Syphilis

What is syphilis?

Syphilis is a sexually transmissible infection (STI) caused by a bacterium called Treponema pallidum. It can affect anyone.

Syphilis is transmitted through close skin-to-skin contact. It is highly contagious when the syphilis sore (chancre) or rash is present.

The incubation period for syphilis ranges from 10 days to 3 months.

You can pick up syphilis through unprotected oral, vaginal or anal sex with a person who is infected.

Syphilis can also be transmitted from mother to baby during pregnancy and birth. This is called congenital syphilis.

Early treatment of syphilis is effective.

Some people may not seek medical advice because they may not have symptoms or notice early syphilis symptoms.

Untreated syphilis may lead to chronic brain or heart disease and can be fatal.

Victorian syphilis cases are rising

In recent years, the number of people with infectious syphilis in Victoria has increased rapidly, mainly among gay, bisexual and and other men who have sex with men (GBMSM).

However, an increase of syphilis in women (particularly those of reproductive age) has also led to the re-emergence of congenital syphilis (including foetal deaths) in Victoria since 2017.

Who is at risk of syphilis?

All sexually active people are at risk of syphilis infection. Regular sexual health check-ups (at least annually) are recommended for anyone who is sexually active. You are more at risk of syphilis infection if you are:

• gay, bisexual or other man who has sex with men
• a sexual partner of a gay, bisexual or other man who has sex with men
• someone with multiple sexual partners
• a traveller who has returned from countries where syphilis is common
• someone who injects drugs
• Aboriginal and Torres Strait Islander
• a sex worker
• someone who has been diagnosed with another STI (such as HIV, gonorrhoea, chlamydia).

How often to get checked for syphilis

If you are sexually active, get a full sexual health check at least once a year. This includes testing for:

• syphilis
• HIV
• gonorrhoea
• chlamydia.

The frequency of sexual health checks depends on your STI risk:

• Gay, bisexual and other men who have sex with men (GBMSM) and have more than one partner – every 3 to 6 months.
• A man who has sex with another man (has one partner) – once a year.
• Pregnancy – all pregnant people should be tested at least 3 times during their pregnancy: at the first antenatal visit, at 26 to 28 weeks and at 36 weeks or birth (whichever occurs first).

What are the symptoms of syphilis?

There are 3 stages of syphilis.

Only the first 2 stages are infectious, and symptoms vary depending on the stage.

You are also at a higher risk of HIV infection during sexual contact if you have syphilis symptoms.

First (or primary) stage syphilis symptoms

The first stage of syphilis is highly contagious and usually occurs over 4 to 12 weeks.

Some people may not notice they have syphilis because they have no symptoms.

Symptoms usually begin as a sore (ulcer) on the genitals (penis or vagina), anus or mouth.

The sore:

• can appear on areas of sexual contact (such as the mouth, rectum, vagina or cervix)
• is likely to occur as a single sore but may appear as multiple sores
• is usually painless
• may be difficult to notice because it is on hidden areas or painless
• appears 3 to 4 weeks after infection (but it can occur any time between one and 12 weeks)
• usually heals completely within 4 weeks without any treatment.

If you are not treated for syphilis at this stage, you may go on to develop the second stage of the infection.

Second (or secondary) stage syphilis symptoms

The second stage begins around 2 to 4 months after contracting syphilis and (may last up to 2 years).

This is a highly contagious stage. You may experience the following symptoms:

• a flat, red skin rash – on the soles of your feet, palms of your hands, or it may cover your entire body
• swollen lymph nodes
• hair loss (especially of the eyebrows)
• joint pain
• flu-like illness
• the rash may mimic other common skin conditions (such as measles).

Diagnosis may be missed if a syphilis blood test is not done.

If you are infected with syphilis and do not seek treatment, you may develop the third stage of the infection.

Third (or tertiary) stage of syphilis

The third stage of syphilis may occur 10 to 30 years after the initial infection.

This stage affects around one third of untreated people.

It can affect various organs, mainly the brain and heart. Severe complications may occur.

Syphilis is not infectious at this stage but is still treatable.

What is congenital syphilis?

Congenital syphilis occurs when a mother with syphilis passes the infection on to their baby during pregnancy or birth.

Congenital syphilis can have serious health impacts on your baby. This depends on how long you had syphilis and if, or when, you were treated for the infection.

Left untreated, syphilis during pregnancy can cause:

• miscarriage (losing the baby during pregnancy)
• stillbirth (a baby born dead)
• premature labour (a baby born early)
• low birth weight
• death shortly after birth.

Congenital syphilis symptoms in babies

While some babies may have no congenital syphilis symptoms at birth, others may be born with:

• bone deformities
• severe anaemia (low red blood cell count)
• issues with their vital organs (liver and kidneys)
• jaundice (yellowing of the skin or eyes)
• brain and nerve problems (like vision or hearing loss)
• skin rashes.

Early congenital syphilis symptoms (up to 2 years of age) may include:

• a runny nose
• skin eruptions
• bone abnormalities
• eye, liver or kidney problems.

Late congenital syphilis symptoms (which presents after 2 years) may include:

• a variety of skeletal problems
• dental defects
• eye problems
• hearing loss.

How does syphilis spread?

You can catch syphilis by having unprotected oral, vaginal or anal sex with anyone who is in the first 2 stages of the infection.

Syphilis is also spread (transmitted) through close skin-to-skin contact.

Syphilis is highly contagious when the sore or rash is present.

Pregnant people who have syphilis can pass on the infection to their baby during pregnancy or birth.

Syphilis can also be passed through infected blood. However, blood used in blood donations is routinely screened for syphilis in Australia.

How is syphilis diagnosed?

A regular sexual health check-up with your local GP (doctor) can detect syphilis. Just ask your doctor or nurse for a test.

Syphilis is easy to detect using:

• a simple blood test
• a swab test – if there are sores present.

Getting your syphilis test results

Test results are normally available within a week.

How is syphilis treated?

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 desensitisation procedure that safely allows you to be given penicillin.

Early treatment helps to prevent further complications and to avoid passing the infection on to sexual partners or to an unborn baby during pregnancy.

Avoid sexual contact until your treatment is completed.

Although the treatment is straightforward, it is important to repeat blood tests to check that the treatment has worked.

Follow-up blood tests may be recommended at 3, 6 and 12 months after treatment.

Can you get reinfected with syphilis?

Having syphilis once does not protect you from getting it again.

Even after you’ve been successfully treated, you can still be reinfected by having sex with a partner who has syphilis.

Letting partners know you have syphilis

It is important to let all your sexual partners (regular and casual) know that you have syphilis. Most people will appreciate being told they may have an infection.

Letting your partners know will also protect you and your partners from serious health problems. It’s also important in helping to prevent further infection in the community.

You do not have to do this alone. Your (GP) doctor, sexual health centre, Local Public Health Units, or the Department of Health nurses (called Partner Notification Officers) can also help you anonymously notify your partners. The Partner Notification Officers can be contacted on (03) 9096 3367.

This publication outlines the role of Partner Notification Officers (PNOs) at the Department of Health:

Partner notification can also be done anonymously via the Let Them Know website. You can look at tips and send an SMS, email or letter if you feel unable to speak to your partners personally.

Reducing syphilis transmission

Ways to reduce your risk of catching syphilis include:

• Practise safe sex – use condoms and water-based lubricant (lube) for all types of sex. Female (or internal) condoms can also be used for vaginal or anal sex.
• If you are sexually active, get a full sexual health check (including tests for syphilis, HIV, gonorrhoea and chlamydia) at least once a year.
• If you are at greater risk of STIs, get tested regularly. Men who have sex with men get a syphilis test and tests for other STIs at least yearly, and up to 4 times a year if you have several partners.
• Seek early medical advice for oral, genital or anal sores, or rashes that are related to recent sexual contact.
• If you are pregnant or planning a family, you and your partner should have an STI test to prevent any infections being passed onto your baby.
• If you are pregnant, you will require testing for syphilis 3 times at a minimum during your pregnancy.
• Remember, syphilis may be spread through unprotected oral sex.

Where to get help

• Your GP (doctor)
• Your school nurse or welfare coordinator. Some secondary schools provide access to an adolescent health trained GP on site
• Your local community health service
• Your pharmacist
• 1800 My Options – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV) – book an appointment online or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017.
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre Clinic, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health Centre Tel. (03) 9416 2889 or email: equinoxadmin@thorneharbour.org
• PRONTO! Clinic for men who have sex with men. Book online or Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic – book online or Tel. (03) 5338 4541
• Bendigo Community Health Services Sexual and Reproductive Health Hub – book online or Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health – Clinic 35, Wodonga. Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: info@gatewayhealth.org.au
• Sunraysia Community Health Services, Mildura Tel. (03) 5022 5444 or email to: schs@schs.com.au
• Barwon Health Sexual Health Clinic (no GP referral, walk-in service) Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 Tel. 132 660 or Epping: Tel. (03) 8592 3920
• Sexual Assault Crisis Line Tel.1800 806 292

Resources

Information in your language

Find out important information about syphilis, treatment and where to get tested.

Melbourne Sexual Health Centre's Syphilis – get the facts is available as a PDF download from Health Translations Directory:

• Syphilis (English)
• الزهري (Arabic)
• 梅毒 (Chinese simplified)
• 梅毒 (Japanese)
• 매독 (Korean)
• Sífilis (Spanish)
• Syphilis (Tagalog – Filipino)
• โรคซิฟิลิส (Thai)
• Bệnh giang mai (Vietnamese)

Listen to STI and syphilis information in various community languages on allgood.org.au including:

• English
• Aboriginal
• Torres Strait Yumplatok
• Bahasa Indonesia
• Bahasa Melayu
• Burmese
• Chinese simplified
• Dari
• Dinka ee Jieng
• Hindi
• French
• Karen
• Khmer
• Lao
• Pashto
• Punjabi
• Shona chiShona
• Somali Af-Soomaali
• Swahili (Kishwahili)
• Tamil
• Thai
• Urdu
• Vietnamese

Videos – get tested for syphilis