Syphilis

Syphilis symptoms are usually mild which may lead to some people ignoring them. The symptoms are similar for AMAB (assigned male at birth) and AFAB (assigned female at birth) people and develop in three stages:

1. The first stage: primary syphilis
2. The second stage: secondary syphilis
3. The third stage: tertiary syphilis

Stage one: primary syphilis

• The first symptom may appear two to four weeks after being exposed to the bacteria (it may be sooner or later).
• This symptom is a small painless sore called a chancre (pronounced ‘shanker’ which means ‘creeping ulcer’).
• The chancre (it is usually just one) will normally appear on the area where the infection entered the body, so the vagina, penis or anus. Sometimes the chancre may appear on your lips, tonsils, hands or buttocks.
• The chancre is painless but highly infectious.
• The sore normally heals and disappears after two to six weeks.
• Some people may ignore the sore or may not even notice it.
• Syphilis can be passed onto other people in this stage.

If left untreated the bacteria can spread to other parts of the body and the infection moves onto the second stage.

Stage two: secondary syphilis

This stage will begin a few weeks after the chancre has disappeared. Even without the chancre, syphilis is still infectious in stage two and can be passed on.

Symptoms may include:

• A non-itchy rash, often on the palms or soles of your feet
• Small flat growths (a bit like warts) around the vagina, penis or anus
• Flu-like symptoms such as headaches, fever, joint pains and tiredness
• Swollen glands in your neck, armpits or groin
• Weight loss
• White patches on the tongue or roof of the mouth
• Patchy hair loss

These symptoms may disappear after a few weeks or can come and go over a period of weeks or months. When the symptoms have disappeared you move into the latent (hidden) phase. This stage can last for years.

If syphilis is not treated it will then move onto its third stage.

Stage three: tertiary stage

It is rare to reach this stage in the UK and of those that do; only a third will experience serious symptoms.

This stage will begin years or even decades after the first infection and the symptoms will depend on where the infection has spread to.

Tertiary stage syphilis can cause life-threatening problems such as:

• skin rashes
• numbness
• paralysis
• loss of coordination
• blindness
• deafness
• stroke
• dementia
• heart disease

By this point, syphilis can be dangerous enough to cause death.

Syphilis is caused by bacteria called treponema pallidum and is easily passed from one person to another through:

• Unprotected vaginal sex
• Unprotected anal sex
• Unprotected oral sex
• Sharing sex toys without washing them or covering them with a condom with each use

Syphilis can also be passed from a parent to their unborn baby but it can be treated during pregnancy. If left untreated it can cause miscarriage or stillbirth. All pregnant people are offered a blood test to check if they have syphilis as part of their antenatal screening during weeks 11-20.

Syphilis can also be passed on if you are an injecting drug user and you share a needle with someone who is infected.

You cannot get syphilis from kissing, hugging, sharing baths or towels, swimming pools, toilet seats or from sharing cups, plates or cutlery.

Order a test online

If you don’t have symptoms of syphilis you can order a test online to complete at home in most areas. This is usually provided by your nearest sexual health service. In some locations you can order a free HIV and syphilis test from freetesting.hiv.

The test you complete at home usually involves collecting a small blood sample in a test tube using a finger prick. Once complete, you then send it back in the post.

If you’ve had unprotected sex, have a test as soon as you can. It’s the only way you can be sure.

It is also possible to buy syphilis self-tests to do at home.

Cervical smear tests and routine blood tests will not detect syphilis.

If you have symptoms

If you have syphilis symptoms then it’s important you go to your nearest sexual health service as soon as possible. Testing is free and you can get this at some Brook services, GUM or sexual health clinics or at some GP surgeries.

1. Examination: Before doing any tests, the doctor or nurse will look for the signs of syphilis. This may include an internal examination of the vagina and possibly of the anus. They may also look in your mouth and throat for skin rashes.
2. Swab test: If you have a chancre then the nurse or doctor may take a swab. The swab looks like a small cotton bud and is used to collect a sample of the fluid from the chancre. Taking the swab should not be painful. This will then be sent to a lab for testing and results are generally available in 7 to 10 days.
3. Blood test: Syphilis can also be confirmed by taking a blood test. When the body’s immune system reacts to syphilis, it produces antibodies (infection-fighting proteins) and the blood test looks for those antibodies.

You will be advised to repeat the blood test after three months. This is because a positive result may detect antibodies from a previous episode that was successfully treated (and therefore you may actually be not have syphilis anymore) and when you do in fact have syphilis, you can get a negative result at first because the antibodies may not be detectable for the first three months after infection.

Syphilis is usually treated with a single antibiotic injection or a course of injections. If you are allergic to penicillin (which is a type of antibiotic) you will be prescribed another type of antibiotic in tablet form.

This treatment is very effective for both first and second stage syphilis and should cure it. Syphilis can also be treated and cured in the latent and third stages but treatment cannot reverse any damage that has already been done to your body.

A few things to note:

• A small number of people will experience flu-like symptoms as a reaction to the antibiotics but this generally only lasts for 24 hours.
• Some of the antibiotics used to treat syphilis can interfere with other medication, including hormonal contraception. It is always a good idea to tell the person prescribing the treatment so they can advise you further.
• Tell the nurse or doctor if you are pregnant or think you may be, or if you are chest or breastfeeding. This will affect the type of antibiotic you are given.
• Treatment for syphilis does not make you immune from getting it again.

If you had symptoms, you should notice improvements quite quickly. You should go back to where you had your test if:

• The symptoms don’t improve within a week
• You have unprotected sex again
• You had unprotected sex with your partner before the treatment was finished
• You did not follow the instructions or complete the treatment
• The test was negative but you develop signs and symptoms of syphilis