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STD - Syphilis

What is syphilis?
Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. The number of syphilis cases in Wisconsin have been decreasing, yet syphilis prevention remains an important objective because of the serious consequences of untreated or inadequately treated syphilis and its role as a potential risk factor for HIV infection and transmission. Wisconsin is currently involved in the National Plan to Eliminate Syphilis.Top of Page

Who gets syphilis?

Anyone who is sexually active can get syphilis, but those at greater risk include:
Persons diagnosed with any STD
Persons with a sex partner diagnosed with any STD
Persons with more than one sex partner
Persons with a new sex partner
Persons who exchange sex for money or drugsTop of Page

How is syphilis spread?
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the penis, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission occurs during vaginal, anal, or oral sex. The bacteria pass through intact mucous membranes and abraded skin; they are then carried by the blood stream to every organ in the body. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.Top of Page

What are the signs and symptoms in adults?
The course of syphilis is divided into three stages, each with different signs and symptoms.
Primary Syphilis - Primary syphilis is the most infectious stage of the disease. The time between infection with syphilis and the start of the first symptom can range from 10-90 days (average 21 days). The primary stage of syphilis is usually marked by the appearance of a single sore or lesion (called a chancre), but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Syphilis - The second stage symptoms vary greatly in appearance and may or may not be noticeable. One of the most common symptoms is the development of a body rash. The rash usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, white mucous patches in the mouth or genital area, swollen lymph glands, sore throat, patchy hair loss, nickel or dime size lesions (often on face), headaches, weight loss, wet wart-like growths in the genital area, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.
Late Syphilis - The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death. All cases of syphilis are latent at some time during the course of an untreated infection.Top of Page

Can a newborn get syphilis?
Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly after birth. If not treated immediately, an infected baby may be born without symptoms but could develop them within a few weeks. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.Top of Page

How is syphilis diagnosed?
A health care provider can diagnose syphilis by using dark field microscopy to examine material from infectious sores. If syphilis bacteria are present in the sore, they will show up with a characteristic appearance.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.Top of Page

Is there a cure for syphilis? What is the treatment?
Yes! A single dose of a prescription will cure a person who has had syphilis for less than a year. Larger doses are needed to cure someone who has had it for longer than a year. There are no home remedies or over-the-counter drugs that will cure syphilis. Syphilis can be cured at any stage of infection. The prescription treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested, and, if necessary, receive treatment.Top of Page

What would happen if a person with syphilis did not get treatment?
In untreated syphilis, signs and symptoms range from inapparent to symptoms that indicate severe damage to one or more organ systems in the body including the brain and nervous system; heart and circulatory system; and destructive lesions (gummas) in the skin, bones, brain, or internal organs. Untreated syphilis during pregnancy can lead to miscarriage, stillbirth, and single or multiple organ system manifestations of illness that appear as the child grows. Syphilis can be cured at any stage of infection, but damage that has already occurred cannot be repaired.Top of Page

Will syphilis recur?
Having had syphilis does not protect a person from getting it again. Reinfection with Treponema pallidum, the bacteria that causes syphilis, can occur any time a person is re-exposed.Top of Page

What is the link between syphilis and HIV?
While the health problems caused by syphilis in adults and newborns are serious in their own right, it is now known that the genital sores or lesions caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.Top of Page

How can people protect themselves against infection?
Two people who know that they are not infected and who have sex only with each other cannot contract syphilis. When someone's syphilis status is unknown, a good defense against becoming infected during sex is to use a latex condom before beginning sex and to keep it on until the penis is withdrawn. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. This is equally important for other STDs, including HIV, as well. Only lab tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Washing the genitals, urinating, or douching after sex does not prevent STDs, including syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.Top of Page

Wisconsin Division of Public Health - Bureau of Communicable Diseases -Sexually Transmitted Disease Control Section

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