What Is Syphilis?

Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. If it’s not treated early, syphilis can progress and ultimately become a serious, life-threatening infection.

Here, we discuss the symptoms, causes, treatments, and screening recommendations for syphilis.

The symptoms of syphilis are different depending on the stage of the disease.

Primary Stage

The most common first sign of syphilis is one firm, round, and painless sore, called a chancre. It develops where the bacteria entered the body. The chancre typically appears within three weeks from the time of exposure, usually in the area of the genitals, rectum, or mouth; it can go unnoticed if it is hidden inside the body. Occasionally, more than one sore develops.

Secondary Stage

• Sores in the mouth, vagina, or anus
• Fever
• Swollen lymph glands
• Sore throat
• Patchy hair loss
• Headaches
• Weight loss
• Muscle aches
• Fatigue

Latent Syphilis

Tertiary Syphilis

• Gummas (or gummata) are large sores on the skin or inside the body.

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• Cardiovascular syphilis can affect the heart and blood vessels and lead to an aortic aneurysm (dilation of the largest artery in the body due to a weakening of the artery wall) and aortic valve insufficiency.

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• Two forms of neurosyphilis — general paresis and tabes dorsalis —are considered a tertiary form of syphilis, although other forms of neurosyphilis can occur at any stage of infection. General paresis causes cognitive impairment, and tabes dorsalis causes a variety of physical problems, including pain in the arms and legs or abdomen.

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Neurosyphilis, Ocular Syphilis, and Otosyphilis

Neurosyphilis, ocular syphilis, and otosyphilis are particularly severe manifestations of syphilis and can be seen during any stage of the disease (primary, secondary, or tertiary).

General paresis is a late-stage type of neurosyphilis that can occur 3 to 30 years after a person is first infected with syphilis. Symptoms of general paresis include personality or mood changes, problems with thinking and judgment, memory and language problems, delusions, and seizures.

• Sexual contact with someone who has syphilis (including vaginal, anal, or oral sex)
• Direct contact with syphilis sores, which are usually found on the genitals, anus, lips, or mouth
• Mother to child transmission during pregnancy or childbirth (called congenital syphilis)
• Sharing needles for IV drug use, though this is rare

You cannot get syphilis from using the same clothing, toilet, toilet seat, or utensils as an infected person. Nor can you get it from doorknobs, bathtubs, or swimming pools.

• Unprotected sex, especially with new or multiple partners
• A man who has sex with men
• HIV-positive (syphilis and HIV often occur together)
• A history of other STIs, which can increase susceptibility
• Sex worker or a partner who does sex work
• Drugs that impair judgment, which can increase risky sexual behavior
• Sexually active with more than one partner.

Prognosis of Syphilis

How long syphilis lasts depends on how early it is caught. If it’s treated, it can be cured. If syphilis remains untreated, it can be a lifelong infection.

The drug of choice for curing syphilis is the antibiotic penicillin G benzathine (Bicillin L-A). A single injection of this antibiotic is typically all that’s needed for primary, secondary, and early latent syphilis. A longer course of treatment may be necessary for late latent (more than a year after the initial infection) and tertiary syphilis.

Once it’s cured, syphilis doesn’t come back on its own, but you can still get it again if you have contact with someone who has an active syphilis infection.

There is no vaccine for syphilis. The only way to completely avoid getting syphilis is to abstain from sex and intimate physical contact. If that’s not practical or desirable, the following can help reduce your risk:

• Having only one sexual partner and ensuring that person is also monogamous
• Using condoms during sexual activity
• Avoiding alcohol and recreational drugs, which can compromise your judgment, leading to unsafe sexual practices

If syphilis is not treated, it can affect your heart, brain, and eyes and may be life-threatening. Complications of syphilis include the following:

• Angina (chest pain)
• Aortic aneurysm (bulging of the body's largest artery)
• Heart failure
• Seizures
• Personality changes
• Chronic pain
• Joint pain
• Joint damage
• Blindness
• Meningitis
• Strokes
• Sexual dysfunction
• Hearing loss
• Incontinence
• Gummas (rubbery or gummy tumorlike masses)
• Dementia or memory loss
• Nerve damage

When syphilis is passed from an infected mother to her baby during pregnancy or childbirth, it’s called congenital syphilis. This is a severe, potentially life-threatening condition for the baby.

The disease is also associated with blindness, deafness, physical deformities, and damage to the baby’s nervous system.

In an infant born with congenital syphilis, the risk of complications can be reduced by early detection and treatment with penicillin.

Congenital syphilis can be prevented by treating the mother for syphilis during pregnancy.

These numbers serve as a reminder that older Americans still need to protect themselves during sex, particularly when initiating a new sexual relationship.

Primary and secondary syphilis are more prevalent among Black, Indigenous, and People of Color (BIPOC) than among white Americans.

Black Americans and Syphilis

That statistic is especially concerning in light of the Tuskegee study, one of the most infamous studies in American health research and a low point in clinical studies. Initiated in 1932, the 40-year study was conducted by Public Health Service officials and followed 600 rural Black men in Alabama, about two-thirds of whom had syphilis. The men were never told their diagnosis and were denied treatment for the disease (penicillin became available as a treatment for syphilis in 1943).

The unethical study was ended when whistleblowers revealed what the researchers were doing. Many men in the study died from complications due to syphilis, and many of the wives and children of the men contracted the disease.

Hispanic Americans and Syphilis

American Indians, Alaska Natives, and Syphilis

Syphilis is one of several common STIs, including gonorrhea, chlamydia, and human immunodeficiency virus (HIV), the virus that causes AIDS.

Syphilis has been afflicting humanity for centuries. The first recorded epidemic swept through Europe in the 15th century, although where it started remains unclear. At that time, syphilis appears to have been a much more severe illness than it is today, causing horrendous skin lesions and pain, and quickly leading to death. The treatments were ineffective, often painful, and sometimes killed the patient before the disease did.

Given how long it took to discover the cause of syphilis, it’s not surprising that some mistaken beliefs about it developed over the years. One early belief was that syphilis is an inherited disease. It is not.

More surprising, perhaps, is that certain myths about syphilis persist even when so much more is known about it.

One potentially dangerous myth is that you can tell if you have syphilis. Often, you cannot. If the initial painless sore is hidden in the anus, vulva, or cervix, you may not notice it at all. Similarly, you may not notice or correctly identify the skin rashes or sores that mark the secondary stage of syphilis. Once they clear up, you may have no symptoms for a long time but still carry the infection in your body.

Another potentially dangerous myth is that syphilis is a thing of the past. In fact, syphilis rates are on the rise. That’s why every sexually active person should be aware of syphilis, how it spreads, and how to avoid getting it.

• Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. There are four stages of syphilis: primary, secondary, latent, and tertiary.
• Syphilis can affect almost all areas of the body. If left untreated, the disease can cause severe complications.
• When caught in its early stages, syphilis can be effectively treated with penicillin or other antibiotics without causing long-term problems.
• Cases of syphilis have been on the rise in the United States in recent years. If you are in a high-risk group, talk to your doctor about getting screened for the disease.