Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.
After the initial infection, the syphilis bacteria can remain inactive in the body for decades before becoming active again. Early syphilis can be cured, sometimes with a single shot (injection) of penicillin.
Without treatment, syphilis can severely damage the heart, brain or other organs, and can be life-threatening. Syphilis can also be passed from mothers to unborn children.
Primary syphilis causes painless sores (chancres) on the genitals, rectum, tongue or lips. The disease can be present with the appearance of a single chancre (shown here on a penis) or many.
Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don't always occur in the same order. You may be infected with syphilis without noticing any symptoms for years.
The first sign of syphilis is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them.
The chancre usually develops about three weeks after exposure. Many people who have syphilis don't notice the chancre because it's usually painless, and it may be hidden within the vagina or rectum. The chancre will heal on its own within three to six weeks.
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet.
This rash is usually not itchy and may be accompanied by wartlike sores in your mouth or genital area. Some people also experience hair loss, muscle aches, a fever, a sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.
If you aren't treated for syphilis, the disease moves from the secondary stage to the hidden (latent) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the third (tertiary) stage.
About 15% to 30% of people infected with syphilis who don't get treatment will develop complications known as tertiary syphilis. In the late stage, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.
At any stage, syphilis can spread and, among other damage, cause damage to the brain and nervous system and the eye.
Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet.
Later signs and symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses.
However, babies born with syphilis can also be born too early, may die in the womb before birth or can die after birth.
When to see a doctor
Call your doctor if you or your child experiences any unusual discharge, sore or rash — particularly if it occurs in the groin area.
Mayo Clinic Minute: Signs and symptoms of syphilis
Vivien Williams: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Dr. Stacey Rizza, an infectious diseases specialist at Mayo Clinic, says syphilis affects men and women and can present in various stages.
Stacey Rizza, M.D.: Primary syphilis causes an ulcer, and this sometimes isn't noticed because it's painless and can be inside the vagina or on the cervix…after a few weeks, two months, they can get secondary syphilis, which is a rash.
Vivien Williams: It may then progress to latent stage syphilis and, finally, the most serious stage: tertiary. Pregnant women are not immune to syphilis. Congenital syphilis can lead to miscarriage, stillbirth or infant deaths. That's why all pregnant women should be screened. Syphilis is preventable and treatable. As for prevention, Dr. Rizza recommends barrier protection during sex.
Dr. Rizza: And that's during oral sex, anal sex, vaginal sex — using condoms, dental dams and any other barrier protection.
Vivien Williams: For the Mayo Clinic News Network, I'm Vivien Williams.
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The cause of syphilis is a bacterium called Treponema pallidum. The most common way syphilis is spread is through contact with an infected person's sore during sexual activity. The bacteria enter the body through minor cuts or abrasions in the skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.
Less commonly, syphilis may spread through direct contact with an active lesion, such as during kissing. It can also be passed from mothers to their babies during pregnancy or childbirth.
Syphilis can't be spread by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs.
Once cured, syphilis doesn't return on its own. However, you can become reinfected if you have contact with someone's syphilis sore.
You face an increased risk of acquiring syphilis if you:
- Engage in unprotected sex
- Have sex with multiple partners
- Are a man who has sex with men
- Are infected with HIV, the virus that causes AIDS
Without treatment, syphilis can lead to damage throughout your body. Syphilis also increases the risk of HIV infection and can cause problems during pregnancy. Treatment can help prevent future damage but can't repair or reverse damage that's already occurred.
Small bumps or tumors
In the late stage of syphilis, bumps (gummas) can develop on the skin, bones, liver or any other organ. Gummas usually disappear after treatment with antibiotics.
Syphilis can cause a number of problems with the nervous system, including:
- Hearing loss
- Visual problems, including blindness
- Loss of pain and temperature sensations
- Sexual dysfunction in men
- Bladder incontinence
These may include bulging and swelling of the aorta — your body's major artery — and of other blood vessels. Syphilis may also damage heart valves.
Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to fivefold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter the bloodstream during sexual activity.
Pregnancy and childbirth complications
If you're pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn's death within a few days after birth.
There is no vaccine for syphilis. To help prevent the spread of syphilis, follow these suggestions:
- Abstain or be monogamous. The only certain way to avoid syphilis is to avoid (abstain from) having sex. The next-best option is to have mutually monogamous sex in which both partners have sex only with each other and neither partner is infected.
- Use a latex condom. Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.
- Avoid recreational drugs. Misuse of alcohol or other drugs can inhibit your judgment and lead to unsafe sexual practices.
Partner notification and preventive treatment
If tests show that you have syphilis, your sex partners — including current partners and any other partners you've had over the last three months to one year — need to be informed so that they can get tested. If they're infected, they can then be treated.
Official, confidential partner notification can help limit the spread of syphilis. The practice also steers those at risk toward counseling and the right treatment. And since you can contract syphilis more than once, partner notification reduces your risk of getting reinfected.
Screening for pregnant women
People can be infected with syphilis and not know it. In light of the often deadly effects syphilis can have on unborn children, health officials recommend that all pregnant women be screened for the disease.
Sept. 25, 2021