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Common Signs and Symptoms of Syphilis

What Are the Symptoms of Syphilis?

A syphilis infection passes through four distinct stages, each with different symptoms. These symptoms are often very similar to those of other diseases, making syphilis difficult to identify without testing.

Syphilis can enter the nervous system during any stage of infection, resulting in neurosyphilis and/or ocular syphilis. Neurosyphilis symptoms include dementia, abnormal behavior, headaches, loss of muscle control, paralysis and sensory deficits. Ocular syphilis can cause changes in vision, decreased vision and permanent blindness.

The stages of syphilis are:

Primary Stage

The first stage of syphilis is usually marked by a single syphilitic sore called a chancre that appears a few weeks after initial infection. The chancre is usually found on the genital area, in or around the anus and in or around the mouth, depending on the point of entry. Chancres are typically small, firm, round and painless. There may be multiple chancres marking the beginning of primary syphilis, but they may not be noticed especially if they are located in the vagina or anus. These sores heal in 3 to 6 weeks, with or without treatment.

Secondary Stage

The second stage of syphilis begins with the appearance of skin rashes while the first chancre is healing or several weeks after it has healed. A syphilis rash normally appears on the palms and the bottom of the feet, but doesn’t itch. It is typically made up of rough, red or reddish-brown spots although these can be so faint they aren’t noticed. Syphilis rashes can be found on other parts of the body and look like rashes from other diseases.

Secondary syphilis can also involve wart-like sores in the genitals, armpits and mouth. Some people also experience fevers, headaches, fatigue, swollen lymph nodes, patchy hair loss, sore throat and weight-loss. Secondary syphilis symptoms last several weeks with or without treatment and then resolve on their own.

Latent Stage

The latent stage of syphilis is divided into two parts: early latent syphilis (first year following infection) and late latent syphilis (any time after early latent syphilis but before the final or tertiary stage). Also known as the hidden stage, this phase of syphilis infection shows no symptoms at all and can last several years.

Tertiary Stage

Tertiary syphilis is the final stage of the disease and can appear decades after the initial infection. 15-30% of untreated syphilis infections will reach the tertiary stage. During the tertiary phase, syphilis can attack the brain, nerves, eyes, bones, joints, heart, blood vessels and/or liver with symptoms varying based on the impacted areas.

What is syphilis?

Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Over 100,000 cases of syphilis were reported to the CDC in 2017, with nearly 60% occurring in men who have sex with men. Syphilis can be treated to stop disease progression, but damage done by the infection cannot be undone.

Who is at risk of a syphilis infection?

Every sexually active person is at risk of syphilis, but it is most commonly found in men who have sex with men.

How is syphilis transmitted?

Syphilis is transmitted through direct contact with chancres (syphilitic sores) and most often takes place during oral, anal or vaginal sex. It can also be passed from a pregnant woman to her child.

What is the incubation period of syphilis?

The incubation period of syphilis is typically several weeks, but can be as long as three months.

What are the long-term consequences of an untreated syphilis?

Untreated syphilis can progress through the tertiary stage and ultimately be fatal. Long-term consequences can include damage to the brain, nerves, eyes, bones, joints, heart, blood vessels and/or liver. Syphilis can also cause dementia, abnormal behavior, loss of muscle control, paralysis and other sensory deficits to include permanent blindness and loss of hearing.

How does syphilis impact pregnancy and expectant mothers?

The impact of syphilis on pregnancy varies with the duration of the mother’s infection. Syphilis can be passed to an unborn child but is also very likely to cause stillbirth and early delivery. Without treatment, up to 40% of children born to women with syphilis will be stillborn.

Children born alive to a mother infected with syphilis should be tested immediately for the infection as they may not show signs. Untreated, syphilis can cause seizures, developmental issues and death in infants. Fortunately, taking penicillin during pregnancy following a syphilis diagnosis prevents transmission from mother to child in 98% of cases.

How can I prevent a syphilis infection?

The only ways to completely avoid the risk of syphilis are abstinence or a monogamous relationship with a partner you know is not infected. Consistent and proper condom use can lower the risk of infection but only protects the areas physically covered by the condom. If there are syphilitic sores outside of that area, you can still be infected.

Who should test for syphilis?

Anyone who is sexually active is at risk for syphilis and should test regularly, especially if experiencing symptoms, following unprotected sex, sex with a new partner or if you are in a high risk group. It is important to test yourself if your partner receives a syphilis diagnosis and to tell your partner if you receive one. Otherwise, the infection will continue to spread.

How is a syphilis test administered?

A syphilis test uses a finger prick to collect a blood sample. The sample is analyzed either for the presence of syphilis or the absence. Typically, both methods are used to confirm a diagnosis.

Is syphilis curable?

Syphilis can be cured with penicillin, but penicillin will not undo any damage done by the progression of the disease before treatment. Syphilis is treated with a shot of Benzathine penicillin if the infection has not reached the late latent stage. Late latent syphilis and syphilis where duration is unknown is treated with three shots of Benzathine penicillin with one week between shots. Neurosyphilis and ocular syphilis are treated with a shot every 4 hours or a continuous infusion for 10-14 days. All sexual contact should be avoided until every syphilis sore has completely healed.

Is a syphilis reinfection possible?

It is possible to be reinfected with syphilis, especially if your partner has not been tested and treated. Retesting is recommended 3 months after treatment to ensure the infection is gone.

What Happens If I Test Positive?

If you test positive, instruction will be provided on how to obtain a free telemedicine consultation with a physician in your state. This physician may be able to prescribe treatment for Chlamydia, Gonorrhea or Trich. Depending on the infection, you may also need to retest after treatment to confirm the infection is gone. 

It is crucial that you inform your sexual partners of your test results, whether they’re positive or negative. Sharing this information will help stop the spread of any infection and will allow your partners to seek testing and treatment immediately if necessary. 

Keep testing. Just because you’ve tested once does not mean that you shouldn’t test again. In fact, it’s common to get infected with certain STDs, including chlamydia and gonorrhea, multiple times. myLAB Box recommends that you test every few months, especially if you’ve received a positive result in the past.