What is syphilis?
Syphilis is a sexually transmissible infection (STI) caused by the bacteria Treponema pallidum. Syphilis is curable but, if left untreated, can lead to serious complications.
Recently, we have seen a rise in syphilis cases in WA. Infections have increased by 45% over the last 5 years.
Syphilis is usually passed on during oral, anal, or vaginal sex. The bacterial infection is transmitted when there is skin-to-skin contact at the area on the body where the infection is (e.g., genitals)
What are the symptoms of Syphilis?
There are four stages, each with its own symptoms. Not everyone will have symptoms, which means people often don’t realise they have the infection. Symptoms often look like those of other conditions.
Primary syphilis
The symptoms usually start as sores called chancres. Chancres are small ulcers that are typically hard and painless and occur at the site of infection – this can be on the penis or vulva, or inside the vagina, the anus, or mouth. There is usually only one chancre, however, there can be multiple. A chancre usually appears 3-12 weeks after infection and will heal with or without treatment within a few weeks. Chancres can be hidden (they might appear inside the vagina or anus), and because they are often painless, you may not know they are there. Despite being easy to miss, these lesions are highly infectious.
Syphilis is highly infections in this stage even after the chancre has healed. Without treatment at this stage, the infection may develop into secondary syphilis.
Primary syphilis images (WARNING: This section includes images of genitals and symptoms)
Penile Chancre
Oral chancre
Secondary syphilis
Symptoms in this stage usually appear 6 weeks after the symptoms of primary syphilis. They may resolve within several weeks, but they can re-occur.
Symptoms may include:
- Fever, headache, generally feeling unwell
- Swollen lymph nodes in the armpits and groin
- Red, spotty, non-itchy rash found on the palms of the hands, the soles of the feet and, in some cases, the chest and back
- Hair loss
- Warty growths around the genitals and anus
Syphilis is highly infectious in this stage.
Secondary syphilis images (WARNING: This section includes images of genitals and symptoms)
Rash on foot
Rash on hands
Rash on back
Latent syphilis
In this stage there are no physical symptoms. While there are no physical symptoms, the body still has the infection if untreated. It can last anywhere between a few years and up to 30 years, and there may not be symptoms in between. Without treatment, the infection may remain in the latent stage for the rest of someone’s life or develop into tertiary syphilis.
Syphilis can still be infectious early in this stage.
Tertiary syphilis
On average, 1 in 3 people with untreated latent syphilis will develop tertiary syphilis. In this stage, the syphilis infection can progress to the heart, brain spinal cord, bones, and skin. This stage of infection can make someone very sick and even be life threatening.
Whilst syphilis is no longer infectious at this stage, it is still treatable.
Syphilis testing
Symptoms are often mild and may be confused for something else, like a sore or the flu. It is important to get tested for syphilis, even if you don’t notice any physical symptoms.
The only way to know if you have syphilis is by getting tested. Find out where to get tested near you.
What is involved in a syphilis test?
Syphilis can be picked up in a simple blood test.
Your healthcare provider may also perform a point of care test (POCT), which is a finger prick. A positive POCT will need to be confirmed by a standard blood test.
If you have a chancre or sore, you can also get that swabbed.
Who should get tested for syphilis?
Everyone should get tested for syphilis.
It is now recommended that healthcare providers include syphilis as part of routine health check.
Ask your healthcare professional to include syphilis when you get a standard STI screening or a routine blood test.
How often should you get tested for syphilis?
Syphilis has a testing window period and can take up to 6 weeks to show up on a serology test.
It is recommended to test every 3-6 months if you have multiple sexual partners. For people in monogamous relationships, testing is still recommended once a year.
Wait for your results (only a few days!) before you have sex again to lower the risk of transmission. Wait until treatment is complete to have sex again.
Treating syphilis
Treatment varies depending on the stage of the infection and symptoms. Treatment involves an injection of antibiotics, or a course of oral antibiotics (if you can’t have the injection due to a penicillin allergy).
Usually only one injection is needed but this may vary depending on the stage of the infection.
Follow up blood tests are required after treatment so that it can be confirmed that the treatment has worked.
Syphilis is not like chickenpox, you can get it more than once. Regular testing and using prevention methods is our best hope in bringing the numbers down.
Letting your partners know
If you have syphilis, it is important to let your partners know so they can get tested and treated too if needed.
Healthcare professionals and anonymous online websites can help you with contact tracing. You can choose to tell someone anonymously by using the following online services:
Not sure who to tell?
Who you should tell depends on the stage of syphilis. A healthcare professional can help you to work out when you may have been infectious and who you should tell.
The general recommendations for the primary and secondary stage are:
- Primary stage = anyone you’ve had sex with in the past 3 months
- Secondary stage = anyone you’ve had sex with in the past 6 months.
Preventing syphilis
To reduce your risk of catching syphilis:
- Use barrier methods such as condoms, dams and/or gloves for all types of sex
- Get tested for syphilis as part of a general health check up
- Include syphilis in your regular STI testing, every 3-6 months if changing partners and every year in monogamous relationships
- Talk about sexual health and safer sex
- See a healthcare provider if you notice any sores or rashes in or around your mouth or genitals.
- Get tested for syphilis if you are pregnant or planning to get pregnant.
Syphilis and pregnancy
Untreated syphilis during pregnancy can be harmful. When syphilis passes from a pregnant person to the foetus, this is known as congenital syphilis.
Congenital syphilis infection is a serious matter and can result in miscarriage, preterm birth, low birth weight, stillbirth, or death soon after birth.
All pregnant people should be tested for syphilis as part of routine care throughout a pregnancy.
Treatment during pregnancy is safe for the pregnant person and baby. Seeking treatment as soon as possible leads to better outcomes.
It is also important for someone to have a syphilis test if they are trying to become pregnant.
Syphilis and HIV
Having primary or secondary syphilis increases the risk of acquiring HIV.
For people living with HIV, the testing and treatment of syphilis is the same as that for people not living with HIV. Research suggests, however, that people living with HIV are more likely to experience more significant symptoms in the primary and secondary stages. For example, this may mean having more than one chancre, possibly multiple, and they may be larger in size. People who are not living with HIV typically only have a single lesion.
The severity of the symptoms experience by a person living with HIV can depend on the individual’s viral load and HIV treatment adherence.
Syphilis and PrEP
While Pre-Exposure Prophylaxis (PrEP) is great for preventing HIV, it cannot protect you from other STIs. If you are taking PrEP and want to avoid syphilis, barrier methods should be used to help prevent syphilis transmission.