Syphilis is caused by the bacterium Treponema pallidium.
The infection is usually sexually transmitted.

Symptoms

The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs and may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages are very infectious:

Primary Stage
One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres can be difficult to notice and are highly infectious. They can appear anywhere on the body, but usually show up:

• on the penis in men
• on the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
• around the anus and mouth (both sexes).

The ulcers usually take between 2 and 6 weeks to heal.
If the infection is not treated at this point then it will progress to the secondary stage.

Secondary Stage
If the infection has not been treated, the secondary stage will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:

• a flu-like illness, a feeling of tiredness and loss of appetite, together with swollen glands (this can last for weeks or months).
• flat, warty-looking growths on the vulva in women and around the anus in both sexes.
• a non-itchy rash covering the whole body or appearing in patches. hair loss
• white patches on the tongue or roof of the mouth.

During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will normally clear up within a few weeks, but may re-occur for years.

Treatment at any time during the first two stages of syphilis will cure the infection.

How It’s Passed On

Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:

• by having vaginal, oral or anal sex with someone who has the infection.
• from a mother to her unborn baby.

Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.

Getting Help

If you have any symptoms or you are worried you may have been infected with syphilis, you should discuss your worries with a doctor immediately. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can. 

The Diagnosis

To find out if someone has syphilis, a doctor usually will carry out the following examinations and tests:

• a specimen of fluid is taken from all sores using a cotton swab and examined under a microscope.
• a blood sample is taken and sent to an STD testing laboratory.
• a sample of urine is taken.
• the genital area is examined for any primary signs of syphilis. The rest of the body is also checked.
• women are given an internal examination to check for sores.

None of the examinations should be painful, but they may be slightly uncomfortable.

If the result is negative it is usually recommended that the person re-tests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test. 

Treatment

If the patient has syphilis, the doctor will talk about the STD and answer any questions. The patient will be asked about their sexual partners as it is important they are informed and tested as soon as possible. It is strongly advisable to avoid any vaginal, oral or anal sex whilst having treatment, especially if the patient is in the early infectious stages of syphilis. Contact with any sores or rashes carries a risk of syphilis transmission. Treatment of syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules.

If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternate medication can be prescribed.

It is important that the full course of treatment be completed. If treatment is interrupted then it may be necessary to start again from the beginning.

After the treatment is completed, the patient will be asked to attend the clinic at regular intervals for blood tests to check that the syphilis has gone.

Once a person has been treated and confirmed cleared of syphilis, any future blood tests (e.g. for immigration reasons) will still be positive, because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis.

Treatment is only capable of killing the syphilis bacteria and preventing further damage.