Syphilis is a sexually transmitted infection (STI). It has been relatively rare in the UK for several decades, but recent trends show that more people are becoming infected. If left untreated it can cause very serious health problems in both men and women.

Read a Paper from Dr Colm O’Mahony here.

What Causes Syphilis?

Syphilis is caused by bacteria which are easily passed from one person to another through sexual contact. Anyone who is sexually active can get it. Both men and women can have syphilis, and pass it on. You can pass syphilis on without knowing you have the infection because symptoms can be mild and you may not notice or recognise them.
Syphilis can develop in three stages:

  • The first stage: called primary syphilis
  • The second stage: called secondary syphilis
  • The third stage or latent stage: called tertiary syphilis

How is Syphilis Passed On?

Syphilis can be passed from one person to another during sex, and by the skin-to-skin contact with someone who has syphilis sores or rashes. Once you have this infection, it can remain in the body and be passed on before symptoms are noticeable or after they’ve disappeared. The infection can spread if you have vaginal, anal or oral sex, or share sex toys. Using a condom correctly will reduce your change of getting or passing on syphilis. Syphilis can also be transmitted by blood transfusion, but all UK blood donors are screened to prevent this. It is also possible for a pregnant woman to pass the infection to her unborn baby. You cannot get syphilis from hugging, sharing baths or towels, swimming pools or toilet seats.

How Can I Protect Myself from Syphilis?

· Use condoms (male or female) every time you have anal or vaginal sex.
· For oral sex, cover the penis with a condom or the female genitals with a latex square (dental dam).
· If you are not sure how to use condoms correctly, ask for a free leaflet.
· If you’re not happy with the condoms you have tried already, why not try a different brand or type ? They come in a variety of shapes and sizes.
· Avoid sharing sex toys – if they are shared, wash them or cover them with a new condom before anyone else uses them.

These measures can also help to protect you from some other STIs such as HIV, chlamydia and gonorrhoea. If you have syphilis without knowing it they will also help prevent you from passing it on.

What are the Signs and Symptoms?

The signs and symptoms are the same in both men and women. They can be difficult to recognise and can be missed. If you think you could have syphilis then go for a check-up and encourage your partner to be checked for infection. Sexual health clinics don’t mind doing check-ups.

If you do get symptoms, you might notice the following :

First stage syphilis – One or more sores – usually painless – will appear where the bacteria entered the body. On average, this will be 3-4 weeks after coming into contact with syphilis, but could be longer. These sores can appear anywhere on the body. In women, they appear mainly on the vulva (the lips around the opening to the vagina), the clitoris, cervix (entrance to the womb), around the opening of the urethra (tube where urine comes out), around the anus (the opening to the back passage) and mouth. In men, they appear mainly around the opening of the urethra, on the penis and foreskin, and around the anus and mouth. The sores of first stage syphilis are very infectious and may take 2-6 weeks to heal. By this time, the bacteria will have spread to other parts of the body.
Second stage syphilis – If the infection remains untreated the second stage usually occurs some weeks after the appearance of sores. The symptoms include:
· a painless rash – not normally itchy – spreading all over the body, or in patches, often including the palms of the hands and soles of the feet.
· flat, warty-looking growths – on the vulva in women and around the anus in both men and women.
· a flu-like illness, tiredness and loss of appetite, with swollen glands (this can last for weeks or months).
· White patches on the tongue or roof of the mouth.
· patchy hair loss.
The second stage of syphilis is very infectious and may last several weeks or months.

Third stage or latent syphilis The second stage of syphilis is very infectious and may last several weeks or months.When the infection remains untreated, it is called latent syphilis and can still be infectious. During this stage, the person infected may have no further symptoms. A latent period with no symptoms or obvious signs of syphilis can last for the rest of someone’s life. After many years untreated syphilis may start to cause very serious damage to the heart, brain, eyes, or internal organs, bones and nervous system. At this stage syphilis could be fatal.

How Will I Know if I Have the Infection?

You won’t know unless you have a syphilis test. If you or your partner think you might have an infection, you should both have a test. Even if you don’t have symptoms you may wish to be tested particularly if:
· you had unprotected sex with a new partner recently
· you or your partner has had unprotected sex with other partners
· a sexual partner tells you they have an STI
· you are found to have another STI

Don’t delay seeking advice – clinics don’t mind doing sexual health check-ups.

How Soon After Sex Can I Have the Test?

You can have a test as soon as you think you might have been in contact with syphilis. The results of the test will usually be known within a week. For many people syphilis won’t show up on the test straightaway, so it will be repeated at a later appointment. You can go to a genitourinary medicine (GUM) clinic, a sexual health clinic or to your GP. If your GP doesn’t offer testing, they will refer you to a clinic that does. A leaflet Sexually transmitted infections – where to go for help and advice is available free. It is not common to have more than one infection at any time, so ask about being tested for others.

What Does the Test Involve?

The doctor or nurse will ask you to give a blood sample. They will do a genital examination, which may include an internal examination of the vagina and anus, as well as an examination of other parts of the body. The doctor or nurse will use a swab to collect a sample of fluid from any sores. There are many myths about how swabs are done. A swab looks a bit like a cotton bud, but it is smaller, soft and rounded. The swab is wiped over any sores and easily picks up samples of fluid. It only takes a few seconds and is not usually painful, though it may be uncomfortable for a moment. Swabs may be used to pick up fluid from:
· the cervix, during an internal examination in women
· the genital area
· the penis and foreskin
· the urethra
· the anus
· the mouth
· sores anywhere else on the body
No tests are 100% accurate, but syphilis test should pick up almost all infections.

Cervical smear tests do not detect infections such as syphilis. If you are not sure whether you have been tested for syphilis, just ask.

What is the Treatment for Syphilis?

Treatment of first and second stage syphilis is simple and involves having a single antibiotic injection or a course of injections or taking antibiotic tablets or capsules. Penicillin is the most common treatment for syphilis, but there are several different antibiotics that can be used. Let the doctor or nurse know if you are allergic to Penicillin. Treatment usually lasts 10-14 days, but sometimes longer. If complications have occurred other treatment may also be needed. If there is a high chance of you having the infection, treatment may be started before the results of the test are back. There are no treatments that you can buy without a prescription and there is no evidence that complementary therapies can cure syphilis. Some of the antibiotics that are used to treat syphilis interact with the combined oral contraceptive pill. If you are taking the pill tell the doctor or nurse and they can advise you what to do.

How Effective is the Treatment?

First and second stage syphilis
Treatment is very effective. Treatment at any time during the first two stages of syphilis should cure the infection. Avoid vaginal, anal or oral sex until you and your partner have both finished treatment, otherwise you could be re-infected. Using a condom will reduce the risk of re-infection but not guarantee it. You should avoid any kind of skin-to-skin contact between you and your partner if either of you has any sores or rashes until the treatment has been completed. Your blood test will probably remain positive in any future tests – even after successful treatment. So, if you need documents for emigration or immigration reasons, ask your clinic for a certificate explaining your treatment.
Third stage or latent syphilis
By this stage syphilis is usually still treatable, but damage already done to your body can be permanent.

What Happens if Syphilis isn’t Treated?

Without proper treatment the infection can spread to other parts of the body causing damage and serious long-term complications. Left untreated syphilis may start to cause very serious damage to the heart, brain, eyes, other internal organs, bones and nervous system. This damage could be fatal.

Can Syphilis Go Away Without Treatment?

No. If you delay seeking treatment you risk the infection causing long-term damage and you may pass the infection on to someone else.

Will Syphilis Affect my Chances of Getting Pregnant?

There is no evidence that syphilis will affect your chances of getting pregnant.

What Happens if I Get Syphilis when I’m Pregnant?

All pregnant women are screened for syphilis. You should be offered a blood test when you attend for ante-natal care. If syphilis is found, then treatment can be given safely 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. This can lead to miscarriage or stillbirth or the baby being born with the infection.

Does Syphilis Cause Cervical Cancer?

There is no evidence that syphilis causes cervical cancer.

How Will I Know How I’v Had the Infection?

It can be impossible to know, particularly if you have not noticed any symptoms. You might not know whether you got syphilis from your current partner or a previous sexual partner. These doubts can be hard to handle. Some people feel upset or angry when they have an STI and find it difficult to talk to their partner or friends about it. Don’t be afraid to talk about how you feel with the staff at the clinic or surgery.

Should I Tell My Partner?

If you have syphilis it is very important that your current sexual partner and any other recent partners are also tested and treated. The staff at the clinic or doctor’s surgery can discuss with you how you might tell your partner(s). If you feel this will be too difficult, GUM clinics and some sexual health clinics can give you a ‘contact slip’ to send to your partner(s) or, if you prefer, the clinic can do this for you. The slip explains to the person that they may have been exposed to an STI and suggests that they go for a check-up. It does not say what the infection is, or have your name on it, so your confidentiality is protected. This is called partner notification. It is strongly advised you do tell your partner(s) but it isn’t compulsory.

Do I Need a Follow-Up Appointment?

You will need to go back to check that the infection has gone and that you have not come into contact with the infection again. You will also be advised to have regular blood tests to make sure that all is well. If you have any questions, ask the doctor, nurse or sexual health adviser and make sure you know how to protect yourself in the future.