“The Old STI That’s Making A Huge Comeback”
Information, Pictures, Signs & Symptoms of Syphilis
A Copyright Extract From
What’s on the radar about Syphilis these days?
What is syphilis?
Syphilis is a serious sexually acquired infection.
Some people call it a bacterial infection, while others call it a parasitic one.
In clinic settings, syphilis may be referred to as T.pallidum.
The old nickname for syphilis is ‘the pox’.
Syphilis is also called ‘the great imitator’ because it provokes many possible symptoms, similar to those of so many other diseases.
Where does syphilis come from?
Syphilis is caused by the spirochaete (pronounced spi-ro-keet) or spiral-shaped bacterium called Treponema pallidum, sub species pallidum.
Syphilis was first recognised in 1494 when Christopher Columbus’s sailors returned from discovering ‘The New World’, now called America.
It was named in 1530 by a physician called Fracastoro who wrote a poem entitled, “Syphilis”.
But, it wasn’t until 1905 that a research scientist, called Fritz Schaudinn, discovered the bacterium called Treponema pallidum to be the cause of syphilis.
How common is syphilis?
In 1999, the World Health Organisation estimated that syphilis affects over 12 million people worldwide, each year.
However, that figure, which equates to approximately 23 people becoming infected with syphilis every single minute of every single day around the world, is likely to be MUCH higher, today.
Where is syphilis found in the body?
Syphilis usually presents as a painless, sore looking area, on the skin in the genital area. But it can be found in any part of the body.
Can syphilis be cured?
Yes. Syphilis can usually be completely cured if it is detected in the first two stages.
However, treatment is becoming more difficult for individuals who also have HIV infection.
Treatment cannot undo the damage that has already occurred to the body, but further damage can be halted.
Left untreated — syphilis kills.
Do any other infections present in a similar way?
Yes. Chancroid, Donovanosis, Herpes, Yaws and Pinta all present in a similar way.
For more information about each of these, see the relevant section by name.
What is the chance of catching syphilis from a single act of unprotected sex with an infected person?
There is approximately a 30 per cent risk of a woman becoming infected with syphilis by a man and approximately a 20 per cent of a man becoming infected with syphilis by a woman following a single act of unprotected sex.
How is syphilis passed on?
Syphilis is mainly acquired sexually.
Can syphilis be transmitted any other way than by having sex with an infected person?
Yes. Syphilis can also be transmitted by:
* a mother to her baby during pregnancy;
* kissing or touching lesions on the lips or mouth of an infected person;
* skin-to-skin contact — shaking hands or touching the peeling skin or rash of an infected person through which they ooze infectious spirochaetes;
* sharing contaminated drug injecting equipment;
* sharing fresh, unscreened blood products used for transfusion (rare, today).
How long does syphilis survive outside the human body?
The syphilis spirochaete needs its host for survival, so it dies quickly in the open air.
Can syphilis be transmitted to anywhere other than the genital area?
Yes. Syphilis can easily be transmitted to the moist mucous membrane of the mouth, or any other part of the skin, with which it has contact.
Can I really pass syphilis to my partner without knowing that I even have it?
Yes. You can pass syphilis to your partner without knowing that you carry it.
It is highly contagious during the first two years.
Could I catch syphilis from a toilet seat?
No. You cannot catch syphilis from a toilet seat.
What about sharing sex toys, towels or other intimate objects?
Sharing used, unwashed sex toys with your partner could transmit syphilis. For reasons of general hygiene, it is not wise to share unwashed towels or other intimate objects with another person.
Syphilis is either acquired (gained somehow) or congenital (someone is born with it).
Syphilis develops in different stages.
Acquired syphilis is classified as being either:
* early latent or less than two years’ duration;
* late / late latent, of more than two years’ duration;
* tertiary or third stage syphilis.
Congenital syphilis is classified as:
* early — when diagnosed within the first two years of life;
* or late congenital — which presents after two years of age.
How long does syphilis take to show?
The symptoms of syphilis usually appear from nine to 90 days, which is roughly one week to three months after acquisition (being acquired or transmitted).
What might I notice if I have syphilis?
FIRST stage or primary syphilis is commonly indicated by the appearance of a small red spot at the site of infection, which loses its surface area, leaving an ulcer — called a chancre.
The chancre is usually round and painless, with a clean indurated or hardened surface, which commonly feels like a button felt through a jumper.
Left untreated, the ulcer can grow to about two centimetres (one inch) and then, in four to eight weeks, slowly heal itself.
There is unlikely to be a scar, but the surrounding area is likely to be swollen and there may be enlargement of the glands in the groin and other areas.
However, there can also be multiple, painful purulent (pus filled) sores in non-genital areas of the body, that destroy tissue.
These may be in the mouth or, in men, on the glans penis as a form of balanitis (inflammation of the glans penis) called ‘balanitis of Follman’.
Rarely, however, syphilis may occur alongside herpes, which is usually painful. So it’s important to ‘think syphilis’ and rule it out when encountering any genital ulcerative disease (GUD).
Another infection, called Chancroid, which presents as a sore in a similar way, should also be ruled out of the diagnostic equation. (see Chancroid)
SECOND stage syphilis
Usually, the second stage of syphilis occurs within two years of infection, when there may be one or more of the following:
* a maculopapular rash on the body — in particular, on the palms of the hands, soles of the feet and on the chest or trunk (macules are small, flat discoloured spots that appear on the surface of the skin; and papules are small, raised bumps or pimples);
* generalised lymphadenopathy (bubo or enlargement of the lymph glands) — which commonly occurs in the groin, under the arms or in the neck;
* although rare, there may be patchy syphilitic alopecia (loss of head hair), with which hair falls out in patches;
* condylomata lata or syphilitic warts may occur.
These highly infectious growths are typically found in warm moist areas of the body and often have a wart-like appearance. They are painless unless they are additionally infected.
Left untreated, syphilis causes a chronic inflammatory condition that affects many organs, including syphilitic hepatitis or inflammation of the liver caused by syphilis (different from viral hepatitis).
Mucocutaneous lesions (moist wet areas of the body may become ulcerated). These mucosal ulcerations or patches, also called snail-track ulcers, appear on mucous membranes around the body such as across the genital area or in the mouth.
There may be fever, tiredness, loss of appetite, weight loss, anaemia (a blood disorder), decreased vision, dizziness, headache, and/or mild weakness.
NOTE: Even in early-stage syphilis, treponemes can invade the brain – and some people with HIV infection develop neurosyphilis quite quickly if their treatment fails.
Amongst pregnant women with untreated early syphilis, 70 — 100 per cent of infants will be infected or have congenital syphilis.
This is why all pregnant women should be screened for syphilis and treated quickly if they have it, to protect the baby.
Left untreated, three out of 10 babies born to pregnant women infected with syphilis are likely to be stillborn (born dead).
Latent and late latent syphilis
Latent syphilis may be defined as infection where there is no clinical evidence of treponemal infection within two years of becoming infected.
In other words, there were no signs or symptoms to indicate that syphilis is present, yet it has been diagnosed via a blood sample.
After this, it is called late latent syphilis where the Treponema pallidum bacterium can lie dormant without causing any obvious symptoms.
THIRD stage – tertiary or symptomatic late stage syphilis
Usually defined as infection with Treponema pallidum (syphilis) of three to 30+ years duration, extensive signs and symptoms of which need ongoing monitoring and assessment.
If syphilis is not detected until the THIRD stage (tertiary syphilis), what might be noticed?
With tertiary syphilis any of the following conditions may occur:
* asymptomatic neuro syphilis is when there are no signs or symptoms of disease but on examination, there is abnormal cerebrospinal fluid i.e. the fluid that surrounds the spinal cord, also called CSF;
* symptomatic neurosyphilis consists of a number of neurological syndromes (group of conditions), usually due to direct central nervous system
infection by Treponema pallidum; most commonly ‘Tabes dorsalis’, a slow and degenerative condition of the nerve fibres that take signals to the
brain, causing GPI (general paralysis of the insane).
Features of GPI include:
* dementia, with which there is loss of recent memory;
* loss of insight or specific understanding;
* euphoria (a mental state of great well-being);
* delusions of grandeur (believing oneself to be greater and more powerful than reality);
* tremor (shaking);
* lower limb paralysis (inability to move the legs);
* shooting pains (sudden pains along a nerve pathway);
* loss of sensation (loss of touch sensation, smell, etc) — convulsions and loss of muscle coordination (fits, with which muscles contract and relax uncontrollably, with loss of muscle control);
* incontinence of urine (inability to control the bladder);
* severe weight loss, from disturbed digestion;
* and ultimately, becoming bedridden and unable to care for oneself.
NOTE: In old age, because syphilis can cause dementia, elderly patients with this condition may be screened for syphilis to try and determine an underlying cause.
Syphilis may cause endarteritis or inflammation of the inside of the arteries (artery lining).
Arteries are the blood vessels that carry oxygenated blood around the body, away from the heart.
Cardiovascular syphilis usually occurs after a latent or inactive period of 10-30 or more years and is characterised by aortitis (inflammation of the aorta).
The aorta is the main coronary (heart) the blood vessel that supplies oxygenated blood to the circulatory system.
Endarteritis can cause narrowing of the coronary (heart) arteries, which may then cause angina (heart pain), heart failure and/an aneurysm (a blood filled bulge in an artery, which causes the walls to balloon and perhaps burst), leading to major internal haemorrhage (bleeding) or even death.
Gummata are growths of pink, fleshy tissue containing Treponema pallidum (syphilis organism) that usually affect the bones and skin but can affect other organs and should, ideally, be monitored carefully by a doctor specialising in that particular part of the body.
Congenital syphilis means it was present at birth, passed from the mother to her baby during pregnancy. It may present soon after birth or later in life and can appear as a wide range of features.
Syphilis can be confused with so many other medical problems that when dealing with a sick child paediatricians (children’s doctors) commonly ‘rule syphilis out’ using a simple blood test before going further with their checklist of potential diagnoses.
What complications can happen if syphilis is not treated?
Syphilis remains highly infectious for two years after transmission.
Left untreated, as for the stages mentioned above, syphilis can affect the heart, eyesight (causing blindness) and/or hearing (causing deafness).
It can affect the brain, causing problems throughout the nervous system.
if it affects the spinal cord it can cause paralysis, called GPI or general paralysis of the insane.
Syphilis can also affect the memory and precipitate mental health
problems such as the distressing condition, dementia.
It can also affect bones, joints, or indeed, almost every other part of the body.
It can physically and mentally destroy the person and for some, when left untreated, syphilis can kill.
Can syphilis cause infertility?
No. Unlike other bacterial infections such as chlamydia or gonorrhoea, syphilis is not linked to infertility.
Does syphilis affect the baby if a woman has it when she’s pregnant?
Yes. Syphilis can seriously affect the baby. Because it is vulnerable to infection after the 16th week of gestation, good ante-natal care is vital to protect the baby.
In the UK and most developed countries, pregnant women are routinely tested for syphilis. if it is found, the mother can be treated and the baby protected.
Left untreated, the baby could be deformed, damaged or die.
What tests are there to check if I’ve got syphilis?
Special syphilis antibody blood tests can be undertaken approximately four to six weeks after infection, even though symptoms may show any time from two to 12 weeks after exposure.
Syphilis blood tests include:
* VDRL (Venereal Disease Research Laboratory) test;
* RPR (Rapid Plasma Reagin);
* Wassermann reaction (WR),
* Treponemal pallidum particle agglutination (TPHA); and
* TPA (Treponema pallidum antibody) tests.
The chancre, seen in primary or secondary syphilitic lesions, can be swabbed or scraped for analysis.The sample is viewed under a ‘dark ground’ microscope in some clinical settings; direct fluorescent antibody testing and nucleic acid amplification tests (NAATs), or the sample can be sent to a specialist laboratory for analysis by PCR (polymerase chain reaction).
Depending on symptoms, a lumbar puncture or spinal tap may be undertaken, to test the CS* (cerebro-spinal fluid / fluid surrounding the spinal column) for exposure to syphilis.
NOTE: since it can take up to three months for blood tests to appear positive after infection, some people are asked to return for further testing. All patients with syphilis should be offered screening for other sexually acquired infections, including HIV.
When is it sensible to be checked for STIs?
It’s sensible to be checked for STIs if:
* you suspect you may have been put at risk at any time or if you have symptoms that make you think you may have an infection;
* you have had sex with a new partner, especially in the last three to six months;
* you, or your partner, have sex with anyone else;
* your partner tells you they have been diagnosed with a sexual infection or a previous partner of theirs asks them to be tested or treated for a sexual infection;
* you are planning to become or are pregnant and want to know that you don’t have an infection that could be passed to the baby;
* you know you have one sexual infection and want to know you don’t have any more.
Where can I be tested for syphilis?
If you are worried about having an SAI or want more information about them, you can talk to:
* your local sexual health or genito-urinary medicine (GUM) clinics, which will be able to test you on site;
* depending on which country you are in, staff at your local family planning clinic may be able to help;
* your family doctor or the practice nurse at your usual surgery may be equipped to take samples;
* or, if you are stuck, you can phone your nearest hospital and they will be able to give you advice and opening times of clinic sessions.
How soon after unprotected sex can I be tested for syphilis?
Although incubation of syphilis can take up to 90 days, you can be tested at any time if you have symptoms.
Without symptoms you may not get a definitive answer unless you wait approximately six weeks from the time of suspected exposure.
This delay gives any transmitted treponemes time to multiply sufficiently for reliable analysis.
At any time, however, you could have a ‘base test’ performed, to check your current status.
How accurate are the tests for syphilis?
Tests for syphilis are extremely accurate.
Can the test show how long I’ve had syphilis?
No. The test for syphilis does not indicate how long an infection has been present.
However, if you have had a negative test in the past and you receive a positive result now, it is logical to assume transmission in that time period. Clinical signs or symptoms may give a better indication, in some cases.
NOTE: if you have had Bejel, Pinta or Yaws in the past, your test for syphilis will appear positive but your healthcare professional will discuss this with you. (see Bejal, Pinta, Yaws)
If I have syphilis, should I have tests for other sexual infections, too?
Yes. You should definitely be screened for all other sexual infections if you have syphilis. Sexual infections tend to ‘hunt in packs’ (co-exist or travel together) making the presence of another infection quite possible.
Is there a link between syphilis and HIV infection?
Yes. There is an association between syphilis and both HIV transmission and acquisition.
When syphilis is present in the body an inflammatory reaction occurs, which causes vulnerability to further infection.
If I have syphilis, should I have an HIV test?
Yes. Most DEFINITELY if you have syphilis you should have an HIV test. They are both contracted the same way sexually and infections are often found together.
Furthermore, having one sexual infection puts you at a tenfold higher risk of contracting another. So, for peace of mind, get tested for HIV.
Have a baseline test done if you have recently had unprotected sex with a new partner, followed by a confirmatory test in three months’ time.
Do I need to be tested after treatment, to make sure I’ve been cured of syphilis?
Yes. You will be closely monitored after treatment for syphilis. Your blood will always show that you have had syphilis (or Bejel, Pinta or Yaws).
How much does the syphilis test cost?
Depending on where in the world you are, in the interest of public health, tests for STIs, including syphilis, are usually free or of minimal charge.
If, however, you are seen privately, charges vary according to tests taken and laboratory used for analysis.
What treatment is there if I’ve got syphilis?
The standard treatment for syphilis is a course of antibiotics given by injection, although tablets may be given to some people.
You must complete the full course. if you don’t, the infection may return and you may become resistant to the treatment used to treat it.
When you’ve finished the treatment, you will be asked to return to the clinic treating you and various tests will be repeated to check that it has worked.
This is particularly important because syphilis is becoming resistant to treatment.
Doctors have noticed that several men with HIV infection, who also have syphilis, have not responded to standard treatment and new regimens are being investigated.
Treatment failure has obvious implications for public as well as personal health.
Can syphilis go away without treatment?
No. Syphilis does not go away without treatment. It stops being infectious to other people after two years, but then starts to do potentially serious internal harm to its host.
What should I do after I finish the treatment for syphilis?
After treatment, make sure you use protection each and every time you have sex and that you attend for follow-up appointments as advised.
Will my partner(s) need to be treated, too?
Yes. Your partner will need to be seen, tested and treated as appropriate.
Syphilis is HIGHLY contagious.
If I am using a hormonal method of contraception, will the treatment interfere with my contraceptive protection?
Some types of antibiotic treatment interacts with combined hormonal methods of contraception, so although it is not always necessary, to be safe any time you are given medication, check with the person prescribing it or your local pharmacist about drug interactions.
In practical terms, it is usually easier to assume that any pharmaceutical or herbal medication, especially St John’s Wort (a herbal antidepressant), interacts with your medication until you are told otherwise.
Check with the person treating you, but continue using your contraception normally and avoid sex for the duration of treatment and for seven days afterwards — or longer if your partner is treated after you.
Can a man catch syphilis if he has sex with other men or a women with other women?
Yes. Men or women having sex or intimate contact with either another man or woman, who has the infection, are at high risk of contracting syphilis and must be tested and treated accordingly.
Because syphilis can be passed during close contact with an infected person, children of people, who have syphilis should also be tested and treated as required.
How can I avoid catching syphilis?
To avoid syphilis and other sexual infections, although it’s not always easy, don’t let anyone coerce you in to having sex.
Take time to get to know your partner, be sure you really want to have sex with them and use a condom every time.
Check the routes of transmission, above, and avoid what you reasonably can, of these.
See the section on Safer Sex.
Is there a vaccination against syphilis?
No. There is no vaccination against syphilis. Anyone can acquire it.
Can I become immune to syphilis or can I catch it again?
No. The body does not develop immunity to syphilis. It can be contracted more than once.
If I get syphilis again, will it present in a similar way?
Yes. if you had symptoms, syphilis is likely to present in a similar way if you encounter it again, but it could be asymptomatic (not have symptoms) next time, too.
Will I need to have any further tests after treatment for syphilis?
Yes. You will need further tests after treatment for syphilis.
Your doctor may advise that you are re-tested after three, six and 12 months following treatment for primary or secondary syphilis.
Latent syphilis may be followed up after treatment with blood tests for two years.
People, who are infected with syphilis and also have HIV infection, should be retested every three months, for two years.
Can syphilis come back after treatment?
No. After syphilis has been successfully treated, it won’t come back unless you become re-infected.
NOTE: Be aware that if you are asked to have blood tests in the future, for example, for immigration purposes, the test for syphilis will appear positive.
So, when travelling, it may be sensible to carry a certificate from your clinic or doctor, stating that you have been fully treated for syphilis, explaining the treatment regimen that you have had and when this was given.
If you don’t have this type of evidence, you may be asked to take another course of treatment.
If you have had Yaws, it would also be wise to carry a certificate or doctor’s letter explaining your medical history. (See Bejel, Pinta and Yaws)
How soon can I have sex after treatment for syphilis?
After treatment for syphilis, be guided by the doctor treating you about when you are safe to have sex again.
It is sensible not to have sex until all/any lesions have fully healed and until your partner has also been treated and advised they can resume sexual activity, too.
Can syphilis be transmitted through mutual masturbation/foreplay?
Yes. Syphilis can be transmitted if the person you share mutual masturbation/foreplay with has the infection, especially if you are in close contact with any infectious lesions, sores or even the syphilitic rash without protection.
What about oral sex, anal sex and syphilis?
Syphilis, which thrives in warm moist areas of the body, can be passed very easily during the giving or receiving of unprotected oral, vaginal or anal sex.
Can I catch syphilis if I share drugs?
Yes. In the same way that HIV and Hepatitis B and C can be passed when sharing drug injecting equipment with someone who has them. Second stage syphilis can be passed the same way.
Can a child get syphilis?
Yes. Syphilis can be passed to children. if the mother is infected it is initially passed from mother to baby during pregnancy.
Child protection is paramount, and when a child is found to have syphilis, healthcare professionals have a duty of care to the child.
The presence of syphilis in anyone older than a newborn baby should raise concerns about possible sexual abuse or sexual activity, and the young person should be cared for appropriately.
Is there a link between syphilis and cervical cancer?
No. Syphilis is not associated with cervical cancer.
What about using condoms and syphilis?
Condoms can certainly help to prevent syphilis. They are the only method to protect against pregnancy and sexual infection. But they must be used consistently and correctly each time they are required.
Remember, though, that a condom can only protect the area it covers or is in contact with, not other areas.
See the section on Condoms.
Other interesting things…
Syphilis lives up to 48 hrs in concentrated blood bank supplies — but it is a fragile micro-organism that dies quickly in the open air and cannot live outside its host, the human body.
Can I catch syphilis if I share the same bath with someone who has it?
No. Syphilis is not transmitted when using the same toilet, bathtub, clothing or clean tableware as an infected person.
REMEMBER: Once acquired, Syphilis is HIGHLY INFECTIOUS for the first TWO YEARS
Pictures of syphilis in different stages of disease
Pictures of Primary Syphilis:
Photos of Second Stage Syphilis:
Images of Tertiary Syphilis
Pictures Of People With Syphilis
Example Information Pages Throughout This Site