Source: CDC
Factsheet :: Last Reviewed January 2008
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What is syphilis?
Syphilis is a 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.
How common is syphilis?
In the United States, health officials reported over 36,000
cases of syphilis in 2006, including 9,756 cases of primary
and secondary (P&S) syphilis. In 2006, half of all P&S
syphilis cases were reported from 20 counties and 2 cities;
and most P&S syphilis cases occurred in persons 20 to 39
years of age. The incidence of P&S syphilis was highest
in women 20 to 24 years of age and in men 35 to 39 years of
age. Reported cases of congenital syphilis in newborns increased
from 2005 to 2006, with 339 new cases reported in 2005 compared
to 349 cases in 2006.
Between 2005 and 2006, the number of reported P&S syphilis
cases increased 11.8 percent. P&S rates have increased in
males each year between 2000 and 2006 from 2.6 to 5.7 and among
females between 2004 and 2006. In 2006, 64% of the
reported P&S syphilis cases were among men who have sex
with men (MSM).
How do people get syphilis?
Syphilis is passed from person to person through direct contact
with a syphilis sore. Sores occur mainly on the external genitals,
vagina, anus, or in the rectum. Sores also can occur on the
lips and in the mouth. Transmission of the organism occurs during
vaginal, anal, or oral sex. Pregnant
women with the disease can pass it to the babies they are
carrying. Syphilis cannot be spread through contact with toilet
seats, doorknobs, swimming pools, hot tubs, bathtubs, shared
clothing, or eating utensils.
What are the signs and symptoms in adults?
Many people infected with syphilis do not have any symptoms
for years, yet remain at risk for late complications if they
are not treated. Although transmission occurs from persons with
sores who are in the primary or secondary stage, many of these
sores are unrecognized. Thus, transmission may occur from persons
who are unaware of their infection.
Primary Stage
The primary stage of syphilis is usually marked by the appearance
of a single sore (called a chancre), but there may be multiple
sores. The time between infection with syphilis and the start
of the first symptom can range from 10 to 90 days (average 21
days). The chancre is usually firm, round, small, and painless.
It appears at the spot where syphilis entered the body. The
chancre lasts 3 to 6 weeks, and it heals without treatment.
However, if adequate treatment is not administered, the infection
progresses to the secondary stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary
stage. This stage typically starts with the development of a
rash on one or more areas of the body. The rash usually does
not cause itching. Rashes associated with secondary syphilis
can appear as the chancre is healing or several weeks after
the chancre has healed. The characteristic rash of secondary
syphilis may appear as rough, red, or reddish brown spots both
on the palms of the hands and the bottoms of the feet. However,
rashes with a different appearance may occur on other parts
of the body, sometimes resembling rashes caused by other diseases.
Sometimes rashes associated with secondary syphilis are so faint
that they are not noticed. In addition to rashes, symptoms of
secondary syphilis may include fever, swollen lymph glands,
sore throat, patchy hair loss, headaches, weight loss, muscle
aches, and fatigue. The signs and symptoms of secondary syphilis
will resolve with or without treatment, but without treatment,
the infection will progress to the latent and possibly late
stages of disease.
Late and Latent Stages
The latent (hidden) stage of syphilis begins when primary and
secondary symptoms disappear. Without treatment, the infected
person will continue to have syphilis even though there are
no signs or symptoms; infection remains in the body. This latent
stage can last for years. The late stages of syphilis
can develop in about 15% of people who have not been treated
for syphilis, and can appear 10 – 20 years after infection
was first acquired. In the late stages of syphilis, the
disease may subsequently damage the internal organs, including
the brain, nerves, eyes, heart, blood vessels, liver, bones,
and joints. Signs and symptoms of the late stage of syphilis
include difficulty coordinating muscle movements, paralysis,
numbness, gradual blindness, and dementia. This damage may be
serious enough to cause death.
How does syphilis affect a pregnant woman and her baby?
The syphilis bacterium can infect the baby of a woman during
her pregnancy.
Depending on how long a pregnant woman has been infected, she
may have a high risk of having a stillbirth (a baby born dead)
or of giving birth to a baby who dies shortly after birth. An
infected baby may be born without signs or symptoms of disease.
However, if not treated immediately, the baby may develop serious
problems within a few weeks. Untreated babies may become developmentally
delayed, have seizures, or die.
How is syphilis diagnosed?
Some health care providers can diagnose syphilis by examining
material from a chancre (infectious sore) using a special microscope
called a dark-field microscope. If syphilis bacteria are present
in the sore, they will show up when observed through the microscope.
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 likely
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.
What is link between syphilis and HIV?
Genital sores (chancres) caused by syphilis make it easier
to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased
risk of acquiring HIV if exposed to that infection when syphilis
is present.
Ulcerative STDs that cause sores, ulcers, or breaks in the
skin or mucous membranes, such as syphilis, disrupt barriers
that provide protection against infections. The genital ulcers
caused by syphilis can bleed easily, and when they come into
contact with oral and rectal mucosa during sex, increase the
infectiousness of and susceptibility to HIV. Having other STDs
is also an important predictor for becoming HIV infected because
STDs are a marker for behaviors associated with HIV transmission.
What is the treatment for syphilis?
Syphilis is easy to cure in its early stages. A single intramuscular
injection of penicillin, an antibiotic, will cure a person who
has had syphilis for less than a year. Additional doses are
needed to treat someone who has had syphilis for longer than
a year. For people who are allergic to penicillin, other antibiotics
are available to treat syphilis. There are no home remedies
or over-the-counter drugs that will cure syphilis. Treatment
will kill the syphilis bacterium and prevent further damage,
but it will not repair damage already done.
Because effective treatment is available, it is important
that persons be screened for syphilis on an on-going basis if
their sexual behaviors put them at risk for STDs.
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 receive treatment if necessary.
Will syphilis recur?
Having syphilis once does not protect a person from getting
it again. Following successful treatment, people can still be
susceptible to re-infection. Only laboratory 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. Talking with a health care
provider will help to determine the need to be re-tested for
syphilis after being treated.
How can syphilis be prevented?
The surest way to avoid transmission of sexually transmitted
diseases, including syphilis, is to abstain from sexual contact
or to be in a long-term mutually monogamous relationship with
a partner who has been tested and is known to be uninfected.
Avoiding alcohol and drug use may also help prevent transmission
of syphilis because these activities may lead to risky sexual
behavior. It is important that sex partners talk to each other
about their HIV status and history of other STDs so that preventive
action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male
and female genital areas that are covered or protected by a
latex condom, as well as in areas that are not covered. Correct
and consistent use of latex condoms can reduce the risk of syphilis,
as well as genital
herpes and chancroid, only when the infected area or site
of potential exposure is protected.
Condoms lubricated with spermicides (especially Nonoxynol-9
or N-9) are no more effective than other lubricated condoms
in protecting against the transmission of STDs. Use of condoms
lubricated with N-9 is not recommended for STD/HIV prevention.
Transmission of an STD, including syphilis cannot be prevented
by washing the genitals, urinating, and/or douching after sex.
Any unusual discharge, sore, or rash, particularly in the groin
area, should be a signal to refrain from having sex and to see
a doctor immediately.
Where can I get more information?
NYSDOH Web Site: http://www.health.state.ny.us/diseases/communicable/std/syphilis.htm
CDC Web site
Sexually Transmitted Diseases - Home Page
Syphilis - Topic Page
STDs
and Pregnancy - Fact Sheet
Order Publications Online
STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348
In English, en Español
Resources:
CDC
National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
Sources:
Centers for Disease Control
and Prevention. Sexually transmitted diseases treatment guidelines
2006. MMWR 2006;55(no. RR-11).
Centers
for Disease Control and Prevention. Sexually Transmitted Disease
Surveillance, 2006. Atlanta, GA: U.S. Department of Health
and Human Service, November 2007.
K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually
Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999,
chapters 33-37.
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