Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
How is syphilis spread?
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.
What are the signs and symptoms in adults?
The time between infection with syphilis and the start of the first symptom can range from 10-90 days (average 21 days). The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.
The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.
The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death.
Can a newborn get syphilis?
Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly after birth. If not treated immediately, an infected baby may be born without symptoms but could develop them within a few weeks. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.
How can people protect themselves against infection?
Two people who know that they are not infected and who have sex only with each other cannot contract syphilis. When someone's syphilis status is unknown, a good defense against becoming infected during sex is to use a latex condom before beginning sex and to keep it on until the penis is withdrawn. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. This is equally important for other STDs, including HIV, as well. Only lab tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Washing the genitals, urinating, or douching after sex does not prevent STDs, including syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.