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Syphilis

Definition

Syphilis is infection with the bacteria Treponema pallidum.

Alternative Names

Lues; Cupid's disease; Syph

Causes, incidence, and risk factors

Syphilis is a sexually-transmitted infectious disease. The bacteria that cause it spread through broken skin or mucous membranes.

Pregnant mothers infected with the disease can pass it to the baby developing in their womb. This is called congenital syphilis.

Syphilis is widespread in the United States. It mainly affects sexually active adults ages 20 to 29.

Syphilis has several stages.

  • Primary syphilis is the first stage. Painless sores ( chancres) form at the site of infection about 2-3 weeks after you are first infected. You may not notice the sores or any symptoms, particularly if the sores are inside the rectum or cervix. The sores disappear in about 4-6 weeks, even without treatment. The bacteria become dormant (inactive) in your system at this stage. For more specific information about this type of syphilis, see primary syphilis.
  • Secondary syphilis occurs about 2-8 weeks after the first sores form. About 33% of those who do not have their primary syphilis treated will develop this second stage. These symptoms will often also go away without treatment and again, the bacteria become dormant (inactive) in your system. For more specific information about this type of syphilis, see secondary syphilis.
  • Tertiary syphilis is the final stage of syphilis. The infection spreads to the brain, nervous system, heart, skin, and bones. The dormant bacteria may be detectable either by seeing the damage they cause to a part of the body, or through a blood test for syphilis. For more specific information about this type of syphilis, see tertiary syphilis.

Symptoms

The symptoms of syphilis depend on the stage of the disease. Many people do not have symptoms.

In general, painless sores and swollen lymph nodes are possible symptoms of primary syphilis. Those with secondary syphilis may also have fever, fatigue, rash, aches and pains, and loss of appetite, among other symptoms. Tertiary syphilis causes heart, brain, and nervous system problems.

For more information, see the article on the specific stage of syphilis.

Signs and tests

Blood tests can be done to detect substances produced by the bacteria that cause syphilis. The older test is the VDRL test. Other blood tests may include RPR and FTA-ABS.

Treatment

Antibiotics are an effective treatment for syphilis. The antibiotic of choice is penicillin. The dose and how it's given (into a muscle or into a vein) depend on the stage of syphilis. Doxycycline may be used as an alternative treatment in individuals who are allergic to penicillin.

Several hours after treatment of early stages of syphilis, you may have a reaction called Jarish-Herxheimer reaction. Symptoms of this reaction include:

  • Chills
  • Fever
  • General feeling of being ill
  • General joint aches
  • General muscle aches
  • Headache
  • Nausea
  • Rash

These symptoms usually disappear within 24 hours.

You must have follow-up blood tests at 3, 6, 12, and 24 months to make sure the infection is gone. You should avoid sexual conduct until two follow-up tests show that the infection has been cured. Syphilis is extremely contagious through sexual contact in the primary and secondary stages.

Syphilis is a reportable infection. That means that doctors must report any cases of syphilis to public health authorities, so that potentially infected sexual partners may be identified and treated.

Expectations (prognosis)

With prompt treatment and follow-up care, syphilis can be cured.

Late-stage syphilis can lead to long-term health problems, despite therapy.

Complications

Complications of untreated syphilis include:

  • Damage to the skin and bones
  • Heart and blood vessel problems, including inflammation and aneurysms of the aorta
  • Neurosyphilis

Calling your health care provider

Notify your health care provider if you develop signs or symptoms of syphilis. Several conditions may have similar symptoms, so you will need to have a complete medical exam.

Also call your health care provider if you have had sexual contact with someone who has syphilis.

Prevention

If you are sexually active, practice safe sex and always use condoms.

All pregnant women, people with HIV, and others at increased risk for having syphilis should be screened for syphilis.

References

Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 340.

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med 2004; 2: 362-365.


Review Date: 5/30/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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