A person can get infected through unprotected oral, vaginal, or anal sex with an infected partner, through direct sexual contact with bacteria contained in syphilitic sores or rashes, from an infected mother to her fetus, and in rare cases from sharing unclean needles to inject drugs. Syphilis increases the risk of transmitting or becoming infected with HIV.
Most people have no symptoms and can pass the infection on to their sexual partner(s) without knowing it. Syphilis is described by stages:
During the first or primary stage, three days to three months after exposure, a small painless sore called a “chancre” develops. The sore appears where the bacteria first entered the body (i.e., external genitalia, on the cervix, in the vagina, under the foreskin, in the rectum, mouth or throat).
During this stage, people are highly infectious to their sexual partner(s) i.e., they can easily pass it on to other people. The sore remains for another three to six weeks, then will heal on its own without treatment. However, the person is not cured.
If primary syphilis is not treated, three to six weeks after the “chancre” has healed, a rash may appear anywhere on the body, on the palms of the hands and soles of the feet. This rash is usually not itchy.
Other symptoms may include flu-like symptoms (swollen glands, aching joints, muscle aches, fever), temporary patchy hair loss, and flat, wart-like growths on the genital area.
During this stage, a person is also very infectious to their sexual partner(s). Secondary symptoms disappear after a few weeks, without treatment, but may return. Sometimes the rash appears while the “chancre” is still present.
Latent and tertiary stages:
A long period with no symptoms follows the secondary stage, during which a person is not infectious; this is the latent stage. However, this does not mean the infection is over.
Symptoms of tertiary syphilis may take from 10 to 30 years to develop. They can be very serious resulting in damage to the brain, nerves, blood vessels and heart. This can lead to blindness and even death.
Syphilis is diagnosed by combining information from the history, physical examination, and lab tests. It is diagnosed by finding syphilis antibodies in the blood or by finding syphilis bacteria in secretions from a sore.
If detected within one year of infection, syphilis is easily treated with penicillin injections, or with antibiotics in pill form for people allergic to penicillin. If syphilis is detected later than one year after infection, longer courses of treatment are needed. HIV positive individuals may require a longer course of medication to ensure the success of treatment.
Some people who are treated with penicillin injections for early syphilis may experience fever, muscle aches, chills, and/or headache. This is known as a “Jarisch-Herxheimer” reaction. This reaction may begin four to six hours after treatment and may last for up to 24 hours. The reaction may be quite severe and is not due to an allergy to penicillin. The symptoms can be treated with acetaminophen or Ibuprofen. If you experience this reaction, please call the clinic the following day.
After the injections, you should have a seat in the waiting room for 15 minutes in case you have an allergic reaction to the penicillin (hives, difficulty breathing, and/or swelling of the face or mouth). The risk of developing a severe allergic reaction is extremely rare. Even if you have had these injections in the past without any problems, you should still remain in the clinic for 15 minutes.
Your sexual partner(s) need to be told that they may have been exposed to syphilis and should be tested. Your healthcare provider will ask you to inform all partners of the last three, six, or 12 months depending on the stage of your infection.
You should not have sexual contact during treatment, two weeks following treatment and/or until all symptoms disappear.
Follow-up blood tests for syphilis are very important as they determine if treatment was effective or if you need further treatment. You will be asked to return for follow-up testing over the next year to confirm that the infection is gone.
It is strongly suggested that persons who test positive for syphilis also consider HIV testing.
Using condoms or dental dams can prevent syphilis transmission as long as the sore is covered.