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Syphilis

• Syphilis [SI-fi-lis] is a sexually transmitted bacterial infection.
• Syphilis is most often passed from person to person through sexual contact. It can also be passed from an infected pregnant woman to her unborn child.
• Syphilis is treatable with antibiotics.
• Without treatment, syphilis moves through the body in stages, damaging many organs over time. Infected persons are highly infectious during the early stages.
• To prevent syphilis: 1) do not have sex with persons who have genital sores; 2) use condoms with new sex partners; 2) if you think you are infected, avoid sexual contact and see a health-care provider; 3) tell all sexual contacts to see a health-care provider. All pregnant women should receive a prenatal blood test for syphilis.

What is syphilis?

Syphilis is a sexually transmitted disease (STD) that progresses in stages and can damage many parts of the body.

What is the infectious agent that causes syphilis?

Syphilis is caused by Treponema pallidum, a spiral-shaped bacterium called a spirochete.

How do people get syphilis?

Syphilis is spread from person to person. A person gets syphilis from direct contact with a syphilis sore on the body of an infected person. Sores occur at the site of infection, mainly on the external genitals, vagina, anus, or rectum. Sores can also be on the lips and in the mouth.

Transmission occurs during vaginal, anal, or oral sex. An infected pregnant woman can also pass the disease to her unborn child. Syphilis cannot be spread by contact with toilet seats, door knobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the signs and symptoms of syphilis in adults?

Without treatment, syphilis in adults progresses through four stages:

• Primary
• Secondary
• Latent (hidden)
• Tertiary (late)

An infected person can easily pass the disease to a sex partner when first- or second-stage symptoms are present.

The first stage (primary syphilis) is marked by a very infectious sore, called a chancre [shan-ker]. The chancre is usually firm, round, small, and painless. It appears at the spot where the bacteria entered the body. Chancres last 1 to 5 weeks and heal on their own.

Without treatment, the spread of the bacteria through the blood causes the second stage (secondary syphilis), which is characterized by a rash that usually does not itch. The rash can appear as the chancre is fading, or it can be delayed up to 10 weeks. It often appears as rough, "copper penny" spots on the palms of the hands and bottom of the feet. It can also look like prickly heat or appear as small blotches, a bad case of acne, moist warts in the groin, slimy white patches in the mouth, coin-sized dark circles, or chickenpox-like bumps. Other symptoms are fever, swollen glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. Second-stage signs and symptoms last 2 to 6 weeks and clear up on their own.

If untreated, the infection progresses to a latent (hidden) stage during which symptoms disappear and the disease is no longer contagious. The bacteria remain in the body, though, and can begin to damage vital organs.

In about a third of untreated persons, the results of the internal damage show up years later in the late (tertiary) stage. Symptoms include paralysis, inability to coordinate movements, inability to feel pain, gradual blindness, dementia (madness) or other personality changes, impotence, blockage or ballooning of the heart vessels, tumors, damage to knee joints, and deep sores on the feet. The damage may be serious enough to cause death.

How soon after exposure do signs and symptoms appear in adults?

The time between exposure and the start of the first symptom can range from 10 days to 90 days (average 21 days).

What are the signs and symptoms of syphilis in newborns?

Syphilis during pregnancy affects unborn babies and newborns. A pregnant woman with syphilis has about a 40% chance of having a stillbirth or a baby who dies shortly after birth. A baby who survives may be born with syphilis. This is called congenital syphilis.

A baby born to a mother with either untreated syphilis or syphilis treated after the 34th week of pregnancy has a 40% to 70% chance of having congenital syphilis. Some babies with congenital syphilis have no symptoms at birth but develop them in a few weeks if not treated immediately. Some babies are born with very serious health problems including skin sores, a very runny nose that is sometimes bloody (and infectious), slimy patches in the mouth, inflamed arms and legs, swollen liver, anemia, jaundice, pneumonia, or a small head. Untreated babies can develop mental retardation or have seizures. About 12% of infected newborns die from the disease.

How is syphilis diagnosed?

Syphilis bacteria can be detected by examining material from infectious sores under a microscope. A safe, accurate, and inexpensive blood test is also available. The test can detect syphilis antibodies produced by the body shortly after infection occurs. A low level of antibodies will stay in the blood for months or years after the disease has been treated and can be found by later blood tests.

Who is at risk for syphilis?

Anyone is at risk for syphilis during sexual contact with an infected person or a person whose syphilis status is not known. Babies born to infected women are also at risk.

What is the relationship between syphilis and HIV infection?

The health problems caused by syphilis in adults and newborns are serious themselves. In addition, the genital sores caused by syphilis in adults make it easier to transmit and acquire HIV infection sexually. Areas with the highest rates of syphilis in the United States have some of the fastest growing HIV infection rates in childbearing women.

What is the treatment for syphilis?

One dose of the antibiotic penicillin will cure a person who has had syphilis for less than a year. More doses are needed to cure someone who has had it for longer. A baby born with the disease needs daily penicillin treatment for 10 days.

Persons who receive syphilis treatment must not have sex with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so they can receive treatment, too.

Penicillin treatment will kill the syphilis bacteria and prevent further damage, but it will not repair any damage already done. Also, having had syphilis does not protect a person from getting it again.

How common is syphilis?

Syphilis rates tend to go up and down. In the United States, new cases of syphilis are now at their lowest rate in 40 years. In 1996, no new cases were reported in more than 70% of U.S. counties. The cases that do occur are concentrated in a few places -- Washington, D.C., Baltimore, Richmond, and several other cities and counties, especially in the South. More cases likely occur each year than are reported to health officials.

Is syphilis a re-emerging infectious disease?

It can be. Syphilis rates increase and decrease in the United States depending on the intensity of prevention programs and on changes in sexual risk-taking and drug use. A rapid rise in cases in the late 1980s was due to changing sexual habits caused by widespread use of drugs such as crack cocaine. Current high rates in some parts of the country result from the combined effect of poverty, drug use, and lax efforts to control STDs.

How can syphilis be prevented?

Two persons who know they are not infected and who have no other sex partners besides each other cannot get syphilis. Other sexually active persons should take precautions to prevent infection:

• Know your sex partners well. Do not have sex with anyone who has genital sores.
• Use condoms. Only laboratory tests can confirm someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it is not obvious by looking if a partner has syphilis. A latex condom put on the penis before beginning sex and worn until the penis is withdrawn is a good defense against infection. Syphilis cannot be prevented by washing the genitals, urinating, or douching after sex.
• See a health-care provider at the first sign of infection. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to seek health care right away. Notify all sex partners immediately so that they can seek care, too.
• If you are pregnant, get a prenatal blood test. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have questions about the disease described above, consult a health-care provider.

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