Syphilis is a bacterial infection spread through sexual interactions. It’s relatively rare, with about 200,000 Americans reporting the infection each year.

How Is Syphilis Spread?

Syphilis is caused by a bacterium called Treponema pallidum, and is normally transmitted through contact with an infected person's chancre (sore) during sexual activity. The bacteria can enter your body through minor cuts or abrasions in the skin or mucous membranes like the mouth, nasal passages, and vagina.

Syphilis is most contagious during the first and secondary stages, but can sometimes spread during the early latent period. Be sure to ask your partner about this STI before having sex or kissing (awkward we know, but syphilis can be transmitted by someone who isn’t suffering from symptoms and many times chancres are located on a person’s tongue or inside their mouth).

Syphilis can also be passed onto babies through the placenta or during childbirth if mom has syphilis.

If you’ve been cured of syphilis, the infection doesn’t come back on its own, but you can be reinfected if you have contact with someone who has syphilis.

Thankfully, you can not  get or spread the infection by sharing clothes or utensils, touching doorknobs, swimming in pools or hot tubs, or using the same bathroom as someone with syphilis.

Lowering Your Risk of Infection

You’re likely to contract this infection if you engage in unprotected sex, have sex with multiple partners, or if you or your partner have HIV since syphilis chancres make it easier to transmit and acquire HIV infection sexually. In fact, you have a 2- to 5-fold increased risk of transmitting or getting HIV if exposed to syphilis when sores are present because they can bleed easily, offering an easy way for HIV to enter your bloodstream during sexual activity.

Reduce your risk of getting syphilis by limiting yourself to one mutually monogamous sexual partner, abstinence, getting yourself and your partner tested before sex, and using latex condoms each time you have sex.

Syphilis Signs and Symptoms

Unlike most other sexually transmitted infections, syphilis develops in stages.

Stage one of syphilis: The first sign is a small sore, called a chancre, that appears at the spot where the bacteria entered your body. They’re normally painless and hidden within the vagina, rectum, or mouth so you may not notice it developing.

Typically chancres show up about three weeks after exposure. You may only get one chancre or you might have several pop up. Within three to six weeks, chancres will heal on their own.

Secondary syphilis: A few weeks after the original chancre heals, a rash will develop on your abdomen and eventually cover your entire body, including the palms of your hands and the soles of your feet.

This rash isn’t typically itchy, but may be followed by wart-like sores in your mouth or genital area.

In a small population of people, stage two of syphilis includes hair loss, muscle aches, a fever, a sore throat, and swollen lymph nodes. These specific symptoms may disappear in a few weeks or repeatedly resurface for up to a year.

Latent syphilis: If you’re not treated for the infection in the secondary stage, syphilis moves into the latent or hidden stage where symptoms disappear—this stage can last for multiple years. Your symptoms may or may not return, or it may progress to the tertiary stage.

Tertiary syphilis: If left untreated, Syphilis has a 15%-30% chance of progressing to late or tertiary syphilis and developing complications. In this stage, the disease may damage your brain, nerves, eyes, heart, bones, joints, blood vessels, and liver. These problems may occur many years after the original, untreated infection.

Neurosyphilis: At any stage in the infection, syphilis can spread and damage the brain and nervous system (neurosyphilis), as well as your eyes (ocular syphilis).

Congenital syphilis: If you’re pregnant and have untreated syphilis, your baby may become infected through the placenta or during birth. Most newborns with congenital syphilis don’t have symptoms, but some experience a rash on the palms of their hands and the soles of their feet. Later in life, these babies may suffer from deafness, teeth deformities, and saddle nose (where the bridge of the nose collapses).

Babies with syphilis can also be born prematurely, stillborn (born dead), or die after birth.

Complications

Without early treatment, syphilis can cause a myriad of issues like small bumps or tumors called gummas. These tumors can develop on your skin, bones, liver, or any other organ in the late stage of syphilis. Thankfully, antibiotics can treat this issue.

Untreated syphilis can also result in neurological problems like headaches, stroke, hearing loss, bladder incontinence, dementia, loss of pain and temperature sensations, blindness, meningitis, impotence, cardiovascular problems, aneurysm, and damaged heart valves.

When To Test for Syphilis?

If you experience any unusual discharge, sores, or rashes, particularly in the groin area, or any of the other above-mentioned symptoms, it’s time to contact your doctor to get tested.

STD Testing

While there are over-the-counter kits available to test for syphilis, doctors can offer screening through the testing below:

1. Rapid plasma reagin (RPR): This is a blood test that looks for antibodies to the syphilis bacteria.
2. Venereal disease research laboratory (VDRL): This is a test that uses blood or spinal fluid to check for syphilis antibodies.
3. Rapid immunochromatographic test: This test is a rapid, in office version of RPR testing

If one of these tests is administered and comes back positive, more testing is required to rule out or confirm a syphilis diagnosis.

Treatment Options

In the first stage of the infection, syphilis is easy to cure with an antibiotic such as penicillin. In the second and third stages, penicillin can still be used, but additional doses of the medicine may be necessary.

The first day you receive treatment you may experience what's known as the Jarisch-Herxheimer reaction. Signs and symptoms include a fever, chills, nausea, body aches, and a headache. This reaction usually doesn't last more than one day.

After treatment, your doctor may ask you to get periodic blood tests and exams to make sure you're responding to the usual dosage of antibiotics. You may also be asked to avoid sexual contact with new partners until the treatment is completed and notify your current and previous partners so they can be tested for the infection and treated. An HIV test may also be recommended after finishing your antibiotics.