You Really Need to Know

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Syphilis Testing

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms of syphilis are indistinguishable from those of other diseases.

How Common Is Syphilis?

In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities and most occurred in people between 20 to 39 years of age. The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis (present since birth) in newborns increased from 2005 to 2006. 339 new cases were reported in 2005, compared to 349 cases in 2006.

How Do People Get Syphilis?

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infections.

Primary Stage

The primary stage of syphilis is usually marked by the appearance of a single sore (chancre), although there may be multiple sores. The time between the initial infection and the appearance of the first symptom can range from 10 to 90 days (with the average being 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage

Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed.This characteristic rash may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Signs and symptoms will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of the disease.

Latent and Late Stages

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10 to 20 years after the infection was first acquired. In the late stages of syphilis, the disease may damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stageinclude difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

How Is Syphilis Diagnosed?

A blood test is one way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly killthe developing baby, every pregnant woman should have a blood test for syphilis.

What Is the Link Between Syphilis and HIV?

Chancres caused by syphilis make it easier to transmit and acquire anHIV infection sexually. It is estimated that the risk of acquiring HIV if exposed to that infection when syphilis is present increases 2 to 5 times.

Ulcerative STDs like syphilis cause sores, ulcers, or breaks in the skin or mucous membranes; they disrupt barriers that provide protection against infections. Chancres can bleed easily and, when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.

What Is the Treatment for Syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had the infection for less than a year. Additional doses are needed to treat someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure this disease. Note that treatment will kill the syphilis bacteria and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

People who receive treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. People with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Will Syphilis Recur?

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sexual partner has this infection. Talking with a health care provider will help to determine the need to be re-tested after completing treatment.

How Can Syphilis Be Prevented?

The most surefire way to avoid transmission of STDs, including syphilis, is to abstain from sexual contact or to be in a long-term, mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission because these activities may lead to risky sexual behavior. It is important that sexual partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken, if needed.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9, or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention. Transmission of an STD, including syphilis, cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to go get tested immediately.

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