Syphilis

What are the symptoms of syphilis?

Symptoms can be mild or absent, and it could take up to 90 days (three months) to appear. Many people do not experience any symptoms at all. This is why it’s really important to get tested for regularly.  

NB: The following information only applies for symptomatic cases.

Syphilis has four main stages of infection: Pre-symptom, Primary, Secondary, and Latent (non-infectious).

Syphilis symptoms can take up to 90 days to appear - if at all - so it may have made itself at home without you even realising it.

If symptoms do present, a sore (also known as a chancre) will form where the bacteria enters the body – on the penis (often under the foreskin), vagina, testicles, mouth or anus. It’s usually painless, but in some cases it can cause discomfort, and there may be more than one. Sores usually clear up on their own after three to six weeks and are followed by symptoms of the secondary stage syphilis.

There are many symptoms that can be present in the secondary stage of syphilis. One of the most common is a rash on the body that often includes the palms of the hands and soles of the feet. The rash is not usually itchy. Other possible symptoms include: headaches, hair loss, fevers, and swollen lymph glands.

If left untreated, syphilis remains in the body and stops being infectious to sexual partners after about two years. During this stage, syphilis often does not have any visible symptoms, but it may begin to damage the body’s internal organs, which may include the brain, nerves, eyes, heart, liver, heart, bones, joints, and blood vessels. In some people this damage may not show up for many years. Damage to the internal organs can occur after ten to twenty-five years and may be serious enough to cause death.

How is syphilis transmitted?  

Syphilis can be passed on through condomless oral, anal or vaginal sex (this includes rimming, fingering and sharing sex toys). It’s not only passed on through penetration though – you can also get it through direct skin-to-skin contact with sores or rashes on your penis, vagina, anus, mouth, lips or skin. 

How can syphilis be prevented?  

There are several ways that you can prevent or reduce the risk of getting syphilis: 

• Avoid any contact with sores or rashes on the skin  
• If you’re having sex with a penis, using condoms is the most effective way to reduce the risk (however, keep in mind that the site of infection may be outside where condoms cover). Using lube with condoms can reduce friction, lowering the risk of breakage (and STI exposure), while also enhancing pleasure. 
• If you’re very sexually active, you have multiple partners, or you’re generally at high risk of STIs (for example – you’re attending orgies, sex parties or saunas often, or you’re going overseas for Pride), DoxyPEP can be a great tool for you. It involves taking 2 pills (or 200mg) of doxycycline within 72 hours after sexual activity and it has shown to reduce the risk of syphilis significantly (and also chlamydia).  

How do you test for syphilis? 

Syphilis is one of the STIs that a standard STI test will look for – so when you want to get tested, you’ll also be able to find out whether you have other common STIs like chlamydia or gonorrhoea at the same time.  

Testing for syphilis occurs through a blood test.  You may also need to provide a sample of your urine, and a swab of your vagina, anus, or any potential sores or ulcers.   

There are several ways you can get an STI test: 

• Through your GP (keep in mind your GP’s fees) 
• At your local sexual health clinic for FREE 
• At a Burnett Foundation Aotearoa clinic or pop-up clinic for FREE
• In the comfort of your own home with a Home Test Kit (from $20)

Rapid / finger-prick tests can also pick up syphilis, however it is currently unclear how accurate these tests are, and these tests can pick up previous infections that have since been treated. For this reason, getting a blood test via your GP or doctor is the best way to know whether you have syphilis. 

Your sample will be sent to a laboratory for testing, and you should hear back about your result within a week.  

What happens if you test positive for syphilis? 

If you test positive for syphilis, don’t feel bad or ashamed or embarrassed about it – just make sure that you get treated as soon as you can, as it can lead to very severe medical issues and complications if you don’t.  

Your GP or sexual health nurse will treat the infection with injections of antibiotics (usually penicillin – or other antibiotics are available if you are allergic). The duration of the treatment will depend on the stage of the infection and ranges from between one day and three weeks.  

Sexual contact should be avoided for at least one week from the end of treatment to ensure the infection has cleared and that you’re no longer infectious.  

If you have contact details and you can do so safely, we also strongly recommend that you let anyone you’ve had sex with recently (in the last 3 to 6 months) know that you have tested positive, and that they may want to get tested as well. This is important as syphilis is highly infectious, and we are currently experiencing an outbreak.  

Some important things to know about syphilis

• Syphilis may be harder to detect and harder to treat in people living with HIV. It is a serious infection that can be mistaken for other infections found in people living with HIV. While the symptoms of syphilis are usually similar, some people living with HIV can develop severe organ and nerve damage much more rapidly than HIV negative people. For some, syphilis can decrease the CD4 count. This can cause damage to the immune system as well as increase the viral load. 
• There’s a testing window of 3-6 weeks for syphilis, which means it may not appear on an STI test if you have just had sex with someone who had it. 
• Treatment is often provided if you have had contact with someone who has had syphilis to prevent it from developing in you. 
• If left untreated, syphilis can seriously affect fertility, so it is very important that you get tested every 3 months if you are sexually active and/or having condomless sex, and that you get treated as soon as possible if you do get syphilis. 
• If you’re able to get pregnant or are pregnant, keep in mind that syphilis can be passed on to a baby if not treated before childbirth.