What is Syphilis?
Syphilis is a bacterial sexually transmitted infection (STI) that affects many
organs / systems of the body. It is usually transmitted during condomless
vaginal, oral or anal sex. It can also be passed on from direct contact with
your partner’s genitals, even if there is no penetration or ejaculation. Mothers
with untreated syphilis can pass the infection on to their unborn child or baby
during labour and this can cause catastrophic consequences, therefore most
pregnant women are offered a syphilis screening test early during
pregnancy.
How does it affect you?
Syphilis often does not cause any symptoms at all and is commonly only
picked up from a blood test. If a person does develop symptoms these
depend on the stage, as there are several stages of syphilitic infection. In
between these stages the person remains symptom free.
Primary syphilis: a red lump or firm ulcer (chancre) appears at the site where
syphilis enters the body (penis, vagina, or anus, or in the rectum, lips, or in the
mouth) Because the sore is painless, it can easily go unnoticed. This chancre
appears within three months of becoming infected, is highly infectious, and
can be accompanied with swelling of local lymph glands. It resolves by itself,
without treatment after 3 to 6 weeks.
Secondary syphilis commonly causes a general body rash, lymph gland
swelling in the neck, groin or armpits, a flu like illness, fevers, patchy alopecia
(hair loss), sore throat, headaches, weight loss, muscle aches, tiredness, warty
lumps on the genitals and mucous membrane changes (superficial sores in
your mouth, vagina, or anus). The spotty rash is red, or reddish brown and
usually appears on the trunk, the palms and/or soles of the feet. It may not be
itchy. Less commonly a person can develop meningitis, hearing loss or eye
involvement. These often appear within the first 6 months of infection.
The signs and symptoms of primary and secondary syphilis can be mild, and
they might not be noticed. Without the right treatment, the infection will
move to the latent and possibly tertiary stages of syphilis.
Latent stage is usually a period where the infected person has no symptoms
or signs, often for many years. Most people with untreated syphilis do not
develop tertiary syphilis.
Tertiary syphilis, is the most serious stage of syphilis and can occur many years
after infection (10-30 yrs). It can affect many different organ systems: heart
and blood vessels, bones, skin, brain and nervous system (paralysis,
dementia) and the results may be life threatening.
Diagnosis
Syphilis can be identified from a simple blood test. In a sexual health clinic, in
those with ulcers or mucous membrane lesions, a swab can also be taken
that can allow the organism to be seen under the microscope. This provides
an immediate diagnosis and enables treatment to be given immediately.
Another highly sensitive swab can be sent off to the laboratory too.
It can take up to three months after acquiring syphilis for a blood test to
become positive so if you test within three months from the last sexual
contact, and the test is negative, it is advisable to re-test at a later date.
Treatment
If you test positive for syphilis for the first time via SHL we may ask you to
attend a local sexual health clinic for further syphilis testing and/or treatment.
After treatment follow-up syphilis testing will be recommended at periodic
intervals to ensure the infection has been adequately treated. Treatment is
fairly straightforward, and involves an injection of penicillin or a course of
antibiotic tablets. The length of treatment depends on the stage of infection.
People who have had syphilis before
Previous successful treatment for syphilis doesn't make you immune to
acquiring syphilis again but, some screening tests will always remain positive
and you may have to undergo a different syphilis test (eg RPR) to see if you
have become re-infected or if the initial infection has been inadequately
treated. At SHL we ask on your kit-order form if you have had a history of
syphilis before and adapt our testing protocol accordingly to ensure you
receive the right type of test. One of our SHL team may call you if your syphilis
test comes back positive/reactive. At this point we will ask you if/when you
last had syphilis, what treatment you received, what clinic treatment was
given at and what your last blood test results (RPR) were. Depending on your
answers, you may be referred to clinic for further tests and may require
treatment as well. Otherwise the SHL team may suggest no clinic referral is
required and no further action. It is always helpful for you to keep any
treatment information about syphilis for future reference, to avoid being
referred back to sexual health clinic unnecessarily for further tests or repeat
treatment. This includes the date and name/type of treatment received and
your last RPR readings.
Contacting partners
If you are diagnosed and treated for syphilis you will need to inform previous
sexual partners. How far back you go in contacting previous partners (look
back period) depends on the stage of infection and your last negative
syphilis test result (if you have ever had one). The SHL team and your sexual
health clinic doctor/nurse will advise you accordingly.
Your sexual contacts should be advised to get tested for syphilis. Your partner
can test through SHL if they wish to but will need to obtain treatment in a
clinic.
Informing, testing and treating partners is really important because it helps
prevent you from becoming re-infected again and minimises onward
transmission to other partners.
Some partners may be given syphilis treatment at the same time as being
tested (ie before their test results are available). This is called epidemiological
treatment and can be obtained from clinic.
If you feel unable to inform previous sexual partners one of our Health
Advisers will be able to notify them on your behalf without revealing your
identity.
Maintaining good sexual health and prevention
You should not have oral, anal or vaginal sex for a certain period of time after
you have started treatment (your clinic will advise you accordingly) and, also
until your current partner completes their treatment and until both you and
your partner’s symptoms have abated. This is to avoid being re-infected and
requiring further treatment.
It is possible you may also have acquired another STI. Therefore, it is advisable
that you have a full sexual health screen for gonorrhoea, chlamydia, LGV,
hepatitis B and C, and HIV. Consider having another STI screen three months
later because there is a higher risk of acquiring a further STI (eg HIV) over the
next year.
Use condoms to help prevent transmission of syphilis. Be aware that infectious
sores occur in areas not covered by a condom and transmission can
therefore still take place. Encourage every partner to test for STIs.
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