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Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. Syphilis infection occurs in stages, called primary, secondary, early latent and late latent. Each stage has different kinds of symptoms.

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.

Although syphilis is much less common than chlamydia and gonorrhea, syphilis rates have been increasing in BC over the past 15 years. Most recent syphilis cases have occurred among men who have sex with men.

Causes

Syphilis is passed between sexual partners through skin-to-skin contact with an open syphilis sore during oral, anal or vaginal (frontal) sex. Syphilis can also be passed from a pregnant person to the baby.

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, secondary and early latent stages are infectious. Often people do not know they have syphilis because they do not notice any symptoms. If left untreated, syphilis can progress to a late stage and cause serious health problems.

Primary stage: A painless sore (chancre) can develop where syphilis entered the body. Often the sore will not be noticeable, but if there is a sore then it increases the chances of getting or passing HIV. The sore usually occurs anywhere from 3 to 90 days after contact. The sore happens most often 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 getting syphilis. 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 or vagina.

Latent or Hidden Stage: If syphilis is not treated, it progresses to a latent, or hidden, 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, when a person got syphilis within the last year, and late latent syphilis. Like all the early stages, early latent syphilis is highly infectious.

Complications

  • 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.
  • Congenital Syphilis: Pregnant people can pass syphilis to an unborn child, resulting in stillbirth, pre-term birth, and abnormalities in the baby.

Tests and Diagnosis

Syphilis is diagnosed with blood tests. Fluid from sores can also be swabbed. Most test results are accurate three weeks after contact to syphilis, but it can take as long as three months.

Treatment

Syphilis is treated with a special type of penicillin. A different antibiotic treatment is available if the person is allergic to penicillin. Antibiotic treatment can cure syphilis, although it will not undo the damage caused by syphilis in the late stage.

After treatment, follow-up blood tests are done at six and 12 months, then every six months for two years to make sure that the antibiotic treatment worked. Testing is done more often if a person has HIV. 

Treatment for Partners

If you have syphilis, you will be asked about who you had sex with in the past 3 to 12 months. This is because syphilis is a reportable infection. Anyone you have had sex with will need to be tested and treated. Partners are almost always given medication whether they have symptoms or not. If you have not had sex in the past 3 months (90 days), your last partner should be tested.

There are a few different ways you can tell partners about STI testing. Some people want to tell partners in person, others prefer to tell partners anonymously. Talk to your health care provider about what ways might work best for you.

Avoid Re-infection or Prolonging Infection

It takes time for an infection to be cleared from the body, so it is important that you do not have oral, vaginal (frontal) and anal sex for 14 days after you and your partners start the antibiotic treatment. If you or your partners do not finish the treatment or miss pills, the infection may be passed back to you or your partners and may cause health problems later on. If that happens, talk with your health care provider to see if you or your partners need more treatment.

Resources

BC Centre for Disease Control – Syphilis
Syphistory.ca – The BC Centre for Disease Control's syphilis information website
HealthLink BC – Syphilis
CATIE – Syphilis

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