Syphilis

Overview

Syphilis spreads through contact with a syphilis sore during vaginal, anal, or oral sex. It can also pass from a pregnant woman to her baby, which can be very serious.

It has stages. The first sore and the later rash go away on their own, but the infection doesn't. Without treatment, syphilis can stay hidden for years and later damage the brain, nerves, eyes, and heart.

Symptoms

Symptoms depend on the stage, and many people don't notice them.

• A firm, round, painless sore on the genitals, anus, or mouth
• A rough, red or reddish-brown rash on the palms or soles that usually doesn't itch

Less common

• Swollen glands
• Fever, sore throat, and fatigue
• Patchy hair loss
• Headaches and muscle aches
• Sores in the mouth, vagina, or anus
• Vision or hearing changes (if it spreads)

How it usually goes

• About 3 weeks (10 to 90 days): A sore appears and lasts 3 to 6 weeks.
• Weeks to months later: A rash and flu-like symptoms may appear, then go away.
• Years: Hidden stage with no symptoms; later, serious damage can occur.

When to get medical care

Causes

Syphilis is caused by the bacteria Treponema pallidum. It spreads through direct contact with a syphilis sore during sex. A pregnant woman can pass it to her baby.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: sex or mother to baby during pregnancy.
• Condoms lower the risk. Sex partners should be tested and treated too.

Who is more likely to get it

• More than one partner
• Not using condoms
• Having HIV

Possible complications

• HIV: Syphilis raises the risk of getting HIV

Diagnosis

Syphilis is found with a blood test.

Questions you may be asked

• Any sores, even painless ones
• Rashes, especially on your palms or soles
• Recent partners
• Whether you could be pregnant
• Vision, hearing, or nerve problems

The exam

They'll check your skin, mouth, genitals, and lymph nodes.

Tests

Tests include:

• Blood tests: Two kinds of blood tests are used to confirm syphilis and track treatment. They may be negative very early.
• Tests for other STIs: Including HIV, which is often tested at the same time.
• Spinal fluid test: If there are signs it has reached the brain, eyes, or ears.

Treatment

Syphilis is easy to cure with penicillin shots. How many shots depends on how long you've had it.

Self-care

• Get treated even after the sore heals. The infection is still there
• Don't have sex until you're treated and any sores are fully healed
• Make sure your partners are tested and treated
• Get follow-up blood tests to make sure treatment worked

Medicines

Treatment is given by a healthcare professional.

Treatment cures the infection but can't undo damage already done.

Syphilis that has reached the brain, eyes, or ears needs IV penicillin in the hospital. Some people get fever, chills, and aches within a day of treatment; this reaction usually goes away within a day.

How it compares

Prevention

You can lower your risk:

• Use condoms correctly every time (they help when they cover the sore)
• Get tested regularly if you're sexually active; ask how often
• Get tested with new partners
• Every pregnant woman should be tested

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a sexual health clinic, an OB-GYN, or a urologist; your local health department can test for free or low cost.

Back to school, work, or sports

• You can go to school and work as usual.
• Don't have sex until you and your partners finish treatment and your doctor says it's OK.

Children, pregnancy, and older adults

• Pregnancy: Syphilis can cause miscarriage, stillbirth, or serious illness in the baby. Testing and penicillin treatment protect the baby.
• People with HIV: Get tested for syphilis regularly.
• Newborns: Babies born to mothers with syphilis need to be checked and may need treatment.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Syphilis is curable. Early treatment prevents the serious damage of later stages.

Getting ready for your visit

STI visits are private.

What to bring

• When the sore or rash started
• Recent partners
• Whether you could be pregnant
• Any penicillin allergy

Questions to ask

• What stage is it?
• How many shots do I need?
• When will I need blood tests again?
• How do I tell my partners?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Syphilis