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Sexually transmitted infections (STIs) affect millions in the United States each year, and many go undetected. If left untreated, serious complications can occur.

Protecting yourself begins with understanding how to prevent and identify STIs. There are eight common STIs, and one that is on the rise is syphilis.

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What Is Syphilis?

Syphilis is a bacterial infection usually spread through sexual contact. The bacteria Treponema pallidum is transmitted by contact with sores.

There are four stages: primary, secondary, latent, and tertiary. The infection can be cured, but early detection and treatment are critical.

“It is important for people to understand how to protect themselves, identify signs of syphilis, and seek care should they become infected,” says Ciara Shank, CNM, obstetrics and gynecology specialist, UPMC Obstetrics & Gynecology Specialists-North Harrisburg. She says she has seen an increase in patients with syphilis in the past year.

Listen to our podcast to learn more about syphilis

How Is Syphilis Transmitted?

A syphilis infection can be active or inactive, but direct contact with a sore during vaginal, anal, or oral sex allows transmission of the infection.

The incubation period, or time between exposure to the virus and the first symptom, can occur anywhere from three weeks to three months. A person is highly contagious and can easily pass the infection to intimate partners when primary- or secondary-stage sores are present. Often, sores are hidden within the vagina or rectum, but they also may appear in the mouth, on the lips, or in the throat.

But sexual intercourse is not the only way to contract syphilis. Women can infect their unborn babies during pregnancy and delivery, which is known as congenital syphilis.

Congenital syphilis can lead to lower birth weight and increase the risk of delivering a stillborn baby. An infected baby may have no symptoms until weeks later, although some develop a rash on their hands or feet. Left untreated, an infected baby can suffer hearing loss, teeth or facial deformities, seizures, and death.

The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force strongly recommend that pregnant women be screened to avoid infecting or having a child born with congenital syphilis. Screening should be done:

  • At the first prenatal visit for all pregnant women.
  • During the third trimester and again at delivery for pregnant women who have an increased risk for syphilis.

Stages and Symptoms of Syphilis

Syphilis has four stages: primary, secondary, latent, and tertiary. Different signs and symptoms are associated with each.

  • Primary syphilis generally begins with a sore at the original site of infection. These sores, called chancres, are typically found in, on, or around the genitals, anus, rectum, or mouth. These sores are usually firm, round, and painless.
  • Secondary syphilis symptoms occur four to eight weeks later. They typically start with a non-itchy skin rash on one or more parts of the body. Other symptoms can include swollen lymph nodes and fever. The signs and symptoms may disappear, come and go, remain mild, or even go unnoticed.
  • Latent syphilis is the next stage if an infected person goes untreated. Also known as the hidden stage, it can last years and present no visible signs or symptoms, especially early on. This stage still responds rapidly to treatment if identified.
  • Tertiary syphilis is the final stage and is associated with severe medical problems. Symptoms can occur many years after the original infection. It can affect the heart, brain, and other organs of the body. Cardiovascular syphilis can affect the aorta and cause damage to other blood vessels. Neurosyphilis, which occurs when syphilis spreads to the central nervous system, can cause memory problems, headaches, or personality changes, and can even lead to meningitis.

Diagnosis and Treatment of Syphilis

Before making a diagnosis and recommending a treatment plan, your doctor will conduct a medical history and physical exam. You may be asked the following questions to determine your plan of care:

  • Do you think you have been exposed to any STIs?
  • What are your symptoms?
  • Do you have sores in your genital area or anywhere else on your body?
  • Do you or your partner engage in risky behaviors, such as having sex without a condom or having more than one sex partner?
  • Have you had an STI in the past?

The physical exam may include:

  • Examination of the skin and mouth to look for rashes or other abnormalities.
  • A pelvic exam to look for abnormal sores in the vagina or on the vulva, labia, rectal area, and inner thighs.
  • A genital exam to look for sores around the penis and scrotal area.

A diagnosis usually is confirmed with one of several blood tests. A technique called dark-field examination uses a microscope to see whether syphilis bacteria are present.

“If you learn you have syphilis, it is important to alert your sexual partner(s) so they can also seek treatment,” Shank says. “Taking precautionary measures and treating the infection early are important to maintaining your reproductive health.”

Syphilis is easy to cure in its early stages with a single injection of penicillin, or another antibiotic if you are allergic. A single injection can often stop the disease from progressing. But if you have had syphilis for longer than a year, more doses may be needed. Treatment does not guarantee that any damage from the infection can be reversed.

After treatment, it is important to follow up with your provider. To ensure your treatment is successful and to avoid additional risks, you may be asked to do the following:

  • Have regular blood tests and exams.
  • Avoid sexual contact until your treatment is complete.
  • Notify your sexual partner(s) to encourage testing and treatment, if necessary.
  • Test for HIV.

Syphilis Risk and Prevention

Any sexually active person can contract an STI through unprotected vaginal, anal, or oral intercourse. It’s important to discuss your lifestyle and risks with your health care provider.

Currently, no vaccine exists to prevent syphilis. But you can help avoid spreading the infection by following three important recommendations:

  • Abstain from sex. The only specific way to avoid syphilis is to abstain from sexual intercourse, including oral sex.
  • Practice monogamy. Choosing to engage in any sexual act with only one person reduces your risk.
  • Use a latex condom. Condoms can reduce your risk of contracting many sexual diseases, particularly if the condom covers a syphilis sore. But sometimes sores cannot be covered by a condom. Even if the infection is not active, it can still spread.

If you are experiencing the symptoms of syphilis, it’s important for you to see a health care provider as soon as possible. Visit our website to find a provider near you.

About Infectious Diseases

If you have a disease caused by bacteria, fungi, parasite, or virus, the UPMC Center for Care of Infectious Diseases can help. Our team of experts is specially trained in the prevention and treatment of infectious diseases, including of HIV-AIDs, postsurgical and transplant infections, illnesses caused by international travel, and more. We research infectious diseases and participate in clinical trials to learn more and develop better treatment and prevention methods. Visit our website to find an expert near you.