Syphilis

This factsheet is for people who have syphilis, or who would like information about it.

Syphilis is a sexually transmitted infection (STI) that often has no symptoms. If untreated, it can lead to serious complications. It's almost always passed on through unprotected sex (sex without a condom).

Effects of the Syphilis in Pictures:

Rash caused by Syphilis in pictures

About syphilis
Syphilis is caused by a bacterial infection, which can be passed on through sexual contact. Syphilis used to be relatively rare in the UK, but has recently become more common - almost 2,500 people were diagnosed at genitourinary medicine (GUM) clinics in 2008. Worldwide, it's very common; between 10 and 12 million new infections occurr every year.

Women between the ages of 20 and 24 and men between 25 and 30 have the highest rates of syphilis. The infection is particularly common among men who have sex with men.

Although syphilis can have serious complications, it can be treated easily with antibiotics.

Symptoms of syphilis
Syphilis causes a number of different symptoms that usually depend on how long you've been infected for. The infection occurs in three distinct stages called primary, secondary and tertiary (late) syphilis.

If you become pregnant when you have syphilis, you can pass the infection on to your unborn child. This is called congenital syphilis.

Primary syphilis
This is the first stage of the infection. If you have contact with someone who has syphilis you may develop a sore, or sometimes lots of sores, on the area where you were exposed. This can be on your penis, anus, in your vagina or rectum (back passage), in your mouth or on your lips. The sore, sometimes called a chancre (pronounced 'shanker'), can develop anywhere between 10 days and three months after you were initially infected.

Syphilis sores are usually painless and can often go unnoticed if they aren't in a visible area. They are firm, round and small - measuring about 1 to 2 cm across - and if left untreated will heal naturally within six weeks. This doesn't mean, however, that the syphilis infection has gone - it will remain in your body and develop into secondary syphilis.

If you think you may have the symptoms of primary syphilis, see your GP. It can be cured with a course of antibiotics before it develops further.

Secondary syphilis
At this stage, the infection starts to spread throughout your body. It usually begins with the appearance of a rash on one or more areas of your skin between six weeks and six months after you first develop a syphilis sore.

Secondary syphilis can cause a wide range of symptoms that vary from person to person as it may affect any organ. You may get some, but not necessarily all, of the symptoms below.

* A non-itchy rash that can develop anywhere on your body. Most commonly, the rash has red or reddish-brown spots and appears on the palms of your hands and the soles of your feet. On rare occasions, sores may develop on the rash;
* Fever and tiredness;
* Swollen lymph nodes (these are glands throughout your body that are part of your immune system and can be felt in your neck or groin);
* Sores or lines of sores (sometimes called 'snail tracks') that join together and develop inside your mouth or in or around your genitalia;
* Groups of moist, wart-like growths known as condylomata lata. These may develop around folds of skin such as your anus or vagina;
* Hair loss;
* Vasculitis (inflamed blood vessels), which can lead to a range of problems including an inflamed liver, swollen eyes or central nervous system complications. This is relatively uncommon, occurring in about one in 10 people who have secondary syphilis;

Without any treatment, most people will notice the symptoms of secondary syphilis disappear in around three to six weeks. However, for about one in four people, the rash, sores and fever may keep coming back from time to time for up to two years.

After the symptoms of secondary syphilis have gone away, you may have no further problems, but enter a 'latent period'. During this stage of the infection, you will not have any signs or symptoms. This doesn't mean, however, that the infection has gone. Your blood will test positive for syphilis antibodies (proteins produced by the immune system that usually fight against bacteria and viruses). If you're not treated with antibiotics, you may remain in the latent period for the rest of your life. About one in six people who aren't treated in the latent period go on to develop tertiary (late) syphilis.

If you think you may have the symptoms of secondary syphilis, see your GP. It can be cured with a course of antibiotics before it develops further.

Tertiary (late) syphilis
Tertiary (late) syphilis can cause three serious syndromes: neurosyphilis, cardiovascular syphilis and gummatous syphilis. Most people will not develop tertiary syphilis as the infection is usually noticed and treated in the primary or secondary stages of the disease.

Neurosyphilis
Neurosyphilis develops when the syphilis infection reaches your brain or spinal cord. It tends to develop between 10 and 20 years after you were originally infected. 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 heart and blood vessels. It can cause the following problems, usually around 15 to 30 years after you were originally infected:
* inflammation of the aorta (the main blood vessel in your body), which may lead to problems with the flow of blood coming out of your heart;
* narrowing of the coronary arteries - this may cause angina-like chest pain;
* nortic aneurysm - this happens when the wall of the aorta becomes weakened and so expands, sometimes to the point where it's at risk of bursting;

Gummatous syphilis
Gummata are small, rubbery, tumour-like swellings that may develop around three to 15 years after you were originally infected. The gumma nodules can form on almost any part of your body, but most commonly affect the skin (especially below the knee) and bones.

Special considerations
If you're pregnant
If you have syphilis and become pregnant, you may pass the infection on to your unborn baby. This is especially likely to happen in the early stages of infection and increases your risk of having a miscarriage, a stillbirth, or your baby not living for very long after birth.

About one in three babies who are conceived by mothers with syphilis are born with the infection (this is called congenital syphilis). If this happens, your baby may or may not develop symptoms, but the condition can be life-threatening. Congenital syphilis can cause rashes, nasal discharge and growth problems within the first two years of life. Later on, your baby may have developmental problems with his or her bones and teeth. If your baby has symptoms similar to those of tertiary syphilis, this means the infection may have reached his or her nervous system.

Congenital syphilis can easily be prevented by screening for the infection when you are pregnant and by having antibiotic treatment before your baby is born. If you think you may have syphilis and become pregnant, see you GP.

Syphilis Q&As
See our answers to common questions about syphilis, including:
* Can I catch syphilis though contact with objects like the toilet seat, in swimming pools or saunas?
* Will I be immune from syphilis after treatment?
* Can I catch syphilis though oral sex?

Related topics
* Chlamydia
* Genital herpes
* Genital warts
* Gonorrhoea
* HIV/AIDS
* Pubic lice
* Sexually transmitted infections (STIs)

Further information
* Family Planning Association
www.fpa.org.uk
0845 122 8690 (England)
0845 122 8687 (N Ireland);
* Health Protection Agency
www.hpa.org.uk
* Terrance Higgins Trust
0845 1211 2000
www.tht.org.uk

Sources
* French P. Syphilis. BMJ 2007:143-47;
* Sexually transmitted infections. Family Planning Association. www.fpa.org.uk, published 2007;
* Syphilis: general information. Health Protection Agency. www.hpa.org.uk, accessed 17 February 2010;
* Syphilis fact sheet. Centres for Disease Control and Prevention. www.cdc.gov, accessed 17 February 2010;
* Carolyn J, Hildreth M. Syphilis. JAMA 2009; 301(7);
* Simon C, Everitt H, Van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:747;
* Syphilis. Merck Online Medical Library, www.merck.com, published 2008;
* Pattman R, Snow M, Handy P, et al. Oxford handbook of genitourinary medicine, HIV and AIDS. Oxford: Oxford University Press, 2005:91-107;
* Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of great Britain, 2009: 286;
* UK National Guidelines on the Management of Syphilis, 2008. British Association for Sexual Health and HIV. www.bashh.org;