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What is syphilis?
Syphilis is a sexually transmitted infection (STI). Like other STIs, such as chlamydia and gonorrhoea, it can be passed on during unprotected sex.
Syphilis cases have increased in recent years in the UK. The number of infections rose from around 3,300 in 2013, to around 7,500 in 2018.
Syphilis can cause serious health problems if it’s not treated. Here I’ll describe how to recognise the signs of syphilis, and what you should do if you think you may have it.
What are the symptoms of syphilis?
Syphilis has different symptoms at different stages. You may also not get any symptoms at all from syphilis, or you may not notice them.
Primary syphilis
The first syphilis symptom you may notice is one or more ulcers around your genitals. These are known as chancres (pronounced ‘shankers’).
Chancres tend to develop between a few weeks and three months of being in contact with an infected person. They might be on your penis, your vagina, or around your anus. Sometimes they can appear in other areas, like your mouth.
There’s usually only a single ulcer that is painless. But sometimes the ulcer is painful, or there might be more than one.
Secondary syphilis
Several weeks after the primary (first) stage of syphilis, the infection can affect other parts of your body. You may have:
- a flat, red rash
- patchy hair loss
- wart-like growths around your genitals
You might also start to feel generally unwell, with headaches and a fever. Sometimes this can happen earlier, at the same time as having an ulcer.
Latent syphilis
The next stage of syphilis is a latent (hidden) phase. In this phase, you don’t have any signs or symptoms. You may still be infectious, particularly if you were infected less than two years ago. Within two years of infection, you may also revert from latent to secondary syphilis.
Tertiary (late) syphilis
In the late stage of syphilis, the infection causes more serious health problems. These can include loss of vision, heart problems, and problems affecting your brain and nervous system. These complications can be hard to treat. This stage can happen after many years of having untreated syphilis.
What causes syphilis?
Syphilis is a bacterial infection. You can get it by having unprotected sex with an infected person. It’s passed on by direct contact with an infected ulcer.
Anyone who is sexually active can get syphilis. In the UK, most infections are currently among men who have sex with men. It’s also possible to pass syphilis on to your unborn baby if you’re infected while pregnant.
Syphilis was very common a few centuries ago. It became very rare by the 1980s because of better treatment and more people using condoms. But rates have been rising rapidly again over the last twenty years.
When should you get tested for syphilis?
It’s important to get tested for STIs as soon as you can if you think you might have symptoms. You should also have a test if you think you could have been exposed to an STI, even if you don’t have symptoms. This might be if you’ve had unprotected sex with a new sexual partner, or if a regular sexual partner tells you they have an STI.
How do you get tested for syphilis?
You’ll need to do a blood test to check for syphilis. There are several ways to get a syphilis test. You can go to a genitourinary medicine (GUM) or sexual health clinic, or you can ask at your GP practice. You can also pay for tests at a private clinic. In some areas, you may be able to get a test that you can do at home from your local sexual health service.
If you’re infected with syphilis, tests won’t always be able to detect it straight away. It may take up to three months from when you are infected. Your doctor will help you understand whether you need to have another test three months after the suspected date you were exposed to syphilis. This is just to make sure the test isn’t done too early.
How is syphilis treated?
Syphilis is treated with antibiotics. You usually have this as an injection, but sometimes you may take tablets. If you’re diagnosed at a later stage of the disease, you may need to have several injections or take tablets for longer. Syphilis treatment is usually very effective, if you have it early enough.
Telling others
It’s important to let any current and recent partners know that you have syphilis. The staff at a sexual health clinic can help you to do this, while keeping your details confidential. You’ll need to avoid having sex again until at least two weeks after you’ve finished treatment.
How can I reduce my risk of syphilis?
There are many things you can do to lower your risk of getting or passing on syphilis, as well as other STIs.
- Use a condom during vaginal, oral, or anal sex with the penis.
- Use a latex square (dental dam) to cover the anus and vaginal opening during oral sex, including the area around it.
- Don’t share sex toys. If you do, wash them well, or cover them with a new condom before anyone else uses them.
- Before you have unprotected sex with somebody new, have a test for syphilis and other STIs.
Hello, I'm Dr Naveen Puri, I'm one of the GPs at Bupa Health Clinics. Today I'd like to talk to you about presenting with problems that may be of a sexual health nature.
We know that people can often feel embarrassed talking about their sexual health for fear of judgement. Some shame or embarrassment may accompany your concerns, but please let me assure you, as doctors, we've heard it all before.
Any concerns you have we've come across on many occasions and we're here to offer you a judgement and pain-free service in as far as we possibly can.
It's in your interest to tell us all your symptoms so we can help you get better and prevent any consequences that might come into play if you don't seek out help for your condition sooner rather than later.
We know for example some untreated infections can lead to problems with fertility. They can lead to pelvic inflammatory diseases or severe infection of the testicles so rather than you getting worse and your symptoms progressing to something more serious, let us know sooner rather than later so we can help you.
In terms of accessing sexual health services, there are many ways young can do this. We offer the services within Bupa and you can also access the services within the NHS as well.
Some people like to go to a walk-in service where they can turn up and wait for an appointment, others prefer to book an appointment in advance and that way they know when they're going to be seen and arrive at the clinic in an appropriate time frame as well.
I'd also say there's nothing to be ashamed or embarrassed about, we have seen and heard all of the symptoms before.
The kind of things people come to us with range from pain during intercourse, a discharge, either from the penis or the vagina, or other symptoms such as abdominal pain, a sore throat or other things that could occur after an infection is acquired.
So, whatever it might be, let us do the detective work for you. Let us know what your symptoms are.
Feel free to bring someone with you if you'd like, write your problems down so you can discuss them with us. Or use the language you want to as well, we don't expect you to know the medical terms for things we can help you with that as well.
And hopefully, together we can get to the bottom of whatever your issue is, and we can provide you with an appropriate treatment or cure if that is available as well.
We offer a range of sexual health services within our Bupa Health Centres. So whether you have symptoms and need to speak to a GP or don't have symptoms but want a check to see if you currently have an STI we have a check to suit you. Any customers who test positive receive a follow up with a GP and support from our 24/7 Nurse HealthLine. Learn more today.
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Sources Sources
- O'Byrne P. Syphilis. BMJ 2019;365: l4159. DOI: 10.1136/bmj.l4159
- Syphilis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2019
- Addressing the increase in syphilis in England: PHE Action Plan. Public Health England. www.gov.uk, published June 2019
- Rayment M, Sullivan AK. “He who knows syphilis knows medicine” – the return of an old friend. Br J Cardiol 2011;18: 56-8
- Sexually transmitted infections and screening for chlamydia in England, 2020. Public Health England. www.gov.uk, published September 2021
- Syphilis. Sexwise. www.sexwise.org.uk, last updated December 2020
- Kingston M, French P, Higgins S, et al. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2016;27(6): 421-46. doi: 10.1177/0956462415624059
- Tampa, M et al. Brief history of syphilis. J Med Life. 2014 (7,1): 4-10
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