Syphilis, a sexually transmitted disease (or STD), is on the rise. According to the Centers for Disease Control and Prevention (CDC), the primary and secondary syphilis rate in the US from 2015 to 2016 was the highest it had been in more than 20 years. There was a 74% increase in the total number of primary and secondary syphilis cases in 2016 compared with 2012. Syphilis rates rose in both men (specifically among gay, bisexual, and other men who have sex with men) and women, and in all racial and ethnic groups. Syphilis can be cured if detected and treated early. Without treatment, it can lead to a number of serious complications. Read on to learn more.
What is syphilis and how can you get it?
Syphilis is a contagious STD caused by bacteria that can cause serious complications. Syphilis is spread by having direct contact with a syphilis sore (also called a chancre) during vaginal, anal, or oral sex. The sores can occur on or around the penis, vagina, and anus. They can also appear on the lips, in the mouth, or in the rectum. In the early stages, the sores are usually painless, so people with syphilis may not notice them or know they have syphilis.
Pregnant women with syphilis can pass the infection to their unborn baby during pregnancy or childbirth.
Who can get syphilis and who should be tested?
The fact is, any sexually active person who has sex (vaginally, anally, or orally) can get syphilis. Some people should be tested for syphilis even if they don’t have symptoms or haven’t had a sexual partner who was diagnosed with syphilis. Be sure to talk with your healthcare provider about your risk factors and whether you should get tested.
If you have (or have had) a sexual partner who has been diagnosed with syphilis, or if you or your partner experiences any symptoms of syphilis, you should get tested.
Those who should get tested for syphilis include:
- Sexually active men who have sex with men.
- People who are HIV positive and are sexually active.
- People who are taking pre-exposure prophylaxis (PrEP) for protection from HIV.
- Women who are pregnant. Pregnant women should get tested for syphilis at their first prenatal visit. Women who are at high risk for getting syphilis, live in areas where the syphilis rate is high, have not been tested for syphilis, or who tested positive for syphilis during the first trimester should be screened during the third trimester (28 to 32 weeks) and again at the time of delivery.
What are the signs and symptoms?
Syphilis is divided into stages: primary, secondary, latent, and tertiary.
Primary: The appearance of one or more sores where syphilis entered the body marks the primary (first) stage of syphilis. The sore:
- Is usually firm to the touch, round, and painless.
- Can be in areas of the body where they are hard to notice, such as the vagina or anus.
- Lasts about 3 to 6 weeks and then goes away, even if not treated. However, you still need treatment even if the sore has gone away. If not treated, the infection will move on to the next stage and can still be spread to a partner.
Secondary: The second stage can start while the sore that appeared in the primary stage is healing or a few weeks after it has healed. You may have skin rashes and/or lesions. A rash (usually non-itchy) may appear as red or reddish-brown spots on the palms of hands or bottom of feet. Lesions are sores that may develop in the mouth, vagina, or anus. The rash can be so faint that it is hard to see or it may look like a rash caused by another disease.
Other symptoms may include: swollen lymph glands, fever, patchy hair loss, sore throat, weight loss, tiredness, muscle aches, headaches.
If no treatment is received, the infection will progress to the later stages.
Latent: This is the stage where the infection is inactive or dormant in the body. In this stage, people with untreated syphilis can go for years without experiencing any symptoms. You still need treatment in order to get rid of the infection from the body.
Tertiary: In this stage, untreated syphilis can damage your organs, including your heart, blood vessels, brain, nerves, eyes, liver, bones and joints. It can even lead to death. This stage can happen 10 to 30 years after the initial infection.
Keep in mind that at any of the stages mentioned above, syphilis can spread to the nervous system (neurosyphilis), or eyes (ocular syphilis). If this happens, syphilis can cause headache, unusual behavior, coordination problems, paralysis, dementia, vision changes and permanent blindness.
Syphilis in pregnant women
Pregnant women should get tested for syphilis at their first prenatal visit. Women who are at high risk for getting syphilis, live in an areas where the syphilis rate is high, have not been tested for syphilis, or who tested positive for syphilis during the first trimester should be screened during the third trimester (28 to 32 weeks) and again at the time of delivery.
Without treatment, syphilis can cause complications for the unborn baby during and after pregnancy. These include:
- Miscarriage, giving birth to a stillborn baby, or having a baby who dies soon after being born.
- Passing the infection to the baby, which can lead to permanent delays in development, seizures, and sometimes death if the baby is not treated immediately. Babies may develop other health problems such as fever, skin sores, and swelling in the liver and spleen.
Talk with your healthcare provider about what is best for you and your unborn baby.
How is syphilis diagnosed?
Syphilis is usually diagnosed with a simple blood test. If a sore is present, your healthcare provider may test fluid from it.
Keep in mind that getting tested is the only way to know for sure if you have syphilis. A person with syphilis may not even realize that he or she is infected because the signs and symptoms can be mild during the primary and secondary stages—and there are no signs or symptoms during the latent stage. What’s more, the signs and symptoms of syphilis may look like those of many other diseases. Be sure to talk with your healthcare provider about your risk factors for syphilis and whether you should get tested.
How is syphilis treated and managed?
Syphilis can be treated with an antibiotic. While treatment with an antibiotic is usually effective, any damage that was caused by the infection before treatment cannot be undone.
You should not have sex during treatment. Tell your partner that you are being treated for syphilis. Your partner should be tested for infection as well. And get retested after your treatment is complete. You may be tested during treatment to ensure that it is working.
Get tested for HIV. Genital syphilis sores can also make it easier to get and spread HIV infection sexually.
Getting treatment doesn’t prevent syphilis in the future
“Unless you’re in a one-on-one, committed relationship with a person who you know for a fact through testing doesn’t have syphilis, you are at risk for being infected if you are sexually active. And people shouldn’t make the mistake of thinking they’re safe just because they were treated successfully for syphilis in the past. The fact is, they can get syphilis again, so they need to get tested regularly.”
Mary Baker, PharmD, MBA, Medical Director at Pfizer Inc.
Can syphilis be prevented?
The only way to prevent getting syphilis (or any other STD) is by not having vaginal, anal, or oral sex. If you are sexually active, you can lower the risk of contracting syphilis by:
- Using a latex condom every time you have sex.
- Being in a long-term relationship with one person who has been tested for syphilis and does not have the infection.
Medically reviewed by Mary Baker, PharmD, MBA, Medical Director at Pfizer Inc.
- 1. Centers for Disease Control and Prevention. Syphilis. Accessed June 28, 2018.
- 2. Centers for Disease Control and Prevention. Syphilis—CDC Fact Sheet (Detailed). Accessed June 25, 2018.
- 3. Centers for Disease Control and Prevention. Syphilis—CDC Fact Sheet. Accessed June 25, 2018.
- 4. The American College of Obstetricians and Gynecologists. Frequently Asked Questions: FAQ071 Gynecologic Problems. Chlamydia, Gonorrhea, and Syphilis. Accessed June 25, 2018.
- 5. U.S. Department of Health & Human Services. Office on Women's Health. WomensHealth.gov. Syphilis. Accessed June 12, 2018.