Syphilis

Syphilis is a sexually transmitted infection caused by bacteria. 

It can be serious if it's left untreated or passed on to a baby during pregnancy or childbirth.

The number of people getting syphilis in Scotland has greatly increased over the last five years. You could be at higher risk if:

• you are a man who has sex with men
• you have had sex overseas
• you have had multiple sexual partners

How do I get syphilis?

Syphilis is usually spread by contact between moist skin areas anywhere on or inside the body. Some of the ways you can catch it include:

• Unprotected vaginal, anal or oral sex (without a condom)
• Mutual masturbation 
• Kissing or licking the anus
• Sharing sex toys that aren't washed or covered with a new condom each time they're used
• Your genitals coming into contact with your partner's genitals – this means you can get syphilis from someone even if there is no penetration, orgasm or ejaculation
• Infected semen or vaginal fluid getting into your eyes

It can also be passed to a baby during pregnancy or childbirth.

Syphilis also makes HIV easier to pass on and catch.

Symptoms of syphilis

Many people with syphilis will not notice any symptoms either at the time of infection or later.

Syphilis usually has three stages.

The first stage (primary syphilis)

Ten days to three months after infection, a small, painless sore or ulcer will appear on the part of your body where the infection was transmitted. This is typically on the penis, vagina, anus, rectum, tongue or lips.

Most people only have one sore, but some people have more.

The sore will then disappear within two to six weeks and, if the condition is not treated, syphilis will move into its second stage.

Swelling in your lymph glands (such as in the neck, groin or armpit) often happens with the ulcers.

The second stage (secondary syphilis)

The symptoms of secondary syphilis will begin a few weeks after the disappearance of the sore. At this stage common symptoms include:

• a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet
• tiredness
• headaches
• swollen lymph glands

Less common symptoms include:

• fever
• weight loss
• patchy hair loss
• joint pains

These symptoms may disappear within a few weeks, or come and go over a period of months.

Syphilis will then move into a stage where you will experience no symptoms, even though you remain infected. This is called ‘latent syphilis’. You can still pass it on during the first year of this stage. However, after a couple of years, you can't pass the infection to others, even though you remain infected.

The latent stage can continue for many years (even decades) after you first become infected. Without treatment, there is a risk that latent syphilis will move on to the most dangerous stage – tertiary syphilis.

The third stage (tertiary syphilis)

The symptoms of tertiary syphilis can begin years or even decades after initial infection. Up to one in three (10-30%) people who are not treated for syphilis develop serious symptoms eventually.

The symptoms of tertiary syphilis will depend on what part of the body the infection spreads to. For example, it may affect the brain, nerves, eyes, heart, bones, skin or blood vessels, potentially causing any of the following symptoms:

• Stroke
• Dementia
• Loss of co-ordination
• Numbness
• Paralysis
• Blindness
• Deafness
• Heart disease
• Skin rashes

At this stage, syphilis can be dangerous enough to cause death.

Testing for syphilis

If you think you may have syphilis, you should make an appointment with your GP or local sexual health services.

The only reliable way to tell if you have syphilis or not, is to have a blood test. This is usually sent to the lab, however in some sexual health services a same day test can be done if you have symptoms.

In the very early stage of the infection, syphilis in an ulcer can be seen if a swab is taken from the ulcer and looked at under a microscope or sent to the laboratory for syphilis detection. These tests are only available in some sexual health services.

Treatment for syphilis

Early syphilis infections can be easily treated with antibiotics (usually penicillin), even during pregnancy.

In late stage syphilis infections, treatment at any time can stop further illness and cure the infection itself, though it does not repair any damaged organs.

Treatment is usually given by injection and may involve one or more doses, depending on the stage of the infection. In some cases tablet treatment may be offered.

Once the treatment has finished, further blood tests are carried out to make sure the infection has gone. These tests may be required at intervals for up to a year.

Avoiding passing on syphilis to a partner

While you are being treated and until you get a clear test result you should:

• not have any kind of sex
• avoid intimate contact with your partner and others

This will stop you from infecting your partner if they're clear, and stop you being re-infected if they also have syphilis.

Your partner should also get tested for syphilis. It can be hard to spot in it's early stages and they might not realise they have it. They will generally be offered treatment regardless.

Syphilis and pregnancy

Syphilis can be passed to a baby during pregnancy and childbirth. Syphilis testing in pregnancy is offered universally.

It can be successfully treated during pregnancy with a course of antibiotics. The treatment does not harm the unborn baby.

If syphilis is left untreated during pregnancy it can cause serious birth defects, miscarriages or stillbirths.

Reducing the risk of syphilis

The best way to prevent all sexually transmitted infections is to practice safer sex. This means using a condom for vaginal, anal or oral sex.

Other STI's

If you have been diagnosed with syphilis it’s essential you are tested for all STI's including:

• HIV
• chlamydia
• gonorrhoea