Syphilis

Overview

Syphilis is a common sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum. It spreads through direct contact with a syphilis sore during vaginal, anal, or oral sex. If left untreated, it can cause serious health problems, but it is curable with the right treatment.

Syphilis is less common than some other STIs, but cases have been rising in many parts of the world in recent years. It is important to get tested if you think you might have been exposed.

Anyone who is sexually active can get syphilis. It is more commonly seen in men who have sex with men, but it affects people of all genders, ages, and backgrounds. Pregnant women can also pass it to their baby, which is why routine testing during pregnancy is important.

Symptoms

Common symptoms

• Small, painless sore or ulcer at the site of infection (often on the genitals, anus, or mouth)
• Swollen lymph nodes in the groin or elsewhere
• Skin rash, especially on the palms of the hands or soles of the feet
• Flu-like symptoms such as fever, tiredness, headache, and sore throat
• Patchy hair loss
• Weight loss or muscle aches

Symptoms in children

• In babies born with syphilis, symptoms may include rash, fever, poor feeding, or a runny nose.
• Older children may have symptoms similar to adults, but this is very rare and usually due to sexual abuse or congenital infection.
• Any child with signs of an STI should be seen by a doctor right away.

Symptoms in older adults

• Older adults may not notice early symptoms because the sores can be painless and hidden.
• The infection may be discovered only when a routine blood test is done for another reason.
• Older adults can be at risk if they have new sexual partners and do not use condoms.

Causes

Main causes

• Direct contact with a syphilis sore during vaginal, anal, or oral sex
• Having multiple sexual partners without using condoms
• Transmission from a pregnant woman to her baby during pregnancy or birth

Risk factors

• Not using condoms with new or casual partners
• Having a partner who has tested positive for syphilis or another STI
• Past history of other sexually transmitted infections
• Men who have sex with men
• Living with HIV
• Having sex while under the influence of drugs or alcohol

When to see a doctor

See a doctor urgently if:

• If you have a painless sore on your genitals, anus, or mouth
• If you develop a rash on your hands or feet
• If you are pregnant and think you may have been exposed to syphilis

Book a routine appointment if:

• If you have had unprotected sex with a new or casual partner
• If you have been told by a partner that they have an STI
• As part of a routine sexual health check-up, especially if you have a new partner or multiple partners

Diagnosis

Syphilis is usually diagnosed with a simple blood test that looks for antibodies your body makes to fight the infection. Sometimes your doctor may also take a swab from a sore and send it to the laboratory.

Tests that may be done

• Blood test for syphilis antibodies
• Swab test from a sore (if one is present)
• Sometimes a spinal fluid test (lumbar puncture) if the infection has spread to the nervous system

What to expect at your appointment

The test is quick and does not usually hurt. Your doctor or nurse will explain the results, and if you test positive, they will talk you through the next steps. You may also be offered tests for other STIs, such as HIV, chlamydia, or gonorrhea, at the same time.

Treatment

Syphilis is treated with antibiotics. The exact medicine and length of treatment depend on the stage of the infection. Early treatment is very effective and can cure the infection and prevent long-term damage.

Self-care at home

• Take the full course of antibiotics exactly as prescribed, even if you feel better.
• Avoid all sexual contact until your doctor confirms the infection is fully cured.
• Tell your current and recent partners so they can be tested and treated too.
• Attend all follow-up appointments to make sure the infection is gone.

Medical treatments

Your doctor will prescribe an antibiotic that suits your stage of syphilis. It is usually given as an injection or as tablets. You may need more than one dose. If you are pregnant, it is very important to be treated to protect your baby. Your healthcare provider will choose the safest option for you.

When is surgery considered?

Surgery is rarely needed for syphilis itself. In very rare cases, surgery may be required for damage caused by advanced untreated syphilis, such as a weakened blood vessel (aneurysm) or certain nervous system problems.

Living with this condition

While you are being treated, rest and take care of yourself. Avoid alcohol and recreational drugs, and keep your appointments. Once the infection is cured, most people can return to their normal lives without any long-term effects.

Lifestyle tips

• Use condoms consistently to prevent catching syphilis again.
• Get tested regularly for STIs if you have new or multiple partners.
• Talk openly with your partner(s) about sexual health and testing.

Diet and exercise

There is no special diet for syphilis, but eating a balanced diet and exercising regularly helps keep your immune system strong. During treatment, drink plenty of water and avoid smoking or vaping.

Mental health and emotional wellbeing

A syphilis diagnosis can feel stressful or embarrassing. It is normal to have strong feelings. Remember that this is a common, treatable infection, and seeking help is a responsible step. Talking to a trusted friend or counselor can help you cope.

Prevention

Yes, syphilis can be prevented. The most reliable way is to use condoms correctly during every sexual encounter. Limiting your number of partners and having open conversations about STI testing also reduce your risk.

Vaccines

There is currently no vaccine to prevent syphilis. Prevention relies on condom use, regular testing, and treating infections promptly.

Screening programmes

Screening is recommended if you are pregnant, have a new partner, have had multiple partners, or if you have another STI. Regular screening helps catch syphilis early and stop it from spreading.

Complications

If left untreated

• The infection can hide in the body for years without symptoms.
• Advanced syphilis can damage the brain, nerves, eyes, heart, and blood vessels.
• In pregnant women, untreated syphilis can cause miscarriage, stillbirth, premature birth, or serious illness in the baby.

Long-term outlook

The outlook for syphilis is very good when it is found and treated early. Even in later stages, treatment can stop further damage, although some effects may not be reversible. With the right care and follow-up, most people go on to live full and healthy lives.

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