Syphilis

It is a bacterial infection. It is usually sexually transmitted, but may also be passed from an infected mother to her unborn child (vertical transmission).

Signs and symptoms

The signs and symptoms of syphilis are the same in both men and women. They can be difficult to recognise and may take up to 3 months to show after having sexual contact with an infected person.

Syphilis has several stages. The primary and secondary stages are very infectious.

Primary stage

One or more painless sores appear at the place where the syphilis bacteria entered the body. On average, this will be after 21 days. You may not notice them.

These sores can appear anywhere on the body but mainly:

• on the vulva (lips of the vagina), the clitoris and around the opening of the urethra (the water passage)
• on the cervix (neck of the womb) in women and on the penis and foreskin in men
• around the anus and mouth (both sexes)

The sore (or sores) is very infectious and may take from 2 to 6 weeks to heal.

Secondary stage

If the syphilis infection remains untreated the secondary stage usually occurs 3 to 6 weeks after the appearance of sores.

The symptoms include:

• 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
• a flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months)
• white patches on the tongue or roof of the mouth
• patchy hair loss

When these symptoms are present, syphilis is very infectious and may be sexually transmitted to a partner.

Treatment at any time during these first two stages of syphilis will cure the infection.

Latent stage

Latent syphilis refers to the presence of untreated syphilis. You can have no symptoms or signs of the infection, which is diagnosed by a positive blood test. If left untreated, you may develop symptomatic late syphilis. This would usually develop after more than 10 years. It is then that syphilis can affect the heart, and possibly the nervous system.

If treatment for syphilis is given during the latent stage the infection can be cured. However, if there has been heart or nervous-system damage before treatment is started this may be irreversible.

How syphilis is passed on?

Syphilis can be transmitted by:

• having sex with someone who has the infection
• a mother to her unborn baby

The tests for syphilis

At the clinic the following tests will normally be made:

• A blood sample is taken.
• If you have a sore, a specimen of fluid is taken from this and looked at under a microscope.
• Your genital area and whole body are examined by the doctor.
• Samples are taken, using a cotton-wool or spongy swab, from any sores.
• Women are given an internal examination.
• A sample of urine is taken.

None of these tests should be painful, but they may be slightly uncomfortable.

You can have the test as soon as you think you might have been in contact with syphilis.

Diagnosis and treatment

Samples taken during the examination are looked at under a microscope to check for infection. Samples are sent to a laboratory for testing. The result is usually available within one week.

If you are told that you have syphilis a health adviser will explain the infection to you and answer any questions you may have. You will also be asked about your sexual partner(s), so that, if necessary, they can get treatment too.

If it is suspected that you have the early infectious stages of syphilis, you should not have oral, vaginal or anal sex. You should also not have any kind of sex involving contact between your partner and any sores or rashes you may have until the treatment is completed.

Treatment for syphilis is usually a 2-week course of penicillin injections or, in some cases, antibiotic tablets or capsules.

If you are allergic to any antibiotics, or if there is any possibility that you may be pregnant, it is important that you tell your doctor. It is important that you finish any course of treatment. If treatment is interrupted, it may be necessary to start again from the beginning.

Once you have completed your treatment, you will be asked to attend the clinic at regular intervals for blood tests.

Pregnancy and syphilis

The blood tests for syphilis are given to all pregnant women when they visit an ante-natal clinic. If syphilis is found, treatment can safely be given during pregnancy with no risk to the unborn baby. If a woman has untreated syphilis she may pass the infection to her baby in the womb. In some cases this can lead to miscarriage or stillbirth.

Once syphilis has been successfully treated, it will not come back unless you become reinfected. However your blood test will be positive in any future tests (e.g. for immigration reasons). Make sure you get a certificate from your clinic explaining about your treatment.

Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections