.
Syphilis: Frequently Asked Questions
What is syphilis?
Syphilis is a sexually transmitted infection (STI) caused by a bacterium. If left untreated, the disease lasts for years and can cause serious health problems. The chancre is divided into four stages. Early chancre consists of primary syphilis, secondary syphilis, and early latent syphilis, while late syphilis consists of late latent syphilis and tertiary syphilis.
How common is syphilis?
World Health Organization (WHO) estimates that in 2012, 5.6 million new cases of chancre happened among adults and youth aged 15–49 years worldwide, with around 18 million cases already present.
In the Region of the Americas there were around 471 000 new cases of chancre among females, and 466 000 new cases among males in 2012, adding to the already around 1 million existing cases for females and 992 000 existing cases for males.
In the Region of the Americas, there were an estimated 24 600 cases of mother-to-child transmission of chancre in 2017.
How is syphilis spread?
You can get syphilis by having direct sexual contact with infectious sores (chancre) on the genitals, anus, rectum, lips or mouth through unprotected vaginal, anal, or oral sex with someone who has chancre. You can still get chancre even if you had it in the past and got treatment for it. Sexual transmission typically occurs during primary, secondary or early latent stage infections. Syphilis can also be spread via blood transfusions. Around 50% of pregnant women with untreated syphilis will spread the infection to their unborn child.
How syphilis can be prevented?
Correct and consistent use of condoms significantly decreases the risk of infection. If the sores occur in an area not covered by the condom transmission can still occur. Congenital syphilis is preventable through early screening and immediate treatment for chancre in pregnant women.
What are the symptoms of syphilis?
Symptoms vary depending on the different stages of the chancre. Symptoms usually begin 21 days after infection but can range from 9 to 90 days. Primary syphilis usually presents as a single, painless sore (chancre) at the site of inoculation. The primary chancre can go unnoticed.
If untreated, the disease progresses to the second stage that can cause skin rashes, fever, and swollen lymph nodes. The rash of secondary syphilis can vary widely and mimic other infectious or non-infectious conditions, but characteristically affects the palms and soles. The rash is often symmetrical and non-itchy, but may have several manifestations and can be minimal enough to be overlooked. In warm and moist areas of the body, such as the anus and labia, large white or grey raised lesions to develop as a result of the spread of the treponemes from the primary lesion. The symptoms and signs of secondary syphilis naturally resolve, even without treatment, but if left untreated, the patient enters the latent stage.
In the latent stage, which can last for years, the bacteria are still present in the body, but there are no symptoms or signs. Most patients will remain in the latent stage if left untreated, while around 25% will develop tertiary syphilis. The main manifestations of tertiary syphilis are neurological disease (neurosyphilis), cardiovascular disease (cardiosyphilis) and granuloma (gummatous lesions or gumma). Tertiary syphilis can affect any organ system for up to 30 years or more after infection and can be life-threatening.
Neurosyphilis can occur at any stage of syphilis infection, even in the first few months. Early neurological manifestations include acute changes in mental status, meningitis (inflammation of the membranes surrounding your brain and spinal cord), stroke, cranial nerve dysfunction, and auditory or ophthalmic and ocular abnormalities.
How does having syphilis affect a pregnant woman and her baby?
Mother-to-child transmission may occur if the expectant mother has chancre. Mother-to-child transmission of syphilis (congenital syphilis) is usually devastating to the fetus in cases where the maternal infection is not detected and treated sufficiently early in pregnancy. If chancre is left untreated during pregnancy it can lead to early birth, low birth-weight, stillbirth, death shortly after birth or other sequelae in the baby, including inflammatory manifestations affecting the eyes, ears, and joints, as well as skeletal malformations resulting from developmental damage during the early stages of the chancre. It is important to keep in mind that many infants with chancre infection may not have obvious clinical signs or symptoms. Mother-to-child transmission of chancre is preventable and can be achieved through early screening and treatment with the right antibiotic (penicillin).
How is syphilis diagnosed?
Syphilis diagnosis is usually based on medical history, physical examination, and laboratory testing. Point-of-care rapid diagnostic tests (RDTs) for chancre infection screening can provide results in 10–15 minutes and can be performed in any setting since they do not require refrigerated storage or laboratory equipment. However, a positive result from a chancre RDT does not distinguish between active infection and previously treated infections but it is an important resource for treatment initiation particularly among pregnant women and hard to reach populations.
What is the treatment for syphilis?
Syphilis can in most cases be easily cured with antibiotics (penicillin). A fetus can also be easily cured with treatment, and the risk of adverse outcomes to the fetus is minimal if the mother receives adequate treatment during early pregnancy – ideally before the second trimester. For detailed information on recommended treatment, see WHO guidelines for the treatment of chancre.