Syphilis

Syphilis is an infection caused by the bacterium Treponema pallidium, which is able to pass through intact mucus membranes and areas of skin that have been damaged (the sores and rashes of the infected person). As someone coming into contact with an infected sore or rash, your skin does not need to be damaged to allow infection to take place. 

Many people do not notice any symptoms of syphilis, and may believe that any symptoms they do notice are connected with other issues. It’s important to test for STIs regularly, particularly if you have multiple partners, have changed partners recently or want to stop using condoms with your partner.

Syphilis has three stages, each with its own different symptoms. If left untreated, it progresses to the second stage. In between the second and third stages, you cannot see or feel any signs or symptoms of syphilis. The disease becomes latent, which means hidden.

If you do get symptoms, you might notice some of the following at different stages:

First stage (primary syphilis)

• Ten days to three months after you become infected a painless sore (called a ‘chancre’) may appear where the infection is. This is usually on the penis or vulva/vagina/front hole, in the mouth or around the rectum. Some people get several sores.
• Glands in your neck, groin or armpits may swell.
• The sores are very infectious. They heal after about two to eight weeks and disappear.

Second stage (secondary syphilis)

A few weeks after the sore disappears you may get:

• a blotchy non-itchy rash on your body, often on the palms of your hands or soles of your feet
• patchy hair loss
• white patches in your mouth
• growths like genital warts appearing near the anus and also near the vulva/front hole.

The rash and growths are highly infectious.

You might also feel ill, with a fever or headache, and swollen glands, and have unintended weight loss. These symptoms could last a few weeks or could disappear and then re-appear.

Third or late stage (tertiary syphilis)

• After years of infection, syphilis can go on to cause serious damage to your heart, brain, bones and nervous system. This damage can be life threatening.
• You could experience stroke, blindness, heart problems, dementia and loss of co-ordination.
• It can still be treated at this stage, but treatment will not repair any damage to the body that has been done. 

Late stage syphilis is rare in the UK.

Syphilis bacteria spreads during vaginal/frontal, anal or oral sex. Condoms greatly reduce the likelihood of you catching syphilis by stopping contact with the sores that carry the bacterium, but condoms do not cover all the places where sores may be present.

 It can be passed on by making close contact with:

• a sore on someone’s body in the first stage, or 
• a rash on someone’s body in the second stage. 

Syphilis bacteria can also spread:

• when sharing sex toys, if they are not washed or condoms used and changed between different people using them
• ‘vertically’, which means it can pass to an unborn baby during pregnancy. 

If left untreated, syphilis can be passed on for up to 2 years after it becomes latent or hidden (in between the second and third stages).

• Avoid coming into contact with the sores or the rash.
• Using external or internal condoms provides a high level of protection, but only if the condom covers the sores or rash. 
• It is also advised that if you want to be as sure as you can be of not getting syphilis orally that a condom is used to cover the penis or a latex or plastic ‘dam’ is used to cover the vulva/front hole or anus. 
• Avoid sharing sex toys – if you do, wash them and cover them with a new condom every time.
• Remember, other types of protection against HIV infection like PrEP (pre-exposure prophylaxis) or contraception, like the contraceptive pill, give you no protection from syphilis or other STIs. 

• If a person with HIV is not taking HIV treatment (usually because they have not tested and do not know they are living  with HIV), having untreated syphilis may make them more infectious and liable to pass on HIV because untreated STI’s can increase the amount of HIV in their blood, semen or vaginal/frontal fluid.  However, if the person with HIV is taking effective HIV treatment and has an undetectable viral load (the level of HIV in the body is so low that tests cannot detect it) they cannot pass on HIV. Syphilis will not make a difference to this.
• If an HIV negative person has syphilis, it is more likely that they could acquire HIV if they are exposed to the virus.
• Syphilis can progress faster and become harder to treat if you are living with HIV and are not taking treatment.
• If you are taking HIV treatment and have an undetectable viral load, it is more likely that treatment for syphilis will be successful. 
• Sexually active people living with HIV should have regular STI check-ups, including a syphilis test.

• Blood tests for syphilis are offered for all pregnancies as the infection can be very dangerous for you and the baby, and they could be born with the disease.
• You can become infected with syphilis at any time during your pregnancy, including after the first initial test result. If you have any sigs or symptoms of a new syphilis infection, such as a sore or rash, get tested for syphilis again at a sexual health clinic.
• It's easy to treat syphilis in pregnancy and the treatment will not harm the baby.
• Syphilis doesn’t affect fertility or cause cervical cancer.

It is important to get tested if you are worried you might have syphilis, have symptoms or a sexual partner has been diagnosed with syphilis. All tests and treatment for sexually transmitted infections (STIs), including syphilis are free on the NHS no matter your immigration or asylum status. 

Most people get tested and treated for STIs like syphilis at sexual health clinics. It's free and confidential for everyone. No one else, including your GP, will be told about your visit.

Some GP surgeries and pharmacies also test for and treat these infections.

What the test for syphilis involves

During a routine face to face STI check-up:

• a blood test (blood taken from the arm)
• a swab test, where a swab, which looks like a smaller more rounded cotton bud, or has a plastic loop instead of the cotton tip is used to take a small sample from any sores that may be present. The swabbing only takes a few seconds and isn’t painful although it could be uncomfortable for a moment.

The doctor or nurse may also ask to do:

• a physical examination, where they will check your genitals and other parts of your body like your mouth and throat for sores. 

Some services may offer a telephone, video call or online consultation instead of a face-to-face appointment. In some areas self-sampling kits for syphilis are available to order online, so you can take a sample yourself and send it off to be tested. If the test shows that you have syphilis it’s very important that you seek treatment straight away, as syphilis does not go away without treatment. The test kit should have instructions explaining what to do.

Cervical screening tests and routine blood tests don’t look for or detect syphilis. If you are unsure whether you have been tested for syphilis ask the doctor or nurse treating you.

Syphilis treatment

Syphilis is treated and cured with antibiotics that are usually given as a short course of tablets, or an injection (or course of injections) into the muscle of your bum. Some people experience a flu like illness with high temperature, headache and muscle and/or joint pain, which starts 12 hours after treatment begins. This will only last 24 hours and isn’t dangerous, getting better on its own. If you need to, take painkillers and drink plenty of water. 

Penicillin is the most common antibiotic used for treatment, although several different antibiotics can be used. Let the doctor or nurse treating you know if you are allergic to penicillin.

If a partner of yours has syphilis, or the doctor treating you thinks there is a high chance of you having the infection, treatment may be started before your test results are back.

Treatment is very effective for both the first (primary) and second (secondary) stages of syphilis. As long as the treatment is taken as prescribed, syphilis will be completely cured.

You will need to go back for a follow-up test six to twelve weeks after treatment to check that the syphilis has gone and that you haven’t come into contact with the infection again. Even after successful treatment and cure your blood test for syphilis usually remains positive for life. If you need documents for emigration or any other reason, ask your clinic or GP for a certificate explaining your treatment.

If complications have occurred as a result of syphilis, then additional or other treatment may be necessary.

Syphilis can be treated and cured in the latent (hidden) stage without developing any long-term problems.

Tertiary/Late stage syphilis: this stage of syphilis is rare in the UK, but can be treated and cured if diagnosed. Any damage that has been done to the body by the disease won’t be reversed by the treatment.

When can I have sex again?

You will need to avoid any sexual contact with others – vaginal/frontal, anal or oral – until at least two weeks after your and your partners treatment has finished, to make sure the infection does not return or spread. It is best to wait until you’ve had a test and know the treatment has worked.

Telling your partner/s

People you have had sex with also need to get checked – a clinic can let them know if you do not want to. If they know, they can be tested and treated. The message they get will say that they may have been exposed to a sexually transmitted infection and encourage them to go get tested. Your name won’t be on the message and it won’t identify you in any way, so your confidentiality is protected.

Syphilis is usually diagnosed and treated in the first or second stages of infection, with a very small number of people being diagnosed in the latent stage. Being diagnosed with late stage syphilis is extremely rare in the UK, although if left untreated syphilis will cause serious long term complications and can be fatal.

Although syphilis is relatively rare in the UK, it doesn’t mean that you can’t become infected. You don’t need to have multiple sexual partners to get an STI.

You can have STIs without knowing as you may not have or recognise any symptoms, so regular STI testing is both a good idea and important for your sexual wellbeing. This is true for everyone although it’s especially the case if you're starting a new relationship, if you want to stop using condoms with your partner, if you have multiple partners or don’t use condoms consistently.

There is no reason to be embarrassed or guilty about getting an STI, in fact we know that these feelings actually stop people from getting tested and treated, making it more likely that STIs will impact on your sexual health and are passed on to your partners.

Terrence Higgins Trust can provide emotional support if you are worried about your sexual health or have concerns about living with HIV. We can help you access services local to you across the UK, whether provided by us or by someone else.

Call THT Direct on 0808 802 1221 for support, advice and information or email info@tht.org.uk

Visit tht.org.uk for the latest HIV and sexual health information.