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Syphilis is a
sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. If it's not
treated by a doctor, it can get worse over time and cause serious health
The infection can be active at times and not active at
other times. When the infection is active, you have symptoms. When it's not
active, you don't have symptoms, even though you still have syphilis. But even
when you don't have symptoms, you can pass syphilis to others.
have to have sexual intercourse to get syphilis. Just being in close contact
with an infected person's genitals, mouth, or rectum is enough to expose you to
Bacteria cause syphilis.
They usually enter the body through the tissues that line the throat, nose,
rectum, and vagina. A person with syphilis who has a sore or a rash can pass
the infection to others. An infected pregnant woman can also pass syphilis to her
Some things increase your chance of getting syphilis. They
You may not notice symptoms
of syphilis. Sometimes they are the same as symptoms for other infections. This
can cause someone with the infection to put off seeing a doctor. And it can make
it harder for a doctor to tell if you have syphilis.
stages of syphilis have different symptoms.
If you have sores,
bumps, a rash, blisters, or warts on or around your genital or anal area, or if
you think you were exposed to an STI, see your doctor.
He or she
will do a physical exam and will ask you about your symptoms and your sexual
history. You will probably have one or more blood tests to check for the
infection. Because the open sores from syphilis make HIV infection more likely,
you may also be tested for HIV.
To prevent babies from getting
syphilis, experts recommend that all pregnant women have a syphilis blood
Syphilis can be cured with
antibiotics. Both you and any sex partners that you
may have exposed to the infection will need to be treated.
important to know that syphilis is not a infection that you can treat on your
own. It must be treated with medicine that only your doctor can give you. With
treatment, you avoid other serious health problems. And treatment keeps you from spreading
syphilis to others.
If a woman is pregnant and has untreated
syphilis, it can cause miscarriage or stillbirth. It can also cause the baby to
be born with the infection. This is called congenital syphilis.
any stage of the infection, antibiotics work well to cure syphilis. They can't
undo the damage already caused by late-stage syphilis. But they can help you
avoid further problems from the infection.
There are some
things you can do to lower your risk for getting syphilis. Whether you have never had the infection or if you have had it before and are trying to keep from getting it again, it is important to practice safer sex. Safer sex includes using
condoms and using them correctly.
Learning about syphilis:
caused by the bacterium Treponema pallidum.
Transmission of the bacteria usually
occurs during vaginal, anal, or oral sex. The syphilis bacteria are passed from
person to person through direct contact with:
Sores mainly occur on the external genitals, vagina,
anus, or rectum. Sores can also occur on the lips and in or around the mouth.
The bacteria most commonly enter the body through mucous membranes, usually in
the area around the genitals and urinary system.
In rare cases,
syphilis enters the body through openings in the skin, such as cuts and
scrapes, or even through wet kisses, if the infected person has a sore on the
mouth or lips. Syphilis may also be transmitted by using a needle previously
used by an infected person. Syphilis can be transmitted through a
blood transfusion. But this is very rare, because all
donated blood in the United States and Canada is screened for some
sexually transmitted infections (STIs). And syphilis
bacteria cannot survive more than 24 to 48 hours in blood stored using modern
A pregnant woman with syphilis can pass the
infection through the
placenta and infect her baby any time during pregnancy
or delivery (congenital syphilis).
Syphilis cannot be
spread through casual contact with toilet seats, door knobs, swimming pools,
hot tubs, bathtubs, shared clothing, or eating utensils.
been infected with syphilis in the past does not protect a person from
becoming infected again.
An incubation period is the time
between exposure to a disease and the first symptom. A skin
sore called a chancre is usually the first symptom of sexually transmitted syphilis. A
chancre appears between 3 weeks to 3 months after a person has been
infected with syphilis.
A person with syphilis can
easily pass the infection (is contagious) to physically intimate partners when
primary- or secondary-stage sores are present. But the person may be contagious for years, off and on, and is always contagious whenever an
open sore or skin rash from syphilis is present.
develops in four stages, each with a different set of symptoms.
During the primary stage of
syphilis, a sore (chancre) that is usually painless develops at the site
where the bacteria entered the body. This commonly occurs within 3 weeks of
exposure but can range from 10 to 90 days. A person is highly contagious during
the primary stage.
Secondary syphilis is
characterized by a rash that appears 2 to 12 weeks after the chancre
develops and sometimes before it heals. Other symptoms may also occur,
which means that the infection has spread throughout the body. A person is
highly contagious during the secondary stage.
A rash often
develops over the body and commonly includes the palms of the hands and the
soles of the feet.
The skin rash usually heals within 2 months on its
own without scarring. After healing, skin discoloration may occur. But even though the skin rash has healed, syphilis is still present and a person can still pass the infection to others.
When syphilis has
spread throughout the body, the person may have:
If untreated, an infected
person will progress to the latent (hidden) stage of syphilis. The latent stage
is defined as the year after a person becomes infected. After the
secondary-stage rash goes away, the person will not have any symptoms for a
time (latent period). The latent period may be as brief as 1 year or range from
5 to 20 years.
Often during this stage, an accurate diagnosis can
only be made through blood testing, the person's history, or the birth of a
A person is
contagious during the early part of the latent stage and may be contagious
during the latent period when no symptoms are present.
About 20 to 30 out of 100 people with syphilis
relapse of the infection during its latent
stage.1 A relapse means the person was
symptom-free but then started having symptoms again. Relapses can occur
When relapses no longer occur, a person is not
contagious through contact. But a woman in the latent stage of syphilis may
still pass the infection to her developing baby and may have a miscarriage or a
stillbirth or give birth to a baby infected with congenital syphilis.
This is the most destructive
stage of syphilis. If untreated, the tertiary stage may begin as early as 1
year after infection or at any time during a person's lifetime. A person with
syphilis may never experience this stage of the illness.
this stage, syphilis may cause serious blood vessel and heart problems, mental
disorders, blindness, nerve system problems, and even death. The symptoms of
tertiary (late) syphilis depend on the complications that develop.
Complications of this stage include:
refers to syphilis passed from a mother to her baby during pregnancy or during
labor and delivery. The U.S. Centers for Disease Control and Prevention (CDC)
U.S. Preventive Services Task Force strongly recommend
that all pregnant women be screened for syphilis because of the severe
consequences of being pregnant while infected or having a child born with
congenital syphilis. Screening should be done:2, 3
Congenital syphilis increases the risk of fetal death and
medical complications in newborns. Syphilis enters the fetal blood system
placenta, causing infection in the newborn or death of
the fetus. Symptoms of congenital syphilis include:
Because there are
other conditions with similar symptoms, an accurate
diagnosis is important for treatment.
About 3 weeks—although the
range is from 10 to 90 days—after a person is infected with
syphilis, a sore (chancre) that is
usually painless often appears on the genitals. This first stage in the course
of syphilis is referred to as the primary stage. The
chancre usually heals without treatment in 3 to 6 weeks.
syphilis is not treated during the primary stage, it often progresses to later
In the secondary stage of syphilis,
a skin rash will usually develop about 2 to 12 weeks after the chancre appears. The
symptoms usually disappear without treatment within 2 months.
After the rash clears, a person may have a period with no symptoms. This
symptom-free period is called the latent (hidden) stage.
Even though symptoms disappear, the bacteria that cause syphilis remain in the
body and begin to damage the internal organs. The latent period may be as brief
as 1 year or range from 5 to 20 years.
A person is contagious
during the primary and secondary stages and may still be contagious during the
early part of the latent stage. During this time, symptoms of
the second stage of syphilis may reappear. This is called a
relapse and can occur several times.
not detected and treated, syphilis may then progress to the tertiary (late) stage, the most destructive stage of syphilis.
During this stage, syphilis may cause serious blood vessel and heart problems,
mental disorders, blindness, nerve system problems, and even death. It may
begin as early as 1 year after infection or at any time during the infected
person's life. About one-third of untreated people who are infected
with syphilis will have the complications of tertiary (late) syphilis. Any
organ system (such as the
central nervous system) may become involved.
Complications of tertiary (late) syphilis include:
Congenital syphilis refers to syphilis passed from the
mother to the baby during pregnancy or during labor and delivery. Congenital syphilis can cause complications in
newborns and children.
Your risk of
syphilis increases if you:
Syphilis is contagious whenever an open sore or skin rash
is present. The risk of being infected with syphilis from a single sexual
encounter with an infected partner is approximately 3% to 10%.4
Infection with syphilis also increases a
person's risk of being infected with HIV. Syphilis causes open sores on the
genitals that allow the HIV infection to enter the body easily. Syphilis is
in general more common in people who are also infected with HIV.
Call to make an appointment if
In most areas, public health clinics or health
departments are able to diagnose and provide low-cost assessment and treatment
of early syphilis and other sexually transmitted infections (STIs).
For more information about symptoms of other sexually
transmitted infections, see the topic
Exposure to Sexually Transmitted Infections.
Watchful waiting, which means taking a
wait-and-see approach, is not appropriate if you think you were exposed to or
syphilis or another sexually transmitted infection
(STI). Any symptoms or other changes that suggest syphilis or another STI should be evaluated by a doctor. If you
suspect a syphilis infection:
If you are diagnosed with syphilis, your sex partner(s)
will need to be treated also.
All states require doctors to report newly diagnosed cases of syphilis (all stages) to
Your primary doctor can
diagnose and treat syphilis.
Health professionals who can diagnose
and treat sexually transmitted infections (STIs) include:
secondary or later stage syphilis may require
treatment by an
infectious disease specialist.
In most areas, public health clinics or county
health departments are able to diagnose and provide low-cost or free treatment
of early syphilis and other STIs.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Diagnosis of syphilis includes a medical history and a physical exam. Your doctor may ask you questions such as:
The physical exam may include:
The diagnosis of syphilis
is usually confirmed with one of several
blood tests. This is especially true if no sores are
present. If sores are present, a doctor may look at the fluid from
one of the sores with a microscope to see whether syphilis bacteria are present
In the diagnosis of the
primary and secondary stages of syphilis,
lumbar puncture (spinal tap) is needed in some cases.
Additional testing should be done to find out if
other sexually transmitted infections are present, especially:
The diagnosis of syphilis can be delayed or complicated
because its symptoms are very similar to those of many
other diseases and are sometimes not recognized.
Syphilis has historically been called "the great imitator."
Screening for syphilis is strongly recommended
for pregnant women and for people who are at increased risk for the
People at high risk of contracting syphilis include those
The U.S. Centers for Disease Control and Prevention (CDC) and the
U.S. Preventive Services Task Force strongly recommend
that pregnant women be screened for syphilis because of the severe consequences
of being pregnant while infected or having a child born with
congenital syphilis. Screening should be done:2, 3
Prompt treatment of
syphilis is needed to cure the infection, prevent
complications, and prevent the spread of the infection to others.
Penicillin is the preferred drug for treating
syphilis. Penicillin is the standard therapy
for the treatment of
congenital syphilis, or syphilis acquired or detected
during pregnancy. If you are allergic to penicillin, make sure you tell
your doctor. Your doctor will still be able to treat the syphilis but may
consult with a specialist on the best antibiotic choice.
Self-care can lower your risk for an
initial infection of or reinfection with
syphilis or other
sexually transmitted infections (STIs).
The treatment of
syphilis and other
sexually transmitted infections (STIs) is complex. If
antibiotic treatment with penicillin will usually cure
a syphilis infection. If syphilis has progressed to the
tertiary stage, antibiotics can prevent further
complications. But they cannot reverse damage that has already occurred. Prompt
antibiotic treatment will decrease complications and prevent the spread of the
Exposed sex partners should be treated
for syphilis. The chancres in
syphilis can make transmission of HIV more likely. So
testing for both syphilis and
HIV should be done.
In rare cases, the first
attempt at treatment does not cure the syphilis infection. Follow-up blood
tests are needed to be sure the infection is cured.
The mission of the American Social Health Association is
to improve the health of individuals, families, and communities, with a focus
on sexual health and preventing sexually transmitted diseases.
Hook EW III (2012). Syphilis. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1922–1929. Philadelphia: Saunders.
Centers for Disease Control and Prevention (2010). Syphilis section of Sexually transmitted diseases treatment guidelines, 2010. MMWR, 59(RR-12): 26–39. Also available online: http://www.cdc.gov/std/treatment/2010/default.htm.
U.S. Preventive Services Task Force (2009). Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 150(10): 705–709.
Eckert LO, Lentz GM (2012). Infections of the lower and upper genital tracts: Vulva, vagina, cervix, toxic shock syndromes, endometriosis, and salpingitis. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 519–559. Philadelphia: Mosby.
Centers for Disease Control and Prevention (2010). Sexually Transmitted Disease Surveillance Report 2011. Atlanta: U.S. Department of Health and Human Services. Available online: http://www.cdc.gov/std/stats11.
Other Works Consulted
American Academy of Pediatrics (2012). Syphilis. In LK Pickering et al., eds., Red Book: 2012 Report of the Committee on Infectious Diseases, 29th ed., pp. 690–703. Elk Grove Village, IL: American Academy of Pediatrics.
Cox D, Ballard RC (2010). Syphilis. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 111–140. Philadelphia: Saunders.
Lukehart SA (2012). Syphilis. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 1380–1388. New York: McGraw-Hill.
October 8, 2013
Kathleen Romito, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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