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Don’t forget to test for syphilis!

Syphilis is a sexually transmitted infection caused the bacterium Treponema pallidum.  Although easily treated with antibiotics, it can cause severe long term complications and death if not treated early.

There has been a significant increase in the number of cases of infectious syphilis in BC over the last year. This has predominantly been in the men who have sex with men (MSM) community.

Syphilis is easily transmitted by oral, vaginal or anal sex with an infected person. Often the infected person has no obvious symptoms.

Primary syphilis

The first symptom of syphilis (primary stage) is a painless open sore, or sometimes multiple sores, at the location where the infection entered the body – for example, the penis, anus or mouth. The syphilis sores(s) are often painless, and therefore, they often go unnoticed.

Perianal chancre

Penile chancre

Secondary syphilis

The next stage is called secondary syphilis and the most common symptom is a rash covering a large part the body, often on the palms and soles.  Very few conditions cause rashes on the palms and soles, so you should be suspicious of syphilis if you see a rash on these sites.

Palmar and plantar rash due to syphilis

Generalize body rash due to syphilis

Latent and tertiary syphilis

The symptoms of primary and secondary syphilis occur in the first few weeks after infection and will clear on their own. The syphilis infection then progresses to the latent stage for 10-30 years, after which some cases progress to the third stage (tertiary syphilis). In this stage, the disease damages the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. Symptoms can include difficulty coordinating muscle movements, paralysis, dementia, blindness, and deafness. This damage can eventually lead to death.

Recently, the BCCDC has observed symptoms of neurosyphilis occurring in the early secondary stage of syphilis, rather than in the later teriary stage of syphilis. Symptoms include visual disturbance, headache, weakness and hearing loss.

Syphilis seems to progress faster and complications are more likely if your client is HIV positive. Also, HIV is more easily transmitted in the presence of syphilis.


Frequent testing, based on your client’s risk, is essential.  If symptoms are not present, then a routine “syphilis screening” test is recommended.  If a suspicious sore or rash is present, a “syphilis screen” plus “syphilis confirmatory” testing is required.

Treatment is very effective at killing the bacteria and preventing further damage but will not repair damage already done.

For further information

Canadian STI Guidelines
BC Centre for Disease Control – Syphilis
HealthLinkBC – Syphilis

If you’re a health care provider and need further information about testing, diagnosis and treatment of syphilis, you can contact the BCCDC STI clinic physician phone line at 604-707-5606.


Avril Spencer, Clinical Nursing Educator, Clinical Prevention Services, BCCDC