Page modified at: 21/02/2010
Syphilis is a sexually transmitted disease caused by a spirochaete called Treponema Pallidum and both men and women can become infected.
It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.
Syphilis in Wales
The incidence of infectious syphilis relative to other sexually transmitted infections (STIs) remained low until the late 1990s. In the United Kingdom between 1998 and 2004 rates of diagnoses of infectious syphilis (primary and secondary) in males increased by 1520%. This is largely as a result of a number of localised outbreaks that occurred during this period.
In Wales, reports of infectious syphilis remained below a rate of 0.2 cases per 100,000 population between 1995-2000. Between 2001-2004 an increase of cases was recorded, reaching a rate of 1.8 cases per 100,000 population in 2003.
Between January 2002 and 31 December 2008, 443 reports of infectious syphilis have been recorded in Wales. Of these, 326 (74%) were in men reporting being either homosexual or bisexual (no females have reported as belonging to these categories).
Twenty-six per cent of cases reported acquiring syphilis through heterosexual sex. The proportion of cases acquired heterosexually has varied from 22% of all cases in 2002 to 27% in 2005, 39% in 2006, 25% in 2007 and 19% in 2008.
Unlike other bacterial STIs, the burden of syphilis does not fall upon teenagers; the highest rates are seen in older age groups. In Wales, the highest numbers of infectious syphilis cases were recorded in men aged 25-34 years. To date, the majority of cases have been reported from clinics in South East Wales (73%) with clinics in North Wales and in Mid and West Wales reporting 13% and 14% of cases respectively.
Sixteen cases in 2007 (20%) were known to be HIV positive also. This compares with 14 (19%) in 2006 and 11 (22%) in 2005.
Click on the graph below to link to the National Public Health Service for Wales website for further information.
How is Syphilis spread?
Syphilis is usually passed from one person to another during vaginal, oral or anal sex. The route of transmission of syphilis is almost always through sexual contact, although there are examples of congenital syphilis via transmission from mother to an unborn child during pregnancy. Both the primary sores and secondary rashes contain active spirochaetes and thus both sexual and non-sexual contact can result in spread of the infection.
You can't get syphilis... from hugging, sharing baths or towels, swimming pools, toilet seats, cups, plates or cutlery
How do I reduce the risk of catching Syphilis?
- Male and female condoms, when used correctly, can help protect against STIs
- Before you have sex, talk to your partner about using condoms
- Use condoms every time you have vaginal or anal sex
- If you have oral sex, use a dam
What are the Symptoms of Syphilis?
It's possible to have Syphilis and not have any symptoms. Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.
Primary Stage: 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 time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage: Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
Late and Latent Stages: The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10 – 20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
Men and women may experience:
* Nothing – many are silent
* Primary - sore (chancre) or multiple sores
* A secondary non itchy skin rash or rashes in multiple areas (typically rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet)
* Secondary - fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.
* Tertiary - difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia and even death
What happens if Syphilis isn't treated?
Without treatment, the infection can spread to other parts of the body causing damage and long-term health problems either manifesting as secondary or late stage disease which can be fatal. Babies born to mothers with Syphilis in pregnancy are at risk of miscarriage, developmental delay, seizures, stillbirth and neonatal death and thus all pregnant women in the UK are currently offered screening for Syphlis at their booking visit.
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present. Men who have sex with men aret herefore particularly at risk of co-infection with HIV.
In late stage disease there is damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints causing difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia and even death
How can I reduce the risk of catching Syphilis?
Practising safer sex reduces the risk of infection with Syphilis. The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.
Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.
Transmission of an STD, including syphilis cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.
How do I reduce the risk of passing Syphilis on to others?
Testing and treating (if appropriate) all sexual contacts helps to prevent the infection being passed on to others. Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
How do I get treatment for Syphilis?
NHS:Testing is free on the NHS from genitourinary medicine clinics, sexual health clinics, many contraception clinics, your GP and pharmacies. You can find an clinic to help with Syphilis by phoning directory enquiries and asking for genitourinary medicine, sexually transmitted disease or venereal disease or locate one using our NHS Genitourinary Medicine Clinic page in the Sexual Health Section of our website.
PRIVATE:Alternatively you can have confidential private testing based on an internet ordered home sampling blood test kit. Telephone 0345 2303386 or use the Confidential Text Service 07786202070
How is Syphilis treated?
The infection can be treated effectively with antibiotics. Syphlis is easy to treat with antibiotics. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis.
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory 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. Talking with a health care provider will help to determine the need to be re-tested for syphilis after being treated.