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Syphilis

• Wellington Sexual Health Service

What is Syphilis?

• Syphilis is a sexually transmitted infection caused by a bacterium (bug) called Treponema pallidum. It enters the body through tiny breaks in the skin - mainly in the genital area or the mouth.

How do you get Syphilis?

• Syphilis is very infectious and is usually caught by having close sexual contact with an infected person. This may include vaginal, anal or oral sex or just close skin-to-skin contact.
• The chances of catching syphilis are lower if you use condoms during sex.
• Syphilis can also be spread from mother to baby during pregnancy if the mother is infected. Infected babies can become very sick.
• Syphilis can also cause miscarriage or still-birth. 

How do I know if I have Syphilis?

• Many people do not get any symptoms and would not know without having a blood test.
• For those who get symptoms syphilis is divided into 3 stages: primary, secondary and tertiary.
• Primary and secondary syphilis are also known as infectious syphilis. 
• Non-infectious syphilis includes late latent and tertiary syphilis.

Primary Syphilis

• The first sign of syphilis is a sore, usually on the genitals but may be at other sites of sexual contact. The sore may occur in hidden sites (e.g. cervix, mouth, anus) and because it is usually painless it may go unnoticed.
• The sore usually appears 3-4 weeks after infection but sometimes it takes longer. The glands in the groin area may also become swollen.
• The sore will disappear on its own accord within a few weeks. Even though the sore heals you still have the syphilis infection and can pass it onto others.
• Any genital sore must be examined by a doctor even if it starts to heal and it is small and painless.

Secondary Syphilis

• Later on sometimes a rash will appear quite suddenly about 6 weeks after infection. It may appear on the body, face, arms and often on the palms and soles of the feet.
• The type and extent of the rash will vary from person to person and even vary on different parts of the body of the same person. It may be very obvious but it may be so mild as to pass unnoticed, and often disappears as suddenly as it appeared. The rash lasts up to 4-6 weeks.
• There may also be one or more of the following symptoms present:
  o mouth ulcers
  o headache
  o swollen glands
  o fever, hair loss
  o general tiredness and
  o flat warty growths in the genital or anal region.
• A person in primary or secondary stage of syphilis is very infectious because the sores and rashes are full of syphilis bacteria. There is a very high chance of infecting a sexual partner.
• If syphilis is not treated in the primary or secondary stage the symptoms will disappear. After two years the person is usually not infectious to others. At this stage infection is only picked up on blood tests.

Tertiary Syphilis 

• In about a third of people, if not treated the syphilis bacteria will eventually cause damage to the internal organs. These include the heart, brain and the nerves in the spinal cord. The doctor may advise that a chest X-ray or a lumbar puncture (spinal tap) is needed to help assess if any of these parts of the body are affected.
• Treatment is still effective and can prevent further damage, but will not repair any damage that has already taken place.
• Tertiary syphilis is not infectious and can be avoided by treatment at an earlier stage. 

How do you test for Syphilis?

• Syphilis is usually diagnosed by blood tests for antibodies to the syphilis bacterium and these should be part of any sexual health check. Ask your doctor or nurse if you can be tested for syphilis when having a check-up. It can take up to 3 months to develop antibodies so the tests may be negative early on.
• If you have a genital sore or body rash, the doctor may need to take samples from the sores to look under a microscope. They will also order blood tests to detect syphilis infection.

How is Syphilis Treated? 

• The length of treatment varies according to the stage of infection and type of antibiotic used.
• In most cases penicillin injections are used but under certain circumstances the medication may be taken by mouth e.g. tetracycline or erythromycin tablets. Take the treatment exactly as prescribed and do not miss any doses as this will reduce its effect.
• After treatment with penicillin injections some people (particularly in early syphilis) have a flu-like illness for 24 hours. This includes fevers, aches and pains and generally feeling unwell. It will go away and doesn’t require any special treatment except paracetamol for fever and pain and rest.
• After treatment, follow-up blood tests are essential for at least one year to make sure cure is complete.

Does Syphilis affect Pregnancy?

• Depending on how long a pregnant woman has been infected, she has a good chance of passing the infection to her unborn baby and this could result in a stillbirth or miscarriage.
• An infected baby may be born without symptoms but could develop them within a few weeks.
• The baby could become very ill.
• Every woman should have a blood test for syphilis during her pregnancy. Proper treatment of the mother during pregnancy will prevent the baby being born with syphilis.

What is the link Between Syphilis and HIV?

• It is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually.
• There is a 2 to 5 times greater risk of catching HIV infection when syphilis is present.

This information is not intended to replace the need for a consultation with your doctor. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. Every effort has been taken to ensure that this information is correct at the time of publishing (March 2009). Acknowledgement to Auckland Sexual Health Service for the use of this material.

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