• Bookmark and Share

Syphilis

Syphilis is a sexually transmitted infection (STI) that often has no symptoms.

If it does cause symptoms at first it causes an ulcer, usually on the genitalia. This often goes unnoticed. Weeks later it can cause a rash, fever and wart-like growths. If syphilis is left untreated it can lead to serious diseases of the heart or central nervous system. It's also a major cause of miscarriage and stillbirths worldwide.

  • About syphilis
  • Symptoms
  • Complications
  • Causes
  • Diagnosis
  • Treatment
  • Further information
  • Sources

About syphilis

Syphilis is caused by a bacterial infection. It's spread by having unprotected (without a condom) sex.

Although it used to be relatively rare in the UK, syphilis is becoming increasingly common, both in the UK and other countries across Western Europe. Between 1998 and 2004 the number of men diagnosed with syphilis in the UK increased more than 15-fold. In 2005, 2,807 people were diagnosed with syphilis in the UK.

Worldwide it is very common, with between 10 and 12 million new infections occurring every year.

Although syphilis can have serious complications if the disease is left to run its course, it can be easily treated with antibiotics.

How can you become infected?

Syphilis is spread from person to person through direct contact with syphilis ulcers or the rash it causes. The ulcers mainly occur on the external genitals, vagina, anus, or in the rectum, but they can also occur on the lips and in the mouth. The infection can be spread during vaginal, anal, or oral sex. Any contact with the rash or ulcer can transmit syphilis. Pregnant women can also pass it to their unborn child.

Using a condom reduces the risk of transmission but doesn't completely eliminate it because it may not cover the part of the body where the syphilitic ulcer or rash is.

Symptoms

Syphilis causes a number of different symptoms, depending on the person infected, and how long he or she has been infected.

The infection occurs in three distinct stages called primary, secondary and late (or tertiary) syphilis.

Primary syphilis

This is the first stage of infection. When you're exposed to syphilis you may develop an ulcer at the site of infection - the point where you had contact with a syphilitic ulcer or rash on someone else. This could be on the penis, anus, in the vagina or rectum, in the mouth or on the lips. The ulcer, sometimes called a chancre (pronounced "shanker"), can develop anywhere between nine and 90 days after you were first exposed, but it is usually after two or three weeks.

The ulcer is usually painless and it can often go unnoticed if it isn't in a visible area. Sometimes they are painful, and occasionally you can develop more than one.

If left untreated, the ulcer will heal naturally some four to five weeks later. However, the infection still remains in the body and you will progress to secondary syphilis.

Secondary syphilis

After primary syphilis has developed, the bacteria spread throughout your body. Anywhere between six weeks and six months later secondary syphilis develops.

Secondary syphilis can cause a wide range of symptoms that vary between individuals. You may experience some, but not necessarily all, of the symptoms below.

  • A non-itchy rash. This can develop anywhere, but may be present on the scalp, palms, soles or trunk (stomach, chest or back). On rare occasions, ulcers may develop on the rash.
  • Fever and feeling generally ill.
  • Swollen lymph nodes (glands throughout your body that are part of your immune system - these can be felt in the neck or groin).
  • Ulcers, or lines of ulcers that join together (called snail track ulcers) that develop inside the mouth or in or around the genitalia.
  • Groups of moist wart-like growths that develop around folds of skin such as around the anus or vagina. These growths are called condylomata lata.
  • Hair loss.
  • A condition called vasculitis - which means inflamed blood vessels - occurs in about one in 10 people with syphilis. This can lead to a range of problems such as an inflamed liver, swollen eyes or central nervous system complications.

In most people, symptoms will disappear in about three to six weeks. However, in about one in four patients they can re-occur over the next two years. It is important to seek treatment for syphilis because it can be cured with a course of antibiotics before it develops further (see Treatment).

After the early stages of illness, the symptoms will usually stop for a number of years. This stage of the disease is called latent syphilis. Latent means hidden; your body is still infected with the syphilis bacteria, but it isn't causing any symptoms.

Some people may have no further problems. However, about 35 percent of people will go on to develop the symptoms of late or tertiary syphilis.

Late (tertiary) syphilis

Late or tertiary syphilis can cause three serious syndromes: neurosyphilis (which affects the brain and spine), cardiovascular syphilis (which affects the heart and blood vessels) and gummatous syphilis (which affects the skin and other tissue). Tertiary syphilis is rare because the infection is usually noticed and treated in the primary or secondary stages of the disease.

Neurosyphilis

Neurosyphilis happens when the syphilis infection reaches your brain or spinal cord. It tends to develop between 10 and 20 years after the original infection.

It causes serious problems such as:

  • personality changes, memory loss, headaches, confusion or mood swings
  • tremors or convulsions (fits)
  • loss of co-ordination
  • incontinence
  • shooting pains

Cardiovascular syphilis

Cardiovascular syphilis affects your blood vessels and heart. It can cause a number of serious illnesses. It develops around 15 to 30 years after the original infection.

Examples of problems caused by cardiovascular syphilis include inflammation of the aorta (the artery leaving your heart leading to the rest of your body) or problems with the flow of blood coming out of your heart. This can lead to heart failure, heart valve damage and other serious complications.

Other problems include narrowing of the coronary arteries, causing angina-like chest pain, or aortic aneurysm - where the wall of the aorta becomes weakened and so expands, sometimes to the point where it's at risk of bursting.

Gummatous syphilis

A gumma is a small, rubbery, tumour-like swelling that can develop in almost any part of the body. They are most common in the skin or bone. They develop around three to 15 years after infection.

Complications

If you have syphilis and become pregnant, the bacteria can cross the placenta and infect your unborn baby. This is especially likely if you become pregnant in the early stages of the infection. This often causes a miscarriage or stillbirth.

If the baby survives, he or she may, but not always, have congenital syphilis (congenital means you are born with a condition). Early congenital syphilis, which occurs in the first two years of life, causes symptoms such as rashes, nasal discharge and growth problems. Late stage congenital syphilis develops after two years of life and causes developmental problems to the bones and teeth and other neurological symptoms similar to tertiary syphilis.

Causes

The bacterium Treponema pallidum causes the symptoms of syphilis as it spreads throughout the body.


Diagnosis

If you have any of the symptoms of syphilis, go to a local genitourinary medicine (GUM) or sexual health clinic that specialises in sexually transmitted infections. Alternatively, you can go and see your GP.

GUM clinics will keep your details confidential, even from your GP if you don't want him or her to know about your visit.

A blood test is the usual test for syphilis, especially if you have no symptoms. This is sent to a laboratory for testing. If you go to a GUM clinic they always offer you this test. Sometimes, if you have symptoms, a sample of fluid from an ulcer might be taken.

If you have syphilis, you need to let any sexual partners know so that they seek treatment as well if they also have it. This is called contact tracing - if you give them the details, the GUM clinic is able to this for you, allowing you to remain anonymous.

Treatment

Syphilis is treated with a course of antibiotics. This is usually a series of penicillin injections, although sometimes tablets can be used. During the early stages of the disease you may only need a single injection. At later stages you may need multiple injections over the course of several days. If you are allergic to penicillin an alternative antibiotic can be used.

Further information

Terrence Higgins Trust

fpa

Sources

  • Simon C, Everitt H, and Kendrick T, Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005:332, 742-743
  • Health Protection Agency. General information - Syphilis. www.hpa.org.uk, accessed 24 October 2007
  • French P. Syphilis. BMJ 2007; 334:143-147. www.bmj.com
  • British National Formulary (BNF). BMJ Publishing Group, 2007. 54: 620
  • Pattman R, Snow M, Handy P, Nathan Sankar K, Elawad B, Oxford handbook of genitourinary medicine, HIV, and AIDS. Oxford: Oxford University Press, 2005: 332, 93
  • UK national guidelines on the management of early syphilis. British Association of Sexual Health. www.bashh.org, accessed 30 November 2007