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Syphilis has been uncommon since penicillin become widely available in the 1950s,
although global syphilis statistics show that an estimated 12 million new infections still
occur each year.1 2
“The past decade has seen a rise in new cases of the almost forgotten ‘historic disease’
syphilis, particularly in certain risk groups.” - Alexandra Geusau and Stefan Wöhrl,
Medical University of Vienna 3
Syphilis symptoms
Syphilis pictures
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The symptoms of syphilis are the same in men and women. They can be mild and
difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months
to appear after initial infection. Syphilis is a slowly progressing disease that has several
stages. The primary and secondary stages are very infectious.
Primary stage
One or more painless ulcers (know as chancres) appear at the place where the syphilis
bacteria entered the body. On average, this will be 21 days after sexual contact with an
infected person. Chancres may be difficult to notice and are highly infectious. The usual
locations for chancres are:
• On the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
• On the penis in men.
• Around the anus and mouth (both sexes).
If the infection is not treated at this point then it will progress to the secondary stage.
Secondary stage
If the infection has not been treated, the secondary stage will usually occur from 3 to 6
weeks after the appearance of chancres. The symptoms often include:
During this stage syphilis is very infectious and may be sexually transmitted to a partner.
These symptoms will usually clear up within a few weeks, but may re-occur for years.
Treatment at any time during the first two stages of syphilis will cure the infection.
If left untreated, the infection may develop into symptomatic late syphilis, also known as
the tertiary stage. This usually develops after more than 10 years and is often very
serious. It is at this stage that syphilis can affect the heart and possibly the nervous
system.
If treatment for syphilis is given during the latent stage the infection can be cured.
However, any heart or nervous-system damage that occurred before the start of treatment
may be irreversible.
• By having vaginal, anal or oral sex with someone who has the infection.
• From a mother to her unborn baby.
The examinations and tests can be done as soon as a person thinks they might have
become infected with syphilis. If the result is negative then it is usually recommended
that the person retests at a later time, as it can take up to 3 months for the immune system
to produce the antibodies that are detected by the test.
The patient will be asked about their sexual partners as it is important they are informed
and tested as soon as possible. It is strongly advised to avoid any oral, vaginal or anal sex
whilst having treatment, especially if the patient is in the early infectious stages of
syphilis. Contact with any sores or rashes carries a risk of syphilis transmission.
After the treatment is completed the patient will be asked to attend the clinic at regular
intervals for blood tests to check that the syphilis has gone.
Once a person has been treated and confirmed cleared of syphilis, any future blood tests
(e.g. for immigration reasons) will still be positive, because the body retains antibodies
against the bacteria. Doctors can give the person a certificate explaining that they have
been treated and no longer have syphilis.
Treatment is only capable of killing the syphilis bacteria and preventing further damage.
It cannot repair damage already done to organs, or prevent re-infection if the person is
exposed to the bacteria again.
Prevention
Although using a condom reduces the chances of becoming infected with syphilis, it is
not entirely effective. A condom may not cover all of the sores or rashes in the affected
areas, and direct skin contact may result in transmission.
If a person has sex regularly with multiple partners, then it is advisable for them to get
frequent STD check-ups.
A person can become re-infected with syphilis even if they have had effective treatment
for a previous infection: past infection with syphilis does not make a person immune.
Congenital syphilis
Syphilis can infect a baby in the womb if the mother's infection is not treated. This is
know as congenital syphilis. If a baby becomes infected then there is a high risk of
stillbirth or miscarriage.
A newborn baby may not display any obvious symptoms of syphilis, but may develop
serious complications within weeks if the disease is not treated.
In many countries, blood tests for syphilis are given to all pregnant women when they
visit antenatal clinics. Women may also be offered other tests for other STDs, such as an
HIV test when pregnant.
If a woman is found to be infected with syphilis, treatment can safely be given during
pregnancy with no risk to the unborn baby.
Where Next?
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References
1. World Health Organization (2001) 'Global Prevalence and Incidence of Selected
Curable Sexually Transmitted Infections Overview and Estimates'
2. World Health Organization (2007) 'The global elimination of congenital syphilis:
rationale and strategy for action'
3. Wohrl S. and Geusau A. (2007, 9th June) 'Clinical update: syphilis in adults' The
Lancet 369(9577).