What is syphilis?

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 after 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 and hands.

There’s usually only a single ulcer that is painless. But sometimes the ulcer is painful, or there might be more than one. The ulcer usually goes away after between three to eight weeks.

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 in the early latent stage which lasts up to two years. In the early latent phase it is also possible for you to relapse to secondary syphilis. This happens to around 25 percent of people. The latent stage can go on for a lifetime.

Tertiary (late) syphilis

If left untreated, syphilis can progress to the tertiary stage. This happens to one-third of people with untreated syphilis, many years or even decades after the infection. In this late stage of syphilis, the infection causes more serious health problems. These vary, and can include:

• changing or loss of vision
• numbness
• loss of coordination and balance
• heart problems
• seizures
• development of dementia

These complications can be hard to treat.

How do you get 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.

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 can have syphilis testing done for free at a genitourinary medicine (GUM) clinic, your local sexual health clinic, or with a GP. A doctor or nurse will first do a physical examination of your genitals to check for any sores, as well as check your skin and eyes for any signs of syphilis. You will also have a blood test to see if you’re infected.

You can also pay for tests. 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. You may have a repeat test sooner if you have an ulcer.

When you get tested, you should tell the healthcare professional if you previously had syphilis. This will help understand if a positive result is from a past or current syphilis infection.

Is syphilis a curable disease?

Syphilis is curable if you get treated early. If you don’t get treated you can have serious complications after several years in later syphilis stages. Treatment for syphilis involves taking 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.

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.

Practising safe sex

• 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.
• Get regularly tested for STIs, ideally once a year. If you regularly have sex with new partners, you should get tested every three months.

DoxyPEP

DoxyPEP (doxycycline post-exposure prophylaxis) is a pill that you can take after having sex. It is a dose of antibiotic which can reduce the risk of syphilis by up to 80 percent. It’s best to take DoxyPEP within 24 hours after having sex, and no later than 72 hours. DoxyPEP is mainly advised for gay and bisexual men and transgender women. Ask your local sexual health clinic about getting DoxyPEP.