Syphilis

Most people with syphilis don't notice any symptoms, so they don't know they have it. The symptoms also change over time, and they may come and go.

Syphilis usually has 3 stages.

Ten days to 3 months after infection with syphilis, you may notice a small, painless sore or ulcer. It's typically on one of these places:

• penis
• vagina
• anus
• rectum
• tongue
• lips

You might have only 1 sore, but you can have more. Swelling in your lymph glands (such as in the neck, groin or armpit) often happens with the ulcers.

The sore will then disappear within 2 to 6 weeks. If left untreated, syphilis will move into its second stage.

Symptoms of secondary syphilis begin a few weeks after the original sore disappears.

Common symptoms of secondary syphilis include:

• a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet
• tiredness
• headaches
• swollen lymph glands

Less common symptoms include:

• fever
• weight loss
• patchy hair loss
• joint pains

These symptoms may disappear within a few weeks, or they may come and go for a few months.

After that, syphilis moves into a stage where you have no symptoms at all. You're still infected during this stage, and it's called "latent syphilis". You can still pass the infection on during the first year of this stage. After a couple of years, you can't pass it to others, even though you remain infected. During this stage, though, a mother can still pass the infection to her unborn child during pregnancy.

The latent stage can go on for many years (even decades) after you first become infected. Without treatment, there is a risk that latent syphilis will move on to the more serious stage, tertiary syphilis.

Tertiary syphilis, the third stage of syphilis, can show up years or even decades after the first infection. About 1 in 3 people who don't get treated for syphilis go on to develop serious symptoms.

What you notice depends on where in the body the infection spreads. It may reach the brain, nerves, eyes, heart, bones, skin or blood vessels, and it can cause any of these:

• stroke
• dementia
• loss of co-ordination
• numbness
• paralysis
• blindness
• deafness
• heart disease
• skin rashes

At this stage, syphilis can be dangerous enough to cause death.

The only reliable way to find out whether you have syphilis is a blood test. Usually the sample goes to a laboratory for analysis. In some sexual health services, though, a same day test can be done if you have symptoms.

Antibiotics treat syphilis, and that includes during pregnancy. You may be given them as an injection, tablets or capsules.

Treatment can be started before your test result is known. Depending on the stage of the infection, you may be given one or more doses.

You'll need to go back to your doctor or a sexual health clinic 6 and 12 weeks after starting treatment, so you can be tested again.

Avoid having sex until you and your partner(s) have finished treatment and your tests show that it has worked. This includes oral sex and sex using a condom.

Your partner should be tested for syphilis too. In its early stages the infection can be hard to spot, so they might not know they have it. They will generally be offered treatment regardless.

If you're pregnant and have syphilis, you can pass the infection on to your baby before they're born. This is called congenital syphilis.

Having syphilis during pregnancy can raise the risk of:

• miscarriage
• premature birth
• stillbirth

You can get syphilis through unprotected vaginal, anal or oral sex (sex without a condom). Around one third of all people who get syphilis catch it through unprotected oral sex, with no other vaginal or anal sex involved. You can also catch it by coming into contact with an ulcer on your partner's penis, vagina, anus or inside their mouth.

Syphilis can also be passed on:

• to an unborn baby during pregnancy (congenital syphilis)
• by injecting drugs with a needle that's been used by someone who has syphilis
• during a blood or organ transplant (this is extremely rare in the UK, where all blood and organ donations are checked for syphilis)

Syphilis also makes HIV easier to pass on and catch.

The number of people getting syphilis in Scotland has greatly increased over the last 5 years. You could be at higher risk if you:

• are a man who has sex with men
• have had sex overseas
• have had multiple sexual partners

The best way to lower your risk of sexually transmitted infections (STIs), syphilis included, is to practise safer sex. That means using a condom every time you have vaginal, anal or oral sex.

If you have been diagnosed with syphilis, you should get tested for all STIs, including:

• HIV
• chlamydia
• gonorrhoea

Syphilis happens more often in people living with HIV, so you should be offered an HIV test. If you've been diagnosed with syphilis and nobody has offered you one, you can:

• speak to your doctor about getting tested for HIV

An HIV test while you have syphilis can help with early diagnosis and treatment, and it can help stop you passing HIV on.