What You Need to Know about Syphilis

Syphilis is increasing

Syphilis is a bacterial infection, caused by the bacteria Treponema pallidum. It is passed on when a person comes in contact with a syphilitic sore, known as a chancre—typically during vaginal, anal, or oral sex. Syphilis can also be passed on during pregnancy or childbirth from a pregnant person to their baby.

Syphilis can be treated more easily if it is caught early. But undiagnosed and untreated syphilis can be dangerous. It can cause irreversible health damage and even death.

At this moment, syphilis cases are increasing and there is a surge in cases of cases among newborns, called congenital syphilis. Over 10 times as many babies were born with syphilis in 2022 than in 2012. Syphilis during pregnancy is a serious issue. It can cause miscarriage, stillbirth, and even infant death. Babies born with syphilis can face lifelong medical issues. This is why testing for syphilis is recommended for all pregnant patients, so infections can be found and treated.

With reported cases of syphilis up 80% since 2018 and more than 3,700 babies born with syphilis in 2022, it’s important to learn more about this curable STI and how to protect yourself from serious health consequences.

The Basics

According to the Centers for Disease Control and Prevention (CDC), there were more than 207,255 cases of syphilis in 2022. Most cases of syphilis reported in the United States are in men, with the majority cases in gay, bisexual, and other men who have sex with men (MSM). However, there has been a rise in cases of syphilis in infants—called congenital syphilis—in recent years.

How is syphilis passed on?

Sexually

  • Syphilis can be passed on when syphilis sores come in contact with the soft skin of the vagina, urethra or with an abrasion during vaginal, oral and anal sex.
  • It is most easily spread during the first (primary) stage because symptoms usually go unnoticed.
  • Syphilis can also be passed on by exposure to syphilitic warts during the secondary stage.

Non-sexually

  • 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.

Stages of Syphilis

  • The first symptom is a painless sore (chancre) that shows up between 10-90 days after exposure.
  • The sore can appear on the genitals (penis, scrotum, vulva), or in places harder to find (anus, inside of the vagina).
  • The sore can last up to six weeks and will go away without treatment. Without treatment, the person will still have syphilis and can transmit it to others.
  • A person is highly contagious during the primary
    stage.

If left untreated, syphilis can move to the secondary stage. This stage of syphilis can develop 17 days to 6 1/2 months after infection and symptoms can last from 2 to 6 weeks.

Symptoms in this stage include a rough, reddish-brown rash or spots on the palms of hands, soles of feet, or rashes on other parts of the body, including the neck, head and torso. Other symptoms could include headache, fever, and generally not feeling well.

The symptoms will go away on their own, but the disease will still be present if untreated. It will then enter into a latent stage, which has no signs or symptoms.

The latent stage begins when the primary and secondary stage symptoms are gone and the infection has been left untreated. During this stage, which can last for as long as 20 years, there are no symptoms, but syphilis is still there.

Symptoms of late stage (also called tertiary syphilis) can occur 2 to 20+ years after infection.

Untreated syphilis can result in damage to organs, including the brain, eyes, heart, bones and joints. The damage caused by untreated syphilis can even lead to death.

How is Syphilis Diagnosed?

Syphilis can be detected by blood tests, which looks for antibodies, or by testing fluid taken from lesions or swollen lymph nodes, which occur during primary or secondary syphilis. Tests on the lymphatic fluid or lesions look for antigens.

Blood tests can be done in all stages of syphilis. There are two types of blood tests available for syphilis—both types are needed to confirm that a person has syphilis.

This is the definitive method for diagnosing early syphilis and congenital syphilis. This test uses a fluid sample taken from the chancre (sore) during primary syphilis or from symptoms that occur during secondary syphilis found in areas such as the vagina or the urethra. The sample is then viewed under a microscope.

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.

How is syphilis treated?

  • The preferred treatment for syphilis is penicillin. If you are allergic to penicillin, your healthcare 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 people. If you are pregnant and are allergic to penicillin, talk to your health care provider. They may want to 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.

Treatment Follow Up

  • 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 six months, and once again after a year.
  • If you are treated in the latent period, follow up tests are recommended after six months, 12 months and again at 24 months.
  • People who are infected with syphilis and also have HIV, should be retested every 3 months for 2 years.

What does it mean for my health?

Left untreated, syphilis can cause blindness, paralysis, and problems with your bones and internal organs, including your heart.

How can I reduce my risk?

  • 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.

How do I tell my partner?

Telling a partner can be hard, but keep in mind that some people with syphilis don’t know they have it. It’s important that you talk to your partner as soon as possible so they can get treatment. Also, it is possible to pass syphilis back and forth, so if you get treated and your partner doesn’t, you may get infected again.

Get Involved—Spread the Word

Congenital syphilis is a public health crisis. You can help raise awareness about the striking rise in syphilis with our social media toolkit. Share our images and messages on all of your social channels—just click to download and copy/paste.

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