Syphilis

Syphilis is a sexually transmitted infection (STI) caused by bacteria, usually passed on through vaginal, anal or oral sex with someone who has the infection. It is easily treated with antibiotics, especially if you catch it early. If left untreated, it can lead to serious, long-term damage to organs such as your heart, brain and nervous system.

What are the symptoms of syphilis?

Syphilis is sometimes called 'the great imitator' because its signs and symptoms can be easy to miss or mistake for something else. Many people don't have any symptoms at all, especially early on.

Symptoms you might notice early on include:

• one or more small, painless sores (called a chancre) where the bacteria entered your body, such as on the genitals, around the bottom (anus), or in the mouth
• swollen glands near the sore
• a sore that's hidden inside the body, so you may not notice it

The sore usually heals by itself within a few weeks, but the infection is still there and will still need treating.

Without treatment, further symptoms can follow, including:

• a rash on the palms of your hands and soles of your feet, which can spread over your body and usually doesn't itch
• wart-like growths in warm, moist areas such as the groin
• white patches inside your mouth
• flu-like symptoms, such as a high temperature, headache, muscle aches and tiredness
• swollen glands
• patchy hair loss on your head, beard or eyebrows

These symptoms can also clear up on their own, but that doesn't mean the infection has gone. You can still pass it on, and you're at risk of serious problems later if you don't get treatment.

What causes syphilis and who is at risk?

Syphilis is caused by bacteria called Treponema pallidum. It spreads through close sexual contact, most often vaginal, anal or oral sex with someone who has it, through direct contact with a sore.

You can also catch it by kissing near a sore, though this is less common. It doesn't spread through toilet seats, sharing cups or cutlery, or hot tubs, because the bacteria can't survive outside the body for long.

Less commonly, syphilis can also spread:

• from a pregnant woman to her unborn baby (known as congenital syphilis)
• by sharing needles used to inject drugs
• through a blood or organ transplant, though this is rare, as donations in the UK are checked for syphilis

You may be more at risk of syphilis if you:

• have unprotected sex, especially with more than one partner
• are a man who has sex with men
• have HIV
• have had another STI, such as chlamydia or gonorrhoea
• have a sexual partner who has tested positive for syphilis

Cases have traditionally been most common among gay and bisexual men, but diagnoses among heterosexual men and women have been rising sharply, and cases are increasingly being seen across a wider range of communities.

Are there different types of syphilis?

If it's not treated, syphilis moves through several stages, each with different symptoms.

Primary syphilis is the first stage. A small, painless sore appears where the infection entered your body, usually 2–12 weeks after you were exposed. It heals by itself within 3–6 weeks, but the infection is still there.

Secondary syphilis follows, often as the sore heals or shortly after. A rash appears, along with flu-like symptoms, swollen glands and sometimes patchy hair loss. These symptoms usually clear up within weeks, though the infection remains in your body.

Latent syphilis has no visible symptoms at all, even though the infection is still present. This stage can last for years.

Tertiary (late) syphilis develops in some people, sometimes decades after the original infection. It can cause serious, lasting damage to the heart, brain, nerves and other organs.

Syphilis can also pass from a pregnant woman to her unborn baby, known as congenital syphilis. This can cause the pregnancy to end in miscarriage or stillbirth and can lead to serious health problems for the baby, including rashes, bone and joint problems, anaemia and difficulties with hearing or eyesight. Some effects may not appear until later in childhood.

How is syphilis diagnosed?

A test is the only way to know for sure if you have syphilis, as many people don't have obvious symptoms. Your doctor or nurse will start by asking about your sexual history, so it helps to be open and honest, and this stays confidential.

They'll also examine you, checking your genitals and bottom (anus) for sores, and the rest of your body for signs such as a rash or wart-like growths. Depending on what they find, you may have:

• a blood test, the most common way to check for syphilis
• a swab (like a cotton bud) taken from a sore, or a small fluid sample looked at under a microscope

You may be offered tests for other STIs at the same time. Rapid tests are also available and can give a result within minutes, so treatment can start on the same visit if needed.

If you're pregnant, you'll be offered a syphilis test as part of your routine antenatal care.

How is syphilis treated?

Syphilis is treated with antibiotics. Penicillin, given as an injection, is the usual choice and works well against the bacteria. A single injection can treat syphilis if it's caught early.

If you're allergic to penicillin, tablets such as doxycycline may be used instead. If the infection has been present for longer, you may need injections once a week for 3 weeks rather than a single dose. Treatment can sometimes start before your test results are back.

Some people get flu-like symptoms, such as a high temperature, headache and aching muscles, within the first 24 hours of treatment. This is a common reaction and usually settles by itself.

After treatment:

• avoid sex until 2 weeks after you and your partner(s) have both finished treatment
• you'll need follow-up blood tests, usually at 6 and 12 weeks, to check it's worked, with further check-ups sometimes continuing over the following year
• your recent sexual partners should also be tested and treated; your clinic can help with this, sometimes without using your name
• you can catch syphilis again after successful treatment, so it's worth continuing to practise safe sex and getting tested regularly if you're at ongoing risk

When should I see a doctor?

See a GP or go to a sexual health clinic as soon as possible if:

• you or a sexual partner have symptoms of syphilis, such as a sore or rash
• a sexual partner has told you they have syphilis or another STI
• you've had sex with a new partner without using a condom
• you're pregnant, or planning to be, and think you might have syphilis
• you've injected drugs using a needle that may have been used by someone with syphilis

The sooner you're tested and treated, the less likely you are to develop long-term complications, so don't wait for symptoms to appear or get worse before getting checked.