Syphilis — CDC Fact Sheet

In brief

• Syphilis is a common sexually transmitted infection (STI) that can be cured.
• Anyone who is sexually active can get it.
• Without treatment it can cause serious health problems.

What syphilis is

Syphilis develops in four stages — primary, secondary, latent and tertiary — each with its own signs and symptoms. Babies can get it too: congenital syphilis is the disease that results when a mother passes syphilis to her baby during pregnancy.

The stages

Primary. One or more sores appear where syphilis entered the body — in, on or around the penis, vagina, anus, rectum, lips or mouth. They are usually (not always) firm, round and painless, so they can go unnoticed. A sore usually lasts 3 to 6 weeks and heals with or without treatment — but you still need treatment to stop the infection moving on to the next stage.

Secondary. Skin rashes and sores in the mouth, vagina or anus. It usually starts with a rash — often on the palms or the soles of the feet, rough and red or reddish-brown — as the first sore heals or weeks afterwards. The rash usually does not itch and may be too faint to notice. Other symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue. These go away with or without treatment; without the right treatment, the infection moves into the latent and possibly tertiary stages.

Latent. No visible signs or symptoms. Untreated, syphilis can stay in the body for years.

Tertiary. Most people with untreated syphilis never reach it, but when it happens — 10 to 30 years after infection — it can damage many organs, including the heart and blood vessels and the brain and nervous system, and can kill. Providers usually diagnose it with several tests.

Brain, eyes and ears. At any stage, untreated syphilis can spread to the nervous system (neurosyphilis), the eye (ocular syphilis) or the ear (otosyphilis):

How it spreads

Syphilis spreads through direct contact with a syphilis sore during vaginal, anal or oral sex, and from mother to baby during pregnancy. You cannot get it from toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, or shared clothing or eating utensils.

Who is affected. Syphilis may be more common in some racial and ethnic and sexual minority groups: gay and bisexual men are disproportionately affected, and people from racial and ethnic minority groups are bearing the brunt of the congenital syphilis epidemic — because of social, cultural and economic conditions that make it harder to stay healthy.

HIV. A sore or break in the skin from syphilis can make it easier for HIV to enter the body, and the same behaviours and circumstances raise the risk of both.

Lowering the risk

The only way to completely avoid STIs is not to have vaginal, anal or oral sex. If you are sexually active:

• be in a long-term, mutually monogamous relationship with a partner who has tested negative for syphilis;
• use condoms correctly every time you have sex. Condoms prevent contact with a sore — but sores can occur where a condom does not cover, and contact with those can still spread syphilis.

Talk openly with your health care provider about whether you should be tested for syphilis or other STIs.

Pregnancy

A pregnant person with syphilis can pass it to the baby. Syphilis can lead to low birth weight, early delivery or stillbirth. Babies born with it may show no signs at first, but without prompt treatment can develop serious problems within weeks — cataracts, deafness, seizures — and can die.

All pregnant women should be tested at their first prenatal visit and treated right away if positive; some need testing again in the third trimester, at 28 weeks, and at delivery.

Testing

Get tested regularly if you are sexually active and:

• are a gay or bisexual man;
• have HIV;
• take pre-exposure prophylaxis (PrEP) to prevent HIV;
• have a partner who has tested positive for syphilis;
• have other risk factors, such as living in a community with high rates of syphilis.

Most often a blood test is used; sometimes fluid from a sore is tested.

Treatment

Syphilis is curable with the right antibiotics, though treatment may not undo damage already done.

Having had syphilis does not protect you from getting it again, even after successful treatment. Only lab tests can confirm infection, and follow-up testing is needed to make sure treatment worked. A partner's sores — in the vagina, anus or mouth or under the foreskin — can be hard to see, so you can be reinfected if your partners are not tested and treated.

Sources

• Centers for Disease Control and Prevention, Syphilis – CDC Fact Sheet. Its stock photo collage is left out.