Answers to common questions about syphilis

Late stage syphilis can cause problems with the heart and other internal organs, and can lead to blindness, and central nervous system disorders such as  insanity and paralysis. While it is treatable even at this stage, prior damage cannot be reversed. Here are answers to some common questions about diagnosing and treating syphilis.

Why get tested?

To screen for syphilis infection

When to get tested?

If you have symptoms of a syphilis infection, if you have another STD, or are pregnant

Is a sample required?

A scraping from a chancre in the affected area, a blood sample from a vein in your arm, or a spinal tap, depending on the test being used

What is syphilis?

• Syphilis is a curable infection caused by the bacteria Treponema pallidum.
• The bacteria enter the body through mucous membranes or abraded skin.
• Once inside the body, syphilis enters the blood stream and attaches to cells, damaging organs over time.
• There are four stages through which untreated syphilis progresses, each stage with its own unique signs and symptoms:
  • primary
  • secondary
  • latent
  • tertiary (or late)

How common is it?

• Up until 2000, the reported rate of syphilis in the United States was at its lowest level since reporting began in 1941. In 2001, the number of cases reported increased slightly by a little over 2%.
• This increase occurred only among men, while the number of cases continued to decline among women and among African American blacks.
• Most of the reported syphilis cases are in the Southeast of the country, with a higher percentage of cases among African-Americans than whites. In 2001, the South had the highest rate of syphilis, accounting for 56% of reported cases in the US.
• While rates appear to be improving, syphilis continues to disproportionately affect African Americans, with reported rates 16 times higher for African Americans than for white Americans.
• Syphilis rates usually increase and decrease in seven-to-ten year cycles, which maybe one reason for the increase.

• Syphilis transmission can occur when infected lesions come in contact with the soft skin of the mucous membrane found inside the vagina, urethra or with an abrasion during vaginal, oral and anal sex, even if there is no sexual penetration.
• It is most easily spread during the first stage because symptoms usually go unnoticed.
• Syphilis can also be contracted from exposure to lesions or syphilitic "warts" during the secondary stage.
• If "warts" are present, they may easily spread the syphilis bacteria, due to the large amount of T. pallidum present.
• Because symptoms of secondary syphilis can recur, a person who has entered the latency stage of syphilis can still transmit the disease.

• Because syphilis bacteria are extremely fragile, they cannot be spread during contact with objects such as toilet seats or towels.
• People, especially health care workers, can be at risk for syphilis if an abrasion or cut on the skin comes into contact with a syphilitic lesion

• Syphilis can also be transmitted during pregnancy or during childbirth from a mother to her infant.

• Chancre
  • The primary stage of syphilis is usually marked by the appearance of a single sore, known as a chancre, within 10 to 90 days after contact with the bacteria at the site of infection.
  • It is usually appears as a single, painless sore, that is raised or elevated.
  • Chancres may be found:
    • outside the genitals, including the penis, scrotum and vagina
    • inside the vagina or rectum
    • at or around the anus
    • on the lips or in the mouth, though this is not as common.
  • The sore can last from one to five weeks and will go away by itself.
  • The chancre will go away with or without treatment. Without treatment, the person will still have syphilis and can transmit it to others.

Secondary Syphilis

• The secondary stage of syphilis can develop 17 days to 6 1/2 months after infection.
• Symptoms can last from 2 to 6 weeks.
• Symptoms can include:
  • A rough, reddish-brown rash that appears on the palms of your hands or the soles of your feet, which normally does not itch.
  • Rashes on other parts of the body, including the neck, head and torso.
  • Condylomata lata or syphilitic "warts", moist, raised or elevated skin lesions, may be found in the anus or genital area.
  • "Mucous patches," flat, round, grayish-white sores, can appear on the mouth, throat, and cervix.
  • Patchy loss of hair on the head and other parts of the body.
  • A general sense of ill health.
• Symptoms of secondary syphilis will clear up with or without treatment, but the disease will still be present if untreated. It will then enter into a latent stage, which has no signs or symptoms.

• Latent syphilis is defined as the time where there are no signs or symptoms of the disease
• Develops from two to 30+ years after infection.
• Because there are no signs or symptoms, the only way to test for infection during the latent period is by blood test.
• A relapse of secondary syphilis can occur once the disease has entered the latent stage. This normally will happen during the first two years of latency.

• Symptoms of late stage or tertiary syphilis can occur 2 to 30+ years after infection.
• Complications during this stage can include:
  • Gummas: Small bumps or tumors that can develop on the skin, bones, liver or any other organ.
  • Problems with heart and blood vessels
  • Chronic nervous system disorders, such as blindness, insanity and paralysis
• If treated during this period, gummas will usually disappear. Though treatment at this phase will cure the disease and stop future damage to the body, it cannot repair or reverse the damage that occurred before treatment.

A mother infected with syphilis can pass the disease to her unborn child, either during pregnancy or in childbirth. A newborn infected in this manner has congenital syphilis.

• Early signs generally appear from three to eight weeks after a baby is born.
• Even though these symptoms develop soon after birth, most cases go unnoticed until late congenital symptoms appear in childhood or adolescence.
• Late congenital syphilis has similar symptoms to tertiary syphilis in adults, though heart complications rarely occur in cases of congenital syphilis

• This test uses a fluid sample taken from the chancre during primary syphilis or from symptoms that occur during secondary syphilis found in areas such as the vagina (women) or the urethra (men).
• The sample is then viewed under a microscope.
• This test can only be done during primary or secondary syphilis, when sores, lesions & warts are present.

• There are two types of blood tests used to detect syphilis: nontreponemal and treponemal. These tests can be done in all stages of syphilis.

• Nontreponemal blood tests are screening tests that look for certain antibodies, but not specifically syphilis antibodies. There are two types of screening test that may be used:
  • VDRL (Venereal Disease Research Laboratory)
  • or RPR (Rapid Plasma Reagent)
• If the results for these test come back positive, a more specific treponemal blood test is performed to confirm a positive result. There are two types of confirmatory tests that may be used:
  • FTA-ABS (Fluorescent Treponemal Antibody Absorption Test)
  • MHA-TP (Microhemagglutination-Treponema Pallidum)
• There is a possibility of a false positive, particularly if the person tested has had syphilis before. A test may also be a false positive result if you are pregnant, have rheumatoid arthritis, use heroin, or have hepatitis, influenza or pneumonia.

• Another test uses cerebrospinal (involving the brain and spinal chord) fluid and is usually done if a person has damage to their central nervous system.

• If no signs and symptoms are found at birth, a blood test should be performed every 2 to 3 months on the infant until the test comes back negative. This is because an infant may test positive for syphilis and not be infected until the mother's antibodies, transmitted during pregnancy, clear the infant's body. For more information about testing and treatment of infants, talk with your health care provider, or visit your local health department.

What is the treatment for syphilis?

• The preferred treatment for syphilis is penicillin. If you are allergic to penicillin, your health care provider can suggest another antibiotic.
• If you have HIV, tell your health care provider. The antibiotic may not be as effective.
• Penicillin is the only recommended treatment for pregnant women. If you are pregnant and are allergic to penicillin, talk to your health care provider. He/she can use a process called desensitization that may allow a person to take penicillin.
• Infants should be checked carefully at birth. Treatment can vary for many reasons. For more information about testing and treatment of infants, talk with your health care provider, or visit your local health department.

• Take all medications as directed.
• All partners should be examined and treated.
• Do not have sex until you and your partner(s) have been treated and cured.
• After treatment for primary or secondary syphilis, it is recommended that a person be retested after 6 months, and once again after a year.
• If you are treated in the latent period, follow up tests are recommended after 6 months, 12 months & again at 24 months.
• People who are infected with syphilis and also have HIV, should be retested every 3 months for 2 years.

What can I do to reduce my risk of getting syphilis?

• Abstinence (not having sex).
• Mutual monogamy (having sex with only one uninfected partner).
• Latex condoms for vaginal and anal sex. Condoms may protect the penis or vagina from infection, but do not protect from contact with other areas such as the scrotum or anal area.
• Several barrier methods can be used to reduce the risk of transmission of syphilis during oral sex. A non-lubricated condom can be used for mouth-to-penis contact. Household plastic wrap, a dental dam, or a latex condom cut-up and opened flat can reduce the risk of transmission during mouth-to-vulva/vagina or oral-anal (rimming) contact.