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Syphilis alternates between times when it is active and inactive. When syphilis is active, there may be symptoms. When the infection is inactive, no symptoms appear even though you still have syphilis.
Syphilis can be cured with antibiotics.
Syphilis rates have been increasing in BC over the past 20 years. Currently, syphilis is most common among men who have sex with men.
You get syphilis through vaginal, oral, and anal sexual contact. This includes both penetrative sex and sexual activities where there is an exchange of body fluids or skin to skin contact. 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.
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.
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.
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 14 days after the start of your treatment. If you do have sex during this time, you could pass syphilis to your sexual partners or get it again. If this happens, talk to your health care provider.
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 6 and 12 months, then every 6 months for 2 years to make sure that the antibiotic treatment worked. Testing is done more often if you are immunocompromised.
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.
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
- 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.
It is a good idea to be tested regularly for STIs, especially if you have new sexual partners or open relationships. Talking with partners about safer sex makes sure everyone knows what to expect. Condoms are great if they work for you – the correct use of condoms reduces your chances of getting and passing syphilis.
HealthLink BC – Information on syphilis in multiple languages
SmartSexResource – If you are worried or have anxiety about syphilis
Trans Care BC – Gender-affirming sexual and reproductive health information
Syphistory.ca – The BC Centre for Disease Control's syphilis information website
CATIE – Information on syphilis (Canada)
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