Syphilis is known as the “great imitator” because its symptoms can be mistaken for symptoms of many other diseases. Syphilis is passed from person to person through direct contact with a syphilis sore. This contact usually occurs during vaginal, oral, or anal sex with an infected partner because sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Usually, the signs and symptoms of an untreated syphilis infection can help determine the stage of the infection and appropriate treatment. A syphilis infection progresses through stages: primary, secondary, latent, and late.
The average time between infection with syphilis and the start of the first symptoms is 21 days, but can range from 10-90 days.
The appearance of a small, round and painless sore, called a chancre, is the classic symptom of a primary stage syphilis infection. This sore may not be visible depending on its location. Primary syphilis is the most infectious stage.
Symptoms in the secondary stage can overlap with the healing of the primary sore. There can be up to 10 weeks between the disappearance of the sore and the development of secondary symptoms.
The most common secondary symptom is a blotchy skin rash, usually located on the palms of the hands or the soles of the feet, but can also be on other parts of the body. Sometimes the rashes are so faint that they are not noticed. Other symptoms may include:
- mucus membrane lesions (sores in the mouth, vagina, or anus)
- swollen lymph glands
- sore throat
- patchy hair loss
- weight loss
- muscle aches
- fatigue (feeling very tired)
Without the right treatment, your infection will move to the latent and possibly late stages.
Latent and Late Stages
The latent stage of syphilis begins when the primary and secondary symptoms disappear. The infection will still be present but it will not produce any symptoms. If allowed to go untreated for more than a year, syphilis advances to its late stage and can cause damage to the internal organs, such as the eyes, brain, joints, bones, liver, and heart; difficulty coordinating muscle movement; paralysis; gradual blindness; and dementia (memory disorders, or personality changes). An untreated syphilis infection can also result in death.
Syphilis can invade the nervous system at any stage of infection, and causes a wide range of symptoms varying from no symptoms at all, to headache, altered behavior, and movement problems. This invasion of the nervous system is called ‘neurosyphilis’.
Syphilis in Pregnancy
Syphilis can be spread from an infected mother to her unborn baby. Syphilis is less common than other sexually transmitted diseases/sexually transmitted infections (STDs/STIs) but can have severe effects on the developing fetus. The bacteria responsible for syphilis can cross the placenta and infect the fetus at any gestational age. The most common way the infection spreads from mother to fetus is through the placenta, but the newborn can be exposed during delivery if the mother has genital lesions at that time. Effects on the fetus depend upon the stage of syphilis in the mother and the gestational age of the fetus. Risks for transmission can range from 10 percent for late latent syphilis to 100 percent for untreated primary syphilis in the mother. The effects on the fetus include stillbirth and fetal death in 40 percent of affected pregnancies, preterm delivery, low birthweight, blisters on the skin, enlarged liver and spleen, bone and dental abnormalities, joint problems, deafness, and brain damage. Screening and treatment of the mother during pregnancy is critical to reduce transmission rate. Since many infants show no obvious signs of the infection at birth, testing should be done for any infant suspected to be at risk for syphilis.
How do you reduce your risk?
- Abstinence (which means not having ANY vaginal, anal or oral sex)
- Using condoms or dental dams the right way every time you have sex
- Having one un-infected partner who only has sex with you
- Avoiding alcohol or drug use because they may lead to risky sexual behavior
- Talking to your partner(s) about their sexual history
Not having vaginal, anal or oral sex is the most effective way to avoid getting syphilis and other STDs/STIs (including HIV).
Use male latex condoms if you decide to have sex.
Condoms are not 100% effective. But they can help protect against syphilis and other STDs (including HIV). Some STDs can be caused by contact with infected areas not covered by a condom.
- Be sure to use a new latex condom properly for each act of vaginal, anal or oral sex.
- Follow instructions on the label exactly. Check the expiration date.
- Never use latex condoms with oil-based products, such as petroleum jelly and vaginal products that have oil.
If you have a latex allergy you have alternatives, there are polyurethane and polyisoprene male condoms available as well as polyurethane female condoms.
Limit your partners.
To be safer, only have sex with one un-infected partner who does not have sex with anyone else.
Avoid alcohol or drug use because these activities may lead to risky sexual behavior. It is important to talk to your partner about their sexual history.
Washing your genitals, urinating, or douching after sex will not protect you from getting syphilis.
Get tested if you think you or your partner may have syphilis. Ask your partner to get tested, too. Avoid having sex until you are sure neither of you is infected.
Regular screenings are advised for many people. Experts recommend yearly screening for syphilis if you:
- Are a man who has sex with other men
- Have HIV
- Have a sexual partner who has tested positive for syphilis
Screenings are also recommended for pregnant women.
Have an open and honest talk with your healthcare provider so they can assess the testing you may need. He or she may also advise getting tested for other STDs, including HIV.
To test for syphilis a blood sample may be taken or sample of the fluid from a syphilis sore may be taken. Talk with your healthcare provider if you have any questions about testing or your test results.
Because syphilis is a bacterial infection, it can be treated and cured. Although syphilis can be cured at any stage, any damage that has been done cannot be corrected.
Having had syphilis once and being successfully treated does not protect you from getting it again!