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Syphilis

WHAT IS SYPHILIS?

Syphilis is a sexually transmitted infection caused by a bacteria called Treponema pallidum.  It is not as common in Australia as it is in some other countries, but there have been increasing diagnoses recently.

Syphilis is easily treated with antibiotics, but without treatment it can cause serious health problems. It has three stages: primary, secondary, and latent syphilis. 

HOW DO YOU CATCH SYPHILIS?

Syphilis is transmitted through skin to skin contact. You can catch it by having oral, vaginal, or anal sex with someone who has syphilis and it is most infectious when a sore or rash is present. Using a condom for all sexual contact will greatly reduce the risk of transmission.

Syphilis can also be transmitted from mother to unborn baby during pregnancy. This can have very serious effects on the baby.

WHAT ARE THE SYMPTOMS?

About 50% of the time there are no symptoms of syphilis infection. When symptoms do occur they will vary depending on the stage of syphilis.

PRIMARY SYPHILIS

In this stage, there may be no symptoms, but typically a hard, painless sore called a chancre appears about 3-4 weeks after infection (although this can occur between 10 and 90 days after infection).

The sore most often appears on the genitals, however, can occur elsewhere. Because these sores are usually painless they may not be noticed, especially if they in a part of the body not easily seen, for example, the anus, cervix, or mouth. These sores are highly infectious. 

The sores usually clear up after 2-6 weeks but the infection remains in the body if you have not had treatment, and can progress to the next stage. The infection can be passed on to others even if there are no symptoms or if the sore has healed. 

SECONDARY SYPHILIS

Symptoms of secondary syphilis occur about 2-4 months after infection if there has been no treatment. The most common symptom is a painless flat red rash on the chest, back, hands, and feet, including the palms and soles. This rash is highly infectious

There may also be flu-like symptoms, swollen lymph nodes in the groin and armpits, tiredness, hair loss, and a genital rash. These symptoms can come and go for up to two years if you are not treated.

LATENT SYPHILIS

If syphilis is not treated in the primary or secondary stage it then becomes latent. In latent syphilis, there are no symptoms and it is not infectious. If syphilis is diagnosed and treated early in this phase there are usually no problems. However, if it is not treated it can progress to tertiary syphilis in about a third of infected people. Tertiary syphilis can cause serious problems in almost any part of the body, but mainly in the heart and brain, and can be fatal. 

HOW SYPHILIS CAN BE PREVENTED?

Syphilis can be prevented by using condoms correctly every time you have sex, and also by you and your sexual partner/s having regular testing for sexually transmitted infections with early treatment when infection is found.  For useful tips on condom use, check out our condom fact sheet.

HOW DO YOU TEST FOR SYPHILIS?

A blood test looking for antibodies to the Treponema bacteria can diagnose syphilis and is also used to monitor response to treatment.  Sometimes more than one test is needed. If a sore is present swabs can be collected to look for the presence of the bacteria. Blood tests which are done routinely during pregnancy include syphilis testing. 

WHAT IS THE TREATMENT?

Syphilis is treated with penicillin given as an injection. Latent syphilis may require a longer course of treatment then the other stages.  If someone with syphilis has an allergy to penicillin other antibiotic treatment is available.

Some people, especially those with early stages of infection, are likely to experience a flu like illness when they are treated. If this occurs it usually does so within 24 hours after treatment. Symptoms may include fever, headache, sweats, and joint pain. It lasts for several hours and simple supportive treatment of an analgesia such as paracetamol, fluids and rest is usually all that is needed. 

 After treatment sexual contact of any type should be avoided until the rash or chancre has healed, and until at least one week after treatment has finished. Your partner/s may need treatment, and it is important to wait for one week after their treatment before having sexual contact in order to avoid being re-infected.

 Follow up blood testing at 3 and 6 months (and sometimes 12 months) is usually recommended to ensure the treatment has been effective. 

DO I NEED TO LET MY SEXUAL PARTNERS KNOW?

If you have been diagnosed with syphilis all your sexual partners in the last few months need to be told as they will need testing and treatment.  If they do not have treatment they could end up with severe problems and may also re-infect you. You will need to discuss this with your practitioner.

There are websites that you can use to help contact your partners: letthemknow.org.au or thedramadownunder.info

SYPHILIS AND HIV

The presence of syphilis can make HIV transmission more likely and if you have been diagnosed with syphilis you may want to consider using HIV pre-exposure prophylaxis (PrEP) if you are in a risk group.

 Talk to your sexual health doctor about this.  Testing for syphilis and HIV is usually done at the same time or during the follow-up after treatment. 

GET TESTED & INFORM YOUR PARTNER

If you are diagnosed with a sexually transmitted infection (STI), it is important to be checked for other STIs such as chlamydia. Your partners should also be notified, checked and treated if required. Be sure to have another test after treatment to make sure it has been cleared up.


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LAST UPDATED: April 2020. REFERENCES: Syphilis; Australian STI Management Guidelines > sti.guidelines.org.au Syphilis, Australian Contact Tracing Manual > contacttracing.ashm.org.au Reexamining Syphilis: An Update on Epidemiology, Clinical Manifestations  Management > Molly E Kent, PharmD; Frank Romanelli, PharmD MPH BCPS The Annals of Pharmacotherapy 2008; 42(2):226-236. medscape.com/viewarticle/571812_4 accessed 9/8/17 Sexual Health Information, Fact Sheets, Syphilis; Melbourne Sexual Health Centre > mshc.org.au Last updated November 2017.

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