What is syphilis?

Syphilis is an STI, or sexually transmitted infection. It's caused by the bacterium Treponema pallidum. You may know STIs by the name STD, or sexually transmitted disease.

Syphilis is most commonly passed on through sexual contact. It affects both men and women. It's easy to pass on to sexual partners and can cause permanent damage if left untreated.

Causes

Syphilis is a bacterial infection most often spread through unprotected sex (sex without a condom or other barrier in place). An infected person who doesn't seek out treatment can spread the infection even without showing symptoms. Untreated syphilis can cause long-term health problems throughout the whole body. This includes problems with the kidneys, brain, eyes, liver and nervous system.

Risk Factors

Anyone who has sex runs the risk of contracting syphilis. But you may be more likely to contract syphilis if you:

  • Have unprotected or unsafe sex
  • Have sex with multiple partners, especially partners who are not tested for STIs regularly
  • Are a man who has sex with men
  • Are infected with HIV
  • Have a partner who has been diagnosed with syphilis
  • Use illicit drugs

Symptoms and How It Works

Syphilis is different from other STIs, like chlamydia or gonorrhea. It's unique because it occurs in stages.

There are four main stages of syphilis.

Primary syphilis: The first sign of syphilis is a painless sore (chancre) on the genitals, rectum, anus, or mouth that occurs on average 2-3 weeks after infection occurs. It is usually a small, red bump that progresses to an ulceration. It's easy to miss this stage, because the chancre may appear within the vagina or anus, and is painless-so goes unnoticed. Some people also experience swollen lymph nodes in this stage.

Secondary syphilis: A few weeks after the chancre heals, you may develop a red or brown rash. It usually begins on the trunk or torso, then spreads to the rest of the body, including hands and feet. The rash usually isn't itchy. It may come and go repeatedly during the secondary stage of syphilis, that can last months. In light-skinned people, these sores appear dark. In dark-skinned people, they may appear lighter than the skin. fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue” are also experienced, according to CDC. Fever, swollen lymph nodes, fatigue, muscle aches, joint aches, and headaches are additional common symptoms during secondary syphilis. Some persons also experience hair loss, weight loss, dizziness, visual problems, confusion, or wart like lesions in the mouth or genital area.

Latent syphilis: Latent syphilis generally occurs weeks to months after secondary syphilis. It is a time when untreated infection remains in your body, but you no longer feel the symptoms like rash, fever, fatigue, and joint aches that occured in secondary syphilis. You may not feel ill at all, but you can still spread the infection to others. A healthcare provider can order a blood draw, to see that you have been infected previously (this blood draw can also be ordered during primary and secondary syphilis, though occasionally in primary syphilis the infection is too early to see in your blood. Occasionally, you can relapse from latent syphilis, to experience symptoms of secondary syphilis again.

Tertiary/late syphilis: This is the most serious stage of syphilis and causes the most lasting damage. It may not present until many years after the untreated syphilis infection occurred. It is estimated that up to 4 out of 10 people who are infected with syphilis will develop tertiary syphilis. In this stage, syphilis may damage the "brain, nerves, eyes, heart, blood vessels, liver, bones, and joints." (Mayo Clinic) It may develop into neurosyphilis, which can cause severe headache, problems coordinating movement, paralysis, numbness, confusion, memory problems, dementia, and even death.

Common Syphilis Treatment

The good news is-syphilis is curable. Antibiotics are the best treatment for bacterial infection, including syphilis. Penicillin is the most commonly prescribed antibiotic for treating syphilis. But if you’re allergic to - or have negative side effects from - penicillin, there are other options. Other antibiotics used to treat syphilis include doxycycline and tetracycline.


Chlamydia treatment

Fortunately, Chlamydia is easily treated with antibiotics. Azithromycin and doxycycline are antibiotics that are effective at treating chlamydia. Duration of antibiotics may be one day, or for one week, depending on which antibiotic you are prescribed.

It’s important to not have sex until you and your current sexual partner/s have also finished treatment. You should avoid having sex for seven days afterwards. This is important for the infection to be fully cured in both people before resuming sexual activity. If it is not, you risk becoming reinfected.. Ask your healthcare professional when it’s safe to have sex again.

Remember that if you’ve been treated for chlamydia, you can still get infected again. For this reason, it is recommended that persons who test positive for chlamydia, have repeat testing in 3 months, to ensure they have not contracted the infection again.

What is the treatment for syphilis if you can't have antibiotics?

There is no common medicine for syphilis other than antibiotics. If you cannot have antibiotics, your doctor may recommend a penicillin desensitization treatment. This is a specialized process that allows you to take penicillin-even if you have been allergic to it in the past.

When to speak to a doctor

Syphilis diagnosis and treatment is important for keeping you healthy, because untreated syphilis can have severe long-term health problems. If you repeatedly have risk factors and /or unprotected sex, you should consider testing for syphilis at regular time intervals-especially because symptoms of initial infection can be easily missed. Online syphilis treatment will likely include drawing your blood to check for the infection, and getting you antibiotic treatment if you are infected. Your online provider can send orders for lab work to a lab located near you, and coordinate treatment in a location near you, as well. If you do not have a known allergy to penicillin, then the recommended treatment for primary, secondary, and latent syphilis is an injection of penicillin antibiotic into your muscle, usually done in the thigh or buttox area. Patients with tertiary syphilis are treated with intravenous antibiotic infusions. Often these patients are quite ill, and treated in the hospital.

You can get a full STI check online when you schedule an appointment with one of our Babylon primary care doctors. Simply download the app and create an account today.

Prevention

Prevent and manage syphilis with these precautions:

  • Always use a condom or a dental dam when you have sex. Transmission can occur during vaginal, oral, and anal intercourse.
  • Visit a healthcare provider for regular STI screenings. Provider visits are safe, confidential, and non judgemental. Providers welcome the opportunity to discuss your concerns because they want to keep you healthy!
  • Ask your partner(s) to be tested for STIs
  • Avoid sexual contact until treatment has been completed to prevent spreading
  • Avoid sharing sex toys

FAQs

How do you know if you have syphilis?

The most common symptom for primary stage syphilis is a painless sore (called a chancre) on your genitals, rectum, or mouth. It differs from similar STIs, like herpes, because there is usually only one sore.

If you suspect you have syphilis, it's best to get a professional opinion. You can get an online STI diagnosis, including a genital or oral syphilis diagnosis, by scheduling a virtual doctor appointment through the Babylon app.

How can you get syphilis?

The most common way syphilis spreads is through vaginal, anal, or oral sex. Chancres usually show up on the genitals, anus, rectum, or mouth.

Is syphilis only transmitted sexually?

Like most sexually transmitted infections, syphilis is mainly spread through sexual contact. Less commonly, syphilis can be spread through direct contact with an unprotected active sore. This can include kissing someone with oral chancres. It can also spread from an infected mother to an unborn baby (congenital syphilis).

When do syphilis symptoms appear?

The primary stage syphilis chancre usually appears about three weeks after infection, but it can appear anywhere from 10-90 days after exposure. The sore commonly lasts for about three to six weeks before healing. The second, more noticeable stage, usually develops between two and eight weeks after the chancre heals.

What does a syphilis sore look like?

Syphilis sores or chancres are usually firm, round, and painless, but they may look slightly different for each person. The lymph nodes around the chancre may also swell.

What does syphilis do to your body?

Without appropriate treatment, syphilis remains in the body until you die. With each stage, the damage gets more severe. Even without symptoms, your sexual partners can still pick up syphilis from you.

What are the stages of syphilis?

  • Primary syphilis symptoms - painless sore on genital, painless sore on roof of mouth
  • Secondary syphilis symptoms (a few weeks after sores appear)- whole body rash (bumpy, red or brown, and non-itchy ), mucus membrane lesions, hair loss, aching muscles and joints, low grade fever, swollen lymph nodes, sore throat
  • Latent syphilis symptoms - none, possible relapse into secondary symptoms
  • Tertiary syphilis symptoms (10-30 years after the primary infection) - damage to major systems, including the nerves, brain, eyes, blood vessels, heart, liver, kidneys, bones, joints

Can you cure syphilis?

Yes. Syphilis can be cured at any stage, but early treatment prevents further damage. Primary and secondary syphilis treatment can be as simple as one shot of penicillin. Late stage or latent syphilis treatment involves more injections than early treatment.

Curing syphilis does not undo any damage the infection has already done. It's always better to seek treatment as soon as you suspect you have syphilis, or have regular screening if you have risks for infection.

Does syphilis go away without treatment?

No. Syphilis is dangerous because it cannot be cured without appropriate antibiotic treatment. It simply enters a latent stage, and can reemerge decades later. Long term complications of syphilis can include tumors that damage organs, many neurological problems, heart problems including heart failure, increased risk of HIV infection, and pregnancy complications for both the mother and infant.

What kind of doctor treats syphilis?

There are many places to get STI testing and treatment. A convenient, and nonjudgmental place to start is at Babylon. Your telemedicine healthcare provider can discuss your risks and symptoms. If needed, a lab near you can be located for an order sent by your provider for testing. Your results will be sent back to your provider, and you will have a follow up consult to discuss them. If positive, your provider can help arrange for you to be referred to a local area for the antibiotic injection.

Can syphilis be treated with antibiotics?

Yes, antibiotics are the necessary treatment for syphilis. Your healthcare provider and team can help arrange for treatment near you.

How do doctors treat syphilis?

Your doctor will help arrange for you to have antibiotics by injection (the “shot” is injected in your thigh or buttox area). Usually, only 1 shot is needed. Occasionally, a series of injections is needed weekly for a few weeks.

Most doctors diagnose syphilis through a blood test. Fluid from an initial chancre can also be tested. While it is possible to get treatment coordinated for online prescriptions for syphilis medication online, blood tests are often a part of the treatment plan.

How long is syphilis treatment?

Syphilis treatment time varies, depending on what stage is being treated. Primary, secondary, and latent stage syphilis can usually be cured in one shot of penicillin. Treating tertiary syphilis, or syphilis in pregnancy, can require a longer course of treatment and weekly shots of penicillin.

How long is syphilis contagious after treatment?

To ensure that syphilis is completely cured, you need to follow the whole treatment plan provided by your healthcare team. Your healthcare provider may want to do additional blood tests to ensure cure, or check for reinfection from a subsequent sexual encounter. Refrain from sexual activity until your doctor tells you it is safe to resume this.

Can syphilis return after treatment?

Once treated, syphilis will be cured. However, it is possible to get syphilis again from an infected partner. Be aware of your potential risks related to syphilis and other STIs, and use a condom when you have sex to prevent infection. Ask your healthcare provider if you have questions or concerns, or think you should be tested.

How do you prevent syphilis?

The only way to completely avoid any STI is to avoid having any form of sex. However, there are other ways to massively decrease your risk. When you do have sex, use a dental dam/condom (follow the CDC guidelines for properly wearing a male condom here). Get regularly tested for STIs if you are at risk, and make sure your partner(s) also get tested if they are at risk. Having sex with multiple partners will increase your risk. If you have any questions or concerns, ask your healthcare provider.

The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.