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Syphilis

What is Syphilis?

Syphilis is a bacterial organism that can cause infection of the skin, blood and organs. The organism is called Treponema Pallidum.
There are a few different Treponema organisms. T. pallidum causes venereal syphilis (sexual), T. pertenue causes yaws (an environmental infection in some developing countries) and T. carateum causes pinta (also an environmental infection in some developing countries).

What bits get infected?

Syphilis infection is categorised into three clinical stages called primary, secondary and tertiary.
In primary infection, the organism infects skin, which has been exposed to the organism. Usually this is the genital skin.
In secondary and tertiary syphilis, the organism travels through the blood to all organs in the body and can infect different parts.

What symptoms does it cause?

In primary syphilis the usual symptom is an ulcer, which is called a chancre, which usually occurs on the skin in the area of infection. This usually occurs 9 to 90 days after exposure. This could be the penis or vagina, and also the mouth or lips and the anus and rectum. The ulcer may occur on any other part of the body too.
The ulcer is typically painless. It may go unnoticed, especially if it is inside the vagina, mouth or rectum.
There is a whole range of atypical (no typical) presentations which may include a red area, a skin split, a rash type lesion or a painful ulcer.
This ulcer is highly infectious. The ulcer will heal by itself without any treatment.
In secondary syphilis there can be a range of symptoms. These usually occur within the 6-12 weeks after exposure but can occur up to two years later. The symptoms can include a rash, fever, unwell, ulcers in the mouth and ano/genital area, lumps around the ano/genital area, baldness and neurological signs. The skin lesions of secondary syphilis are very infectious. This stage will also heal up by itself without any treatment . It is unusual for all the symptoms to occur in one person. Sometimes all that can be seen is a rash.
In tertiary syphilis there can be a range of complex symptoms which can involve the blood vessels, skin and nervous system. This is very uncommon and can occur from 2-40 years after exposure.

How is syphilis acquired or passed on?

Syphilis is passed on through skin to skin contact with an active skin lesion. This is usually sexual contact which can include rubbing, oral sex, or vaginal/anal sex.
Syphilis can be passed on from an infected mother to her child during the pregnancy.

How long does it take to cause symptoms after exposure?

The incubation period for primary syphilis is 9-90 days.
Secondary syphilis can occur within the first 6-12 weeks but can occur upto 2 years following exposure.
Tertiary syphilis can occur at any time after the first 2 year, but usually takes many years to develop.

Can I have syphilis without knowing?

Yes. A person could have been exposed to syphilis and never had a symptom that they recognised. The syphilis could still be in the body and therefore treatment is usually offered.
This would be picked up by performing a syphilis blood test.
It would be possible that a positive blood test for syphilis could represent infection acquired many years ago.

How can I protect myself from getting infected?

Condoms do offer some protection but are not 100% effective in preventing transmission or acquisition of syphilis.
Having fewer numbers of sexual partners, having less vaginal or anal sex (having other types of sexual contact instead), abstaining and always using condoms will decrease your chance of coming across syphilis.

How is it diagnosed?

Syphilis is usually diagnosed on a blood tests.
Swabs of lesions can be performed, but this is a special DNA test not routinely performed.

Are there any other infections that would give the same blood test result?

Infection with Treponema pallidum (sexual syphilis), T. pertenue (yaws) and T. carateum (pinta) will all give the same result on a blood test.
Usually a history of country of origin and a sexual history will provide enough information to determine which one is most likely.

How common is it?

Syphilis infection is not common in the general Australian population. It is common in men who have sex with men, in those with HIV infection, in indigenous Australians and overseas.

What is the treatment?

Treatment is with Benzathine Penicillin as an intramuscular injection.
Depending on the stage of the infection a single injection or three injections one week apart will be given. Occasionally a patient will need to go to hospital for intravenous penicillin.
In a patient with penicillin allergy we can use Doxycycline oral tablets. At the same time though we would refer the patient for penicillin desensitisation and then given the correct penicillin injection.

After treatment, will my blood tests become negative?

After successful treatment, some of the blood tests for syphilis (three out of the four) will usually stay positive for life.
One test called the RPR will usually become negative. This tells us that treatment was successful.
The blood tests are complex and require expert interpretation.

When should I be tested again?

The best time to get tested again is in three months, six months and twelve months.

What else do I need to know?

If you are diagnosed with infectious syphilis, then your sexual partners for the last 3-6 months on average will need to be told so that they can be tested and treated.
After your treatment do not have sex for at least one week.
If you are in a relationship your partner must get tested and treated before you have sex again.
Syphilis is a notifiable infection in South Australia and the Health Department will be notified of the infection so that they can keep statistics on the infection. Occasionally the health department may contact you for more information.
Disclaimer
All of the information contained in this leaflet is designed to provide basic level education. It does not represent medical advice and no action should be taken as a result of the information contained within without discussing it with a doctor. Medical information changes rapidly and this content may be out of date and therefore incorrect. The content has been written with the intention of helping those who read it and specific medical terminology, complex and detailed information has been purposefully omitted. The author holds no responsibility for any action taken as a result of reading this information. The content of this leaflet remains the property of Two One Five Melbourne Street Medical Practice and any usage, apart from personal use, must receive the authority of the owner.
©2014 Two One Five Melbourne Street Medical Practice