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Definition

Syphilis is a sexually transmitted disease (STD). If left untreated, syphilis can cause brain, nerve, tissue damage, and death. Fortunately, syphilis can be treated with antibiotics.

Causes

Syphilis is caused by specific bacteria. It is transmitted through direct contact with a syphilis lesion. This may occur when:

  • There is vaginal, anal, or oral sexual contact with an infected person
  • A pregnant woman passes the infection to her unborn baby—congenital syphilis
Risk Factors

Factors that may increase your chance of getting syphilis include:

  • Having sex with a person infected with syphilis
  • Having multiple sex partners
  • Not using a latex condom during vaginal, anal, or oral sex
  • Touching a syphilis lesion
  • Having other sexually transmitted diseases
Symptoms

Symptoms will depend on what stage the syphilis is in. There are four main stages.

Primary (First) Stage within 10-90 days of exposure

A single lesion will usually appear. It will occur in the area where the infection was originally passed. Common sites include the genitals, rectum, tongue, inside of the mouth, or lips.

It will start as a raised and painless lesion. It will gradually break down to form an ulcer. The ulcer is painless at first with raised edges. It usually last for 3-6 weeks. The ulcer will heal on its own.

Without treatment, the infection may move to the secondary stage. This can happen even if the ulcers are no longer visible.

Lymph Nodes

Male Lymph nodes

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Secondary Stage Several Weeks to Months after the Original Lesion

This stage is marked by the appearance of a non-itchy rash. This rash may appear as rough, red, or reddish brown spots on the palms of the hands or soles of the feet. It is also possible for different rashes to appear in other places on the body. These rashes may appear as:

  • Small blotches, pustules, or scales
  • Moist warts in the groin area
  • Slimy white patches in the mouth

The rash may be accompanied by flu-like symptoms, such as:

  • Sore throat
  • Swollen lymph nodes throughout the body
  • Fever
  • Headache
  • Fatigue
  • Muscle aches

Untreated secondary symptoms will disappear within a few weeks, but there may be repeated episodes during the next few years.

Latency (Resting) Stage May Last for Years

The infection is still present but there are no symptoms. It may or may not progress to the third stage. Blood tests for syphilis will be positive during this stage.

Tertiary (Third or Late) Stage

This stage may begin years after the initial infection. This stage has become very rare in developed countries. In this stage, the infection begins to damage:

  • Brain and nerves
  • Eyes
  • Heart and blood vessels
  • Liver
  • Bones and joints

Damage can be serious enough to cause death. Symptoms include the following:

  • Small bumps called gummas on the skin, bones, or internal organs
  • Blindness
  • Central nervous system damage, including weakness, numbness, trouble walking, difficulty with balance, memory and psychiatric problems, and loss of bladder control
Congenital Syphilis

Babies born with this infection can have problems, such as deafness, cataracts, brain and nerve damage, and seizures. It can also cause premature births or stillbirths.

Fetal Infection

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Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

  • Examining samples taken from lesions
  • Blood test to detect syphilis antibodies.
  • Spinal tap to look for infection in fluid around the spine and brain called neurosyphilis

Syphilis testing is part of routine prenatal care. This is done to treat and prevent congenital syphilis.

All people who have syphilis should also be tested for HIV.

Treatment

Syphilis can be treated with antibiotics. The type of antibiotic and length of treatment will depend on how long you have been infected. Half of those being treated for syphilis will have fever with headache, muscle aches, and other symptoms during the first 24 hours of treatment.

If you have syphilis of any stage, avoid sexual relations until treatment is complete and the infection is cleared up. All sex partners should be notified. They will need to be treated as well.

Prevention

To reduce your chance of getting syphilis:

  • Abstain from vaginal, anal, and oral sex.
  • Have a mutually monogamous sexual relationship with an uninfected partner.
  • Use a latex condom during vaginal, anal, and oral sex. This is especially important if you are unsure of your partner's status.
  • Have regular checkups for sexually transmitted diseases.
  • Make sure your sexual partner is also treated if you have primary, secondary, or early latent syphilis.

It may not be obvious that a sex partner has syphilis. Do not assume your partner is healthy just because you do not see lesions.

RESOURCES:

American Social Health Association
http://www.ashastd.org

Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Sex Information and Education Council of Canada
http://www.sieccan.org

References:

Congenital syphilis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated January 16, 2014. Accessed May 22, 2014.

Latent syphilis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2014. Accessed May 22, 2014.

Syphilis. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/syphilis/understanding/Pages/default.aspx. Updated Accessed May 22, 2014.

Syphilis-CDC Fact Sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm. Updated April 1, 2014. Accessed May 22, 2014.

Syphilis (primary phase). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2014. Accessed May 22, 2014.

Syphilis (secondary phase). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2014. Accessed May 22, 2014.

Syphilis (tertiary phase). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 16, 2014. Accessed May 22, 2014.

Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12):1-110.



Last reviewed May 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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