Syphilis
Syphilis is a bacterial infection that can be passed between people during sexual activity. Syphilis cases have been rising quickly in British Columbia over the past 20 years.
What is Syphilis
Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. Syphilis can be passed during any kind of sexual activity with your mouth, vagina or anus. In some circumstances it can even be passed by deep kissing.
Syphilis alternates between times when it is active and inactive. When syphilis is active, you might have symptoms. When the infection is inactive, you will not have symptoms but you can still pass the infection to others.
Syphilis rates have been increasing in BC over the past 20 years.
Is syphilis curable?
Syphilis can be cured with antibiotics called penicillin. Treatment is usually offered as an injection of a long-acting penicillin (Bicillin) into each hip or buttock muscle.
How would I know if I have syphilis?
It is common to not notice any symptoms if you have syphilis. If you get symptoms, they can include:
- A rash on the chest, back, hands or feet
- A sore on your body that may look like a crater but isn’t very painful.
The best way to know if you have syphilis is to get tested from either a blood test, or a swab taken from sores or rashes if you have them.
Syphilis goes through different stages in your body, from active (having symptoms) to inactive (no symptoms). You can pass Syphilis to someone else in either of these stages.
What should I know about syphilis if I’m pregnant?
Check out the resources below for some great information about Syphilis in pregnancy, developed by the University of British Columbia:
Causes
Syphilis is most commonly spread from contact with a lesion (sore) during oral, anal, or vaginal sex with a person who has the infection. It can also be passed during pregnancy, and sometimes through sexual fluids or a rash. You can get it by sharing sex toys.
Once you have syphilis you can pass it to others even if you don’t have symptoms. You can spread or get syphilis during the primary, secondary and early latent stages.
Symptoms
If you have syphilis, it’s common to not notice any symptoms. Syphilis is known as the great imitator since it appears to be like many other infections or conditions, and is difficult to diagnose.
Syphilis infection occurs in stages: primary, secondary, early latent and late latent. Each stage has different symptoms associated with it.
Primary stage: A painless sore (chancre) can develop where syphilis entered the body. The sore is often not noticeable and usually occurs anywhere from 3 to 90 days after sexual contact. The sore most often appears in the genital area, but may also be on the lips and mouth. The sore will go away on its own within a few weeks, but syphilis will continue to progress.
Secondary stage: A non-itchy rash can develop anywhere from 14 to 90 days after sexual contact. The rash can appear anywhere on the body, but it is most often found on the chest, belly, genitals, palms of the hands and soles of the feet. The rash usually disappears, but it can come back months later. Other symptoms may include headache, fever, hair loss, swollen lymph nodes and bumps or patches inside the mouth, anus, penis/external genitals, or vagina/internal genitals.
Latent Stage: If syphilis is not treated, it progresses to a latent stage. The latent period can last up to 30 years or more, and you may not have symptoms during this time. Latent syphilis has two stages: early latent syphilis (if a person got syphilis within the last year), and late latent syphilis.
Tests and Diagnosis
Testing is usually done with a blood sample or a swab from the sore (chancre) if it is present.
It is best to get tested for syphilis if you:
- have symptoms
- have a sexual partner who has tested positive for syphilis
- are doing routine screening for STIs
- are pregnant
Window Period (how long to wait before testing): Most swab tests are accurate once you have symptoms. Blood tests are the most accurate 90 days after you come in contact with syphilis. In British Columbia, most test results should be ready in 10 days.
What is a false positive syphilis result?
There are three separate tests done for syphilis with your blood sample. Sometimes, a syphilis test can react to something in your system that is from a different infection or condition.
Sometimes, one (or two) tests can show a Positive result, while the other tests are Negative, or Non- Reactive. You will be asked to repeat the blood test in two weeks if this happens. If the result remained the same after the repeat test, it would be considered a False Positive result.
Why is follow-up syphilis testing important after treatment?
It is important to get syphilis blood testing every three to six months after treatment to make sure that the treatment was effective. Repeat blood testing for syphilis will also let us know if there is a new infection so it can be treated as quickly as possible.
After treatment your future blood tests will show that you have antibodies for syphilis, which is your body’s memory of the infection. The number of antibodies should continue to go down over the next year or two.
Will my test results be negative if I had syphilis in the past?
After you have had syphilis, future blood tests will show that you have antibodies, which is your body’s memory of the infection.
Your blood tests will show if you have a new infection or not. This is because each blood sample will have 3 tests performed on it to help get a full picture.
Treatment
Syphilis is treated with prescription antibiotics, usually through injection by a health care provider. It is important to take your medications as directed. If you miss any doses, the infection may not be cured. See your health care provider if this happens or if you still have symptoms after you finish your treatment.
It is important to not have sex (even with a condom) for 7 days after the start of your injection treatment, and to wait after all lesions have fully healed. If you received oral medications (pills) it’s important to wait until you’ve finished taking those pills.
The medications used to treat syphilis are available for free in BC. Talk to your health care provider to see if they have them in stock. If your health care provider doesn’t have the medication in stock, it can be sent to them by the BC Centre for Disease Control.
After treatment, follow-up blood tests are done at 3 and 6 months to make sure that the antibiotic treatment worked. Testing is done more often if you are immunocompromised.
What can I do to help decrease discomfort with syphilis treatment injections?
You might experience discomfort or pain during or after injectable syphilis treatment. Some options to reduce this include:
- Take Acetaminophen and/or Ibuprofen about 30-45 minutes before treatment.
- Bring a support person with you to your appointment for treatment.
- Try to distract yourself during the treatment – feel free to use your phone to read or play a game.
- If you are lying face down for the treatment, point your toes inward to help relax the hip muscles.
- Try to move around as much as possible after the treatment – this will help the medication to move away from the injection site and decrease the discomfort.
- You can take another dose of Acetaminophen 4 hours later, or Ibuprofen 6 hours later.
- Apply ice soon after treatment (this will help to stop more swelling at the injection sites) and heat later in the day (this will help the swelling to move away from the injection sites)
Why does my care provider want me to get treated for syphilis even before I get my results back?
In some cases your care provider will know that there is a pretty high likelihood that you have Syphilis, even before you get test results back.
If you have been told by a sexual partner that they have Syphilis, or if you have a sore or a rash that looks suspicious, your provider will offer treatment at the same time as testing. This helps you to be cured more quickly and decrease the risk of passing it on to others.
I was treated for syphilis, but my partner was not. Can they re-infect me if they tested negative?
It can take up to 3 months after sexual contact for a blood test to show that someone has syphilis, so your partner could still have the infection even if they tested negative. This means that you could be re-infected if you have sex before they are treated.
Sexual Partners
Your sexual partners within the last 3 to 12 months should be tested and treated for syphilis. This will depend on what stage of syphilis you are diagnosed with.
There are a few ways to tell partners. You can tell partners yourself or anonymously. Talk to your health care provider about what is right for you.
How do I know how many partners to notify if I was recently been diagnosed with syphilis?
By looking at your test results, symptoms and medical history, your healthcare provider can get a good idea of how long you may have been infected with syphilis.
- If you are diagnosed with Primary Syphilis, you are considered to have been exposed within three months before your symptoms started. You would be asked to notify your partners in that time frame.
- If your diagnosis is Secondary Syphilis, partners from 6 months before your symptoms started should be notified.
- If you haven’t had a Syphilis test within the last year, you will be asked to notify all partners from the last year to be notified.
If you are diagnosed with syphilis, all sexual partners from the last 3 months will be asked to get treatment as well as testing.
Complications
There are usually no other health problems if you treat syphilis early. If left untreated, it can lead to serious complications including:
- higher chance of getting and passing HIV
- infertility
- Late stage: Untreated syphilis can cause damage to the brain, heart and other organs in the body. Severe cases of the disease can cause death.
- Neurosyphilis: Infection of the central nervous system can occur at any stage. Symptoms may include headache, dizziness, personality changes, balance problems, dementia, vision changes, hearing loss, numbness or weakness in the legs.
Pregnancy: If you are pregnant, you should be screened for syphilis. You can pass syphilis to your child during pregnancy and birth. For more information visit the Syphilis in Pregnancy Resource List.
Prevention
It is a good idea to be tested regularly for STIs, for example, if you have new or casual partners.
Talk with partners about safer sex safer sex, sexual activities or preferences, and STI testing.
Communication can help protect the health of you and your partners, and can help you have positive sexual relationships and experiences.
Condoms or other barrier methods are great if they work for you – the correct use of condoms can reduce your chances of getting and passing syphilis.
Downloadable Guides
Syphilis Information Sheet
A PDF version of the Syphilis topic page on SmartSexResource.
Syphilis: Frequently Asked Questions
A list of common questions about syphilis answered by our nurses in this downloadable resource.