Syphilis is a sexually transmissible infection (STI) caused by a bacterium called Treponema pallidum
. It can affect both men and women. Syphilis is transmitted through close skin-to-skin contact and is highly contagious when the syphilis sore (chancre) or rash is present.
The incubation period for syphilis ranges from 10 days to three months. You can pick up syphilis through oral, vaginal or anal sex with a person who has recently become infected. Syphilis can also be transmitted from mother to baby during pregnancy and at birth. This is called congenital syphilis and is rare in Australia.
Since 2002, the number of people with infectious syphilis in Victoria has increased rapidly, mainly among gay men and other men who have sex with men.
Early treatment is effective, but people may not have any symptoms or may not notice the symptoms of early syphilis. Sexual health check-ups are recommended for people at risk. The frequency of the check-ups depends on the STI risk of the person. For example, it is recommended that men who have sex with men, who have more than one partner, are checked every three months, whereas a man who has sex with one man, (has one partner) may choose to be checked once a year.
Many years after it is acquired, untreated syphilis can be fatal or may lead to chronic brain or heart disease. Syphilis testing is always done as part of routine antenatal screening when a woman is pregnant.
Syphilis testing is also recommended for women who have sex with men who have male sexual partners. It is also advisable to have a blood test for syphilis if sexual partners are from a country where there are higher rates of sexually transmitted infections and HIV.
Symptoms of syphilis
There are three stages of syphilis. Only the first two stages are infectious and symptoms vary according to the stage. Having symptoms of syphilis can make you more at risk of HIV infection during sexual contact.
Symptoms in first stage of syphilis
The first stage of syphilis (four to 12 weeks) can be missed as there may be no symptoms, or it may occur as a sore (ulcer) on the genital area (including the penis or vagina), anus or the mouth. The sore:
- may not be noticed; in the mouth, rectum or on the vagina or cervix
- is usually painless
- appears three to four weeks after infection – however, it can occur any time between one and 12 weeks after infection
- usually, the sore heals completely within four weeks.
If a person is not treated for syphilis at this stage, they may go on to develop the second stage of the disease.
Symptoms in second stage of syphilis
During the second stage of syphilis (up to two years), there may be:
- a flat, red skin rash on the soles of the feet or palms of the hands, or it may cover the entire body. The rash is contagious and may mimic other common skin conditions such as measles. The diagnosis may be missed if a syphilis blood test is not done
- swollen lymph nodes
- non-specific symptoms and may include hair loss, pain in the joints or flu-like illness.
If you are infected with syphilis and do not seek treatment at this stage, you may develop the third stage of the infection.
Third stage of syphilis
The third stage of syphilis (which may occur five to 20 years after the initial infection) can affect various organs, especially the brain and the heart. This stage occurs in about one third of untreated people. Severe brain or heart complications may occur during this stage. Syphilis is not infectious at this point and is still treatable.
Infants born with congenital syphilis may be asymptomatic at birth. Early congenital syphilis may include symptoms such as a runny nose, skin eruptions, bone abnormalities, eye, liver or kidney problems. Late congenital syphilis, which presents after two years of age, may have a variety of skeletal problems, dental defects, eye problems and deafness. Syphilis is unlikely to be infectious at this time.
How syphilis is spread
Syphilis is spread (transmitted) through close skin-to-skin contact with an infected area. You can catch syphilis by having oral, vaginal or anal sex with a person who is in the first two stages of the infection. Syphilis is highly contagious when the sore or rash is present and direct contact with either can result in syphilis being transmitted from one person to another.
Although rare in Australia, pregnant women who have syphilis can pass on the infection to their unborn baby. It can also be passed through infected blood. However, blood used in blood donations is routinely screened for syphilis in Australia.
Diagnosis of syphilis
A regular sexual health check-up with your local doctor or sexual health centre can detect syphilis using a blood test. If you are a man having sexual contact with other men (including oral sex), it is important to be screened at least twice a year. Just ask your doctor or nurse for a test. Test results are normally available within a week.
Syphilis is easy to detect using:
- a simple blood test
- a swab test, if there are sores present.
Treatment for syphilis
Penicillin is a very effective treatment for all stages of syphilis, including congenital syphilis. Other treatments are available if you are allergic to penicillin, or you may be able to undergo a procedure that safely allows you to be given penicillin.
Treatment early in the infection is needed to help prevent further complications and to avoid passing the infection on to sexual partners.
You should avoid sexual contact until your treatment has finished.
Sexual partner notification
It is important to let your sexual partner or partners know that you have syphilis. Most people appreciate being told they may have an infection and it is an important step in preventing further infection in the community.
Your local doctor and sexual health centre can help you inform your partners. This process is called ‘partner notification’. It can be done anonymously and your confidentiality is always respected.
You can also anonymously notify your sexual partners of the need to get tested and treated for syphilis via www.letthemknow.org.au
website if you feel unable to speak to them personally. The Letting your partner know booklet
(pdf) also contains more information on this topic.
Reduce your risk of infection
Ways you can reduce your risk of catching syphilis include:
- Always have safe sex – use a condom, and water-based lubricant.
- Remember that syphilis may be spread through oral sex.
- If you are a gay man or a man who has sex with other men, get a syphilis test and other STI checks at least yearly, and up to four times a year if you have a number of partners.
- Seek early advice if you notice oral, genital or anal sores, or rashes on your body, hands or feet related to recent sexual contact.
Where to get help
- Your local doctor or nurse
- Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
- Victoria AIDS Council/Gay Men’s Health Centre Tel. (03) 9865 6700 or 1800 134 840
- The Action Centre (for young people 24 years and under) Tel. (03) 9660 4700 or 1800 013 952.
- Family Planning Victoria Tel. (03) 92570100
- Sexual Health Clinic Ballarat Tel. (03) 5338 4500
- Bendigo Community Health Tel. (03) 54481600
Things to remember
- There are three stages of syphilis. The first two stages are infectious.
- Syphilis is curable but, if left untreated, syphilis can lead to serious complications.
- A simple blood test can detect syphilis.
- It is important to let your sexual partner or partners know that you have syphilis. Your local doctor and sexual health centre can help you to do this.