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Therapeutics in Dermatology
A reference textbook in dermatology

Syphilis

1 - ACKNOWLEDGEMENTS

The text below has been provided by IUSTI (International Union against Sexually Transmitted Infections). This text was written with the help of the IUSTI, the EADV (European Association of Dermatology and Venereology) and its task force on Sexually Tansmitted Infections, the ISIDOG (International Society for Infectious Diseases in Obstetrics and Gynecology) and the UEMS-EBDV (European Union of Medical Specialists - European Board of Dermatovenereology).

The update is from 2017

You can download the pdf here.

2 - KEY POINTS

Syphilis is a sexually transmitted infection.

It is easily passed from one person to another during sex, including oral sex.

It often causes no symptoms.

Treatment is simple.

If syphilis is not treated it can cause serious long term health problems.

You can usually protect yourself by ALWAYS using condoms when you have sex.

3 - WHAT IS SYPHILIS?

Syphilis is a sexually transmitted infection. It is caused by a bacterium called Treponema pallidum.

4 - HOW DO YOU GET SYPHILIS?

You can catch syphilis when you have sex with someone who already has the infection. This can be by vaginal sex, oral sex or anal sex. Pregnant women can pass it to their baby.

The infection is more common in men who have sex with other men, people who frequently change sexual partners and who do not use condoms during sex.

Even if you have had syphilis before, you can still catch it again.

5 - WHAT ARE THE SYMPTOMS OF SYPHILIS?

The signs and symptoms are the same in both men and women. There are 4 stages of infection.

5.1 - PRIMARY SYPHILIS

An ulcer (chancre) develops where the bacteria enters the body, usually about 2 – 3 weeks after having sex with an infected person, but it may appear anytime up to three months later. There is usually one ulcer which is painless and this is most commonly on the penis in men, on the vulva or vagina in women, or on the anus. Depending on where the ulcer is, you may not notice it. The ulcer may take up to 6 weeks to heal and is very infectious to sexual partners.

Occasionally there may be several ulcers, they may be painful, or in places such as the mouth and lips.

5.2 - SECONDARY SYPHILIS

Secondary syphilis develops 3-6 weeks after the appearance of the ulcer if you do not get treatment. This is caused by the bacteria spreading in your blood stream. You may notice a skin rash, often including the palms of the hands and soles of the feet, lumps in the genital area, white patches in the mouth, swollen glands, or less commonly, patchy hair loss, deafness, eye problems, inflammation of the liver, kidneys or brain. Secondary syphilis is very infectious to sexual partners.

Without treatment, the rash and other symptoms from secondary syphilis usually disappear after several weeks. However, the symptoms may ‘come and go’ for up to two years.

5.3 - LATENT (HIDDEN) SYPHILIS

After the symptoms of secondary syphilis have cleared, you may not have any symptoms for several years, but the infection can be found on a blood test.

5.4 - TERTIARY SYPHILIS

About 1 in 10 people with untreated syphilis will develop serious damage of the nervous system, brain, bones, or heart. This may be many years later.

6 - DO I NEED ANY TESTS?

— Yes, if you have an ulcer which might be caused by syphilis, it is possible to take a swab from the ulcer to make the diagnosis. A blood test will need to be taken too and sent to a laboratory where it will be tested for antibodies against the bacteria that cause syphilis. For some people syphilis will not show up on the test straight away so it might need to be repeated.

— If you think you have been in contact with syphilis or have symptoms that could be syphilis you should visit your local sexual health or venereology/dermatology clinic.

— If you have syphilis, you should also be tested for other sexually transmitted infections, as you can have more than one infection at the same time. You should have a test for HIV infection.

7 - WHAT IS THE TREATMENT FOR SYPHILIS?

— It is important to receive treatment for syphilis as quickly as possible, as the infection can cause complications and serious health problems if it is left untreated.

— Syphilis is treated with a course of antibiotics, usually penicillin injections.

8 - SHOULD I HAVE SEX IF I HAVE SYPHILIS?

You should avoid sex until after both you and your partner(s) have finished all your treatment and your symptoms have gone.

9 - WHAT ARE THE POSSIBLE COMPLICATIONS OF SYPHILIS?

— Syphilis is unlikely to lead to any long-term problems if it is treated quickly. However, without treatment syphilis can spread to other parts of your body and cause serious problems.

— In 1 in 10 cases, where syphilis has been left untreated, it can spread through the bloodstream to cause infections in other parts of your body, such as your bones, heart and brain. This may not show up for several years.

— Once you have had treatment for syphilis, some of your blood tests will always be positive. This does not mean you need further treatment but you need to remember that you have been treated for syphilis (and keep a copy of your blood results) so you can tell doctors in the future if they ask you.

10 - SYPHILIS AND PREGNANCY

If you are pregnant, syphilis can be passed from you to your baby during the pregnancy. This can lead to miscarriage, still birth or serious illness in the baby (congenital syphilis) if the mother is not treated during pregnancy. If you are found to have syphilis, treatment can be given safely during pregnancy.

11 - DO I NEED TO TELL MY PARTNER?

— If you have primary syphilis, it is important that your current sexual partner, and any other sexual partner you have had over the last three months, is tested and treated. If you have secondary syphilis it is important to contact partners over the last 2 years.

— This is to stop you getting the infection again, and also so your partners do not develop complications.

12 - FURTHER HELP AND INFORMATION

If you suspect that you have syphilis or any other sexually transmitted infection, then see your local sexual health or venereology/dermatology clinic.


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