Syphilis

What is syphilis?

Syphilis is a bacterial sexually transmissible infection (STI). Syphilis can affect anyone who is sexually active. It can be passed on whether your sexual partner/s are the same sex as you or a different sex.

How do you get syphilis?

Syphilis is mainly passed on during sexual skin-to-skin contact with someone who has syphilis. Sexual skin-to-skin contact may be during genital-to-genital contact, vaginal, anal or oral sex. Syphilis can also be passed on by touching the genitals with fingers (if infection on hand) or sharing sex toys.

Syphilis is usually passed on through direct contact with a sore, known as a chancre. Chancres can occur on the genital skin or surrounding skin (vulva, penis, scrotum, buttocks, anus and upper thighs), vagina, cervix (top part of vagina), rectum (anal passage) and in or around the mouth. You may not notice a chancre as it is often painless and may be on a hidden part of the body.

Syphilis is also passed on through sexual contact when a person with syphilis has a rash.

Syphilis can affect anyone who is sexually active. It can be passed on whether your sexual partner/s are the same sex as you or a different sex.

Syphilis can also be passed on from a pregnant person to the baby in the uterus (womb).

How would I know if I have syphilis?

Regular STI testing is the best way to know if you have syphilis.

Most people with syphilis do not know because they do not have symptoms, do not notice symptoms or believe the symptoms to be a different illness.

There are four stages of syphilis infection: – primary, secondary, latent and tertiary syphilis. There are different symptoms associated with each stage. The timing of each stage and associated symptoms vary between people.

The symptoms of syphilis can come and go over time – but the infection will still be there and can still be passed on in the primary, secondary and latent stages.

Syphilis stages and symptoms some people may have:

Primary syphilis

Usually develops 3 – 4 weeks (but up to 3 months) after infection.

• The appearance of a chancre (sore) – you may not notice the chancre as it is often painless and maybe on a hidden part of the body.
• The chancre will heal itself – with or without treatment.

Secondary syphilis

Usually begins 2 – 4 months after infection. Symptoms can come and go.

• Rough, red, spotty rash – usually on the back, chest, hands and feet.
• Sores in the mouth, vagina, or anus.
• Fever.
• Tiredness
• Headache.
• Sore throat.
• Swelling of the lymph glands.
• Muscle aches.
• Hair loss.
• Wart-like lumps around the genital area, underarms and/or mouth.

Latent syphilis

Can last for years.

• No visible signs or symptoms.
• You are still infectious within the first 12 – 24 months.

Tertiary syphilis

Begins 1 – 30 years after initial infection, in around one third of people who do not have treatment.

• Skin lesions.
• Disease in multiple organ systems (brain, nervous system, eyes, heart, blood vessels, liver, bones, joints).
• You are no longer infectious.

What does a test involve?

Testing for syphilis involves a blood test (usually from your arm) taken in a clinic which is sent to be processed at a laboratory. The blood test checks for syphilis antibodies – proteins that the immune system makes in response to syphilis infection. It can take up to 3 months after infection for a blood test to detect antibodies to syphilis. The time between infection to a positive blood test is called the window period.

If your test result is negative and you have been at risk of syphilis or have symptoms, you may need to repeat the test in a couple of weeks.

If your test result is positive, you have either a current or past infection. You may need another blood test to confirm you have syphilis.

If you have symptoms (e.g. a sore or rash), your doctor or nurse will examine your body and use a cotton swab to collect a sample from the sore or rash.

You may choose to test for other STIs or BBVs at the same time as testing for syphilis. More information on STI and BBV testing

Sexual Health Victoria (SHV) provides expert, confidential STI and BBV testing to Victorians. We also provide expert information, healthcare and support on a range of reproductive and sexual health matters. For more information on SHV clinical services, see our clinics or you can book an appointment online.

How is syphilis treated?

Syphilis is treated with antibiotics. This is usually a single dose of penicillin given in two injections. Treatment of non-infectious syphilis (late latent or tertiary) will require additional (more) injections of penicillin.

Around 6 – 12 hours after treatment for syphilis, you may experience fever, headache, tiredness, rigors and joint pains that lasts for several hours. Rest and pain medications can be used to relieve symptoms. Speak to your doctor or nurse for more information.

It is recommended you have repeat blood tests at 3, 6 and 12 months after you have finished your treatment, to check the treatment has worked.

It is recommended you avoid sexual contact or use barrier protection (external condoms, internal condoms or dental dams) until your sore/s and rash have resolved (cleared up) and for 7 days after you (and your current sexual partner/s) have finished treatment.

Where do I get treatment?

Your doctor or nurse will give you the antibiotics or a script which you can take to the pharmacy. You cannot buy medications to treat syphilis over the counter without a script. You will need to return to the clinic to have the injection.

What if I do not get treated?

Syphilis can cause serious health complications if not treated.

Without treatment, tertiary syphilis can happen years after initial infection and cause disease in multiple organ systems (brain, nervous system, eyes, heart, blood vessels, liver, bones and joints).

Untreated syphilis during pregnancy can cause serious health complications for both you and your baby.

If you do not get treated for syphilis, you can pass the infection to your sexual partner/s — even if you do not have symptoms.

Having syphilis can increase the risk of getting or spreading other sexually transmissible infections.

Will syphilis come back?

Syphilis is cured by effective treatment, but you do not develop any immunity. It is possible to get another syphilis infection.

To avoid being reinfected with syphilis it is recommended you avoid sexual contact or use barrier protection (external condoms, internal condoms or dental dams) until your sore/s and rash have resolved (cleared up) and for 7 days after you (and your current sexual partner/s) have finished treatment.

Safer sex, including STI testing is the best way to lower your risk of getting syphilis.

Do I need to let my sexual partner/s know I have syphilis?

If you have been diagnosed with syphilis it is recommended you let your sexual partner/s know so they can make informed decisions about ways to lower the risk of passing it on and be tested and treated if needed. If your current sexual partner/s are not treated, you could end up with syphilis again.

Depending on the stage of your syphilis infection, it is recommended you contact any sexual partner/s you have had as follows:

• Primary syphilis: 3 months plus duration of symptoms.
• Secondary syphilis: 6 months plus duration of symptoms.
• Late latent syphilis: long term partner/s only.

There are some great websites to support you informing your sexual partners via a phone call, text message, letter or email. There are ways of doing this either personally or anonymously.

• Let Them Know
• The Drama Downunder – for men who have sex with men
• Better to know – for Aboriginal and Torres Strait Islander people

Your doctor or nurse can assist with informing your current or previous sexual partners.

What should I do if a sexual partner has been diagnosed with an STI or a BBV?

You may be notified that a sexual partner of yours has been diagnosed with an STI or a BBV. Notification may be in person or via a phone call, text message, letter or email. You too may have an infection and be unaware as you may not have symptoms. See your doctor or nurse to discuss ways to lower the chances of passing it on, get tested and treated.

Will syphilis affect my pregnancy or breastfeeding?

People who are pregnant or breastfeeding can be infected with the same STIs and BBVs as people who are not pregnant or breastfeeding.

If you are infected with an STI or BBV during pregnancy it can cause serious health complications for both you and your baby. Complications can include:

• Infection in the uterus (womb) after birth.
• Passing the infection to the baby (during pregnancy, birth or breastfeeding) causing health conditions.
• Miscarriage.
• Premature (early) birth.

If you are planning a pregnancy or already pregnant, it is recommended you and your sexual partner/s have other STI and BBV screening tests, even if you have been tested in the past. Syphilis testing should be part of a routine antenatal screen. You can speak to your doctor, nurse or midwife for more information.

If you are pregnant or breastfeeding and considering treatment for an STI or BBV, ask your doctor, nurse or midwife about the possible effects of the treatment on your baby or breastfeeding. Syphilis treatment is usually safe to take while pregnant or breastfeeding.

How can I lower my risk of getting STIs and BBVs?

You can lower your risk of getting STIs and BBVs by using barrier protection (external condoms, internal condoms or dental dams) correctly during any type of sex (vaginal, anal or oral sex) and when sharing sex toys.

Barrier protection is not 100% effective at preventing STIs and BBVs.

You can also lower your risk of getting a BBV by:

• not sharing injecting equipment, razors, nail clippers
• only getting tattoos and piercing in regulated places
• talking to your doctor or nurse about HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) if you are at risk of HIV exposure.

You can also lower your risk of getting an STI or BBV by both you and your sexual partners having regular STI and BBV testing. To get an STI or BBV test at Sexual Health Victoria, see our clinics or you can book an appointment online.

Where to get more information and support

• Sexual Health Victoria
• Better Health Channel
• The Centre Clinic – a safe and friendly general practice, providing care for LGBTI community members as well as specialist medical care for people living with HIV, and expert sexual health screening and treatment.
• DirectLine 1800 888 236 – support for people affected by alcohol and other drugs including information on where to obtain new needles and syringes.
• Equinox – for transgender services
• Headspace – for young people
• Melbourne Sexual Health Centre – a specialist sexual health clinic.
• Minus 18 – for young lesbian, gay, bisexual, transgender and intersex (LGBTI) people.
• Multicultural Centre for Women’s Health – for culturally and linguistically diverse women.
• PRONTO! – a peer-led service for men who have sex with men.
• Thorne Harbour Health (formerly Victorian AIDS Council)
• TouchBase – information, support and services for LGBTI people.
• A doctor or nurse.
• Your local community health service

If you are using the internet for information, only use reliable and reputable websites. Be aware of websites containing inaccurate and harmful information and imagery.