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Syphilis

Syphilis is a sexually transmitted infection (STI) caused by a bacteria. It is less common than other STIs but it is on the rise. It develops in three stages but can be cured if treated early.

Here are some key facts:

  • It is a bacterial infection 
  • It can affect anyone who has ever had unprotected sex
  • It is passed on through unprotected vaginal, anal or oral sex, sharing sex toys or genital-to-genital contact
  • It develops in three stages but third stage syphilis is very rare in the UK
  • The first symptom is small, painless sore in the genital or anal area called a chancre
  • Symptoms can progress to include a non-itchy rash on the palms or soles of the feet, small skin growths, flu-like symptoms, swollen glands, weight loss and patchy hair loss
  • If left untreated can cause serious illness and even death
  • Diagnosis usually involves an examination, followed by swabs (if there are sores) and a blood test
  • The only way to protect yourself is to use condoms every time you have sex
  • If caught early, it can be treated with an antibiotic injection (often penicillin) or other forms of antibiotics
  • Statistics for 2014 showed that of all the STIs, syphilis had seen the sharpest rise – with a 33% increase in diagnoses.

You can read about syphilis in more detail below.

Signs and symptoms of syphilis

To start with, the symptoms of syphilis are usually mild which may lead to some people ignoring them. The symptoms are similar for men and women and develop in  three stages:

  • The first stage: primary syphilis
  • The second stage: secondary syphilis
  • The third stage: tertiary syphilis

Stage one: primary syphilis

The first symptoms may appear two to four weeks after you have been exposed to the bacteria, (it may be sooner or later). The first 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  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 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 and most dangerous 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 skin rashes, numbness, and paralysis, loss of coordination, blindness, deafness, stroke, dementia and heart disease. By this point, syphilis can be dangerous enough to cause death. 

The causes and spread of syphilis

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

Unless someone with syphilis is treated, they can pass syphilis on for up to two years after the infection.

Syphilis can also be passed from a mother to her unborn baby but it can be treated during pregnancy. If left untreated it can cause miscarriage or stillbirth. This is why all pregnant women 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 don’t need to have had lots of partners and your partner doesn’t need to have experienced symptoms to pass it on to you.

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

Remember, if you have had unprotected sex, you also need to consider emergency contraception.

Testing for syphilis

Examination: Before doing any tests, the doctor or nurse will start by examining you, to 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 and for skin rashes.

Swab test: If you have a chancre (the sore that appears in stage one) 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 send to a lab for testing and results are generally available in 7 to 10 days.

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 nearly always 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 free from syphilis) 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.

The blood test cannot inform you how long you have had the infection. 

Syphilis testing is free and you can get this at some Brook services, GUM or sexual health clinics or at some GP surgeries. Cervical smear tests and routine blood tests will not detect syphilis.

It is possible to buy syphilis self-tests to do at home but the accuracy of these tests can vary. Some are very accurate if you carefully follow the instructions but others are less reliable. Get advice from your nearest Brook clinic, GUM or sexual health clinic, GP or pharmacy if you’re unsure.

If you’ve had unprotected sex, don’t wait and hope for the best, have a test as soon as you can. It’s the only way you can be sure that you have syphilis or not and left untreated, it can cause serious damage to your body.

Treatment of syphilis

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 often used to treated syphilis) you will probably 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. See your GP or go back to clinic where you were treated if the symptoms are severe and do not settle down
  • 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 breastfeeding. This will affect the type of antibiotic you are given
  • Treatment for syphilis does not make you immune from getting it again

You may be advised to return for another test after three months to ensure you are clear of syphilis.

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

You should also avoid having vaginal, anal or oral sex and any skin contact until you have been given the all-clear, to prevent you being re-infected or passing the infection on.

It is important that you tell your current and any recent sexual partners that you are being treated for syphilis, so that they go for treatment too. In the UK it is recommended you tell any sexual partners you have had over the last six months.

The staff at Brook or sexual health clinics can help if you find it hard to talk to partners  about syphilis. Some clinics may also offer to contact your partner using what’s called a ‘contact slip’. This is to inform them they may have been exposed and to recommend they get tested and it doesn’t mention your name.

Page last reviewed: September 2015
Next review due: September 2017