Syphilis

Looking after your sexual health

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How’s syphilis passed on?

Syphilis Syphilis is easily passed from one person to
Syphilis is a sexually transmitted infection (STI). another through sexual contact.You can pass
It’s not as common as some sexually transmitted syphilis on without knowing you have it because
infections but if it’s not treated, it can cause very symptoms can be mild and you may not notice
serious health problems. or recognise them. It can also be passed on
This booklet gives you information about before symptoms are noticeable, or after they’ve
syphilis, what you can do if you’re worried that disappeared.
you might have the infection and advice on how O Syphilis can be passed from one person to
to protect yourself and your partners. another during sex and by contact with the
ulcers of someone who has syphilis.

What causes syphilis? O It can be passed on through vaginal, anal or oral

Syphilis is caused by bacteria (tiny living cells) sex, or by sharing sex toys. Using a condom
called Treponema pallidum. Anyone who’s sexually correctly can reduce your chance of getting or
active can easily get and pass on syphilis. passing on syphilis.
O Syphilis can also be passed on by blood
transfusion and injecting drug use (sharing
needles) but this is very rare. In the UK, all

Contents
What causes syphilis?...........................................................................2 Will syphilis go away without treatment? ............................. 11
How’s syphilis passed on? .................................................................3 How soon can I have sex again? ................................................ 12
What are the signs and symptoms?............................................4 Will I know how long I’ve had syphilis?.................................. 12
How will I know if I have syphilis? ................................................6 Should I tell my partner(s)?...........................................................12
How soon after sex can I have a check-up?...........................7 Will syphilis affect my fertility?.....................................................13
What does the check-up involve?................................................7 What happens if I get syphilis when I’m pregnant? ......... 13
How accurate are syphilis tests?....................................................8 Does syphilis cause cervical cancer?........................................ 13
Where can I get a syphilis test? .....................................................8 How can I help protect myself from syphilis and other
Will I have to pay for tests and treatment? ............................8 sexually transmitted infections?...................................................14
What’s the treatment for syphilis?................................................9 Using a service .....................................................................................14
How effective is the treatment? ................................................. 10 Where can I get more information and advice?............... 15
Are there any side effects from the treatment?................ 10 Clinics ........................................................................................................15
Do I need a test to check the syphilis has gone? ............. 10 A final word...........................................................................................16
What happens if syphilis isn’t treated?.................................... 11
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blood donations are screened for syphilis O They may be around the opening of the
before the blood is used. urethra (tube where urine comes out) or
O If you’re pregnant, it’s possible to pass the around the anus.
infection to the baby before birth.This is known O Less commonly, ulcers may appear in the
as congenital syphilis (see What happens if I get mouth, and on the lips, tonsils, fingers or
syphilis when I’m pregnant? on page 13). buttocks.
You can’t get syphilis from hugging, sharing baths O The ulcers of primary syphilis are very
or towels, swimming pools, toilet seats or from infectious and may take 2–6 weeks to heal. By
sharing cups, plates or cutlery. this time, if the syphilis hasn’t been treated, it
will spread to other parts of the body. It’ll then
What are the signs and symptoms? be known as secondary syphilis.
The signs and symptoms can be difficult to
recognise and you might not notice them. Syphilis Secondary syphilis
can develop in stages: If syphilis isn’t treated, the secondary stage usually
O the early stage (primary and secondary syphilis) occurs around 4-10 weeks after any ulcers have
O the latent stage appeared. Syphilis is still infectious at this stage and
O the late stage (also called tertiary syphilis). can be passed on to someone else.
Symptoms might include:
Early and late syphilis may cause symptoms, while
O a painless rash that’s not normally itchy; it can
in latent syphilis there are no symptoms. If you do
spread all over the body, or appear in patches
get symptoms, you might notice the following at
and is often seen on the palms of the hands
different stages.
and soles of the feet
Primary syphilis O flat, warty-looking growths on the vulva or
O One or more ulcers can appear, where the around the anus (often mistaken for genital
syphilis entered the body.These ulcers are warts)
called chancres (pronounced ‘shankers’) and O a flu-like illness, tiredness and loss of appetite,
are often painless.They may appear between 2 with swollen glands (this can last for weeks or
weeks and 3 months after coming into contact months)
with syphilis but it can be sooner or later. O white patches on the tongue, cheeks, or roof of
O These ulcers can appear anywhere on the body. the mouth
O Ulcers may appear on the vulva (the opening O patchy hair loss.
to the vagina and urethra, the labia - vaginal lips
- and the clitoris), or the cervix (entrance to
the uterus - womb).
O Ulcers may appear on the penis or foreskin.
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Latent syphilis tested for other sexually transmitted infections

When syphilis remains untreated, without any (STIs). It’s possible to have more than one STI at
signs or symptoms of infection, it’s known as latent the same time.
syphilis. Diagnosis is made by a positive blood test.
People with latent syphilis may still be infectious. How soon after sex can I have a
check-up?
Tertiary or late syphilis It’s important not to delay getting a test if you
Untreated syphilis may, after many years, start to think you might have syphilis.
cause serious damage to the heart, brain, bones A test can be done straight away but you may
and nervous system. be advised to have another test later to confirm
Late syphilis is rare in the UK and this booklet the result.You can have a test even if you don’t
doesn’t cover it. have signs and symptoms.

How will I know if I have syphilis? What does the check-up involve?
You can only be certain you have syphilis if you A doctor or nurse will ask you to give a blood
have a test. If you think you might have syphilis, sample.
it’s important not to delay getting a test so you They may do a genital examination.This may
can start treatment, if needed, and don’t pass the include an internal examination of the vagina, or
infection on to anyone else. an examination of the penis, foreskin and opening
Have a test if: of the urethra (where urine comes out).
O you, or a sexual partner, have or think you They may also examine your anus, internally and
might have symptoms externally.
O you’ve recently had unprotected sex with a The doctor or nurse will also check the body
new partner for any rashes, ulcers or warty growths.They may
O you, or a partner, have had unprotected sex check the mouth and throat area.
with other partners They’ll use a swab to collect a sample of fluid
O a sexual partner tells you they have syphilis or a from any ulcers. A swab looks like a cotton bud,
sexually transmitted infection but is smaller and rounded. It sometimes has a
small plastic loop on the end rather than a cotton
O you have another sexually transmitted infection
tip. It’s wiped over any ulcers.This only takes a
O you’re pregnant or planning a pregnancy. few seconds and isn’t painful, though it may be
You could still have syphilis even if a partner has uncomfortable for a moment.
tested negative.The only way to make sure you Cervical screening tests and routine blood tests
don’t have syphilis is to get tested yourself. don’t detect syphilis. If you’re not sure whether
If you’ve had syphilis before, you can still get it you’ve been tested for syphilis, just ask.
again, even if you’ve been treated.
If you have syphilis, you’ll be advised to get
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How accurate are syphilis tests? Will I have to pay for tests and
No tests are 100% accurate, but syphilis tests treatment?
should pick up almost all syphilis infections if done All tests are free through NHS services.Treatment
at the right time. is also free but if you get a test at a general
practice you might have to pay a prescription
Where can I get a syphilis test? charge or go to another service for the treatment.
There are a number of services you can go to.
Choose the one you feel most comfortable with. What’s the treatment for syphilis?
A syphilis test can be done at: O Syphilis is treated with antibiotics.This may be a
O a genitourinary medicine (GUM) or sexual single injection, a course of injections or tablets
health clinic or capsules. Penicillin is the most common
O some general practices (ask a doctor or treatment for syphilis, but there are several
practice nurse). different antibiotics that can be used. Let the
For information on how to find a service see doctor or nurse know if you’re allergic to
Where can I get more information and advice? on penicillin.
page 15. O If complications have occurred you may also
If you’re pregnant you’ll be offered a syphilis test need other treatment.
when you attend for antenatal care (see What O If there’s a high chance of you having syphilis,
happens if I get syphilis when I’m pregnant on treatment may be started before the results
page 13). of the test are back.You’ll usually be given
In some areas you can order a free self-sampling treatment if a sexual partner has syphilis.
kit from your local sexual health service.This is O There’s no evidence that complementary
where you take your own sample and send it to therapies can cure syphilis. Complementary
be tested. therapies are therapies that fall outside of
It’s also possible to buy a syphilis test to do at mainstream healthcare.
home.The accuracy of these tests varies so it’s
O Treatment can safely be given during pregnancy
recommended that you go to a sexual health
(see What happens if I get syphilis when I’m
service to have a test.You can also choose to pay
pregnant? on page 13).
for a syphilis test at a private clinic.
If a self-sampling test or home test shows that
you have syphilis it’s important to seek treatment
straight away.The test should have instructions
explaining what to do.
If you have symptoms you should always get
tested at a sexual health service.
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How effective is the treatment? Even after successful treatment and cure, you
may still sometimes get a positive blood test for
Primary and secondary syphilis syphilis in the future. So, if you need documents
O Treatment is very effective for both primary for emigration or any other reason, ask your
and secondary syphilis. As long as the treatment clinic for a certificate explaining your treatment.
is taken correctly the syphilis will be completely You may be advised to have regular blood tests
cured. to check there are no changes, monitor your
condition and make sure that all is OK.
If you have any questions, ask the doctor or
Latent syphilis
nurse and make sure you know how to protect
O Syphilis can be treated and cured in the latent
yourself in the future (see How can I help protect
stage without developing any long-term
myself from syphilis and other sexually transmitted
problems.
infections? on page 14).

Tertiary or late syphilis

O Syphilis can be treated and cured in the late
What happens if syphilis isn’t
stage but any damage already done to your treated?
body won’t be reversed. If it’s not treated, syphilis can spread to other parts
of the body causing serious, long-term complications.
It may start to cause very serious damage to the
Are there any side effects from the heart, brain, eyes, other internal organs, bones and
treatment? nervous system. In some cases, this damage could
After the first treatment some people get a lead to death.
reaction known as the Jarisch-Herxheimer If you have syphilis you may be at more risk of
reaction.This is a flu-like illness with high becoming infected with HIV if you have sex with
temperature, headache and aches and pains in someone who’s HIV positive and they’re not on
the muscles and joints.This only lasts for up to 24 effective treatment. If you’re HIV positive and not
hours and starts within 12 hours after treatment. on effective treatment then you may be more at
This reaction isn’t dangerous, and will get better risk of transmitting syphilis to a partner.
on its own but it may help to rest, drink plenty of Effective HIV treatment can suppress HIV in the
water and take some pain-relieving drugs. body (known as having an undetectable viral load)
and means HIV can’t be passed on to a partner.
Do I need a test to check the
syphilis has gone? Will syphilis go away without
Yes.You’ll need to go back for follow-up tests 6-12 treatment?
weeks after treatment to check the syphilis has No. If you delay seeking treatment you risk the
gone and that you haven’t come into contact with infection causing long-term damage and you might
the infection again. pass the infection on to someone else.
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How soon can I have sex again? general practice can discuss with you which of
Don’t have any sexual intercourse, including your sexual partners may need to be tested.
vaginal, anal or oral sex until two weeks after you
and your partner(s) have finished the treatment Will syphilis affect my fertility?
and any follow-up treatment. If you or a partner No.There’s no evidence that syphilis will affect
have any ulcers or rashes you should avoid any your fertility.
kind of sexual contact until sores are fully healed
and two weeks after treatment is finished.This is What happens if I get syphilis when
to help prevent you being reinfected or passing I’m pregnant?
the infection on to someone else. If you’re pregnant, you’ll be offered a blood test
for syphilis when you attend antenatal care and
Will I know how long I’ve had your health professional should explain why this is
syphilis? happening.
The test can’t tell you how long you’ve had If syphilis is found, you can be given treatment
syphilis. If you feel upset or angry about having safely during pregnancy.This can help prevent the
syphilis and find it difficult to talk to a partner or baby from becoming infected.There’s no risk of
friends, don’t be afraid to discuss how you feel the treatment harming the baby.
with the staff at the clinic or general practice. If the syphilis is untreated you may pass the
infection to your baby before the birth.This can
Should I tell my partner(s)? lead to miscarriage, premature (early) birth or
If the test shows that you have syphilis then it’s stillbirth, or the baby being born with syphilis.
very important that your current sexual partner(s) If you have unprotected sex with a new partner
and any other recent partners are also tested and or think you might have been at risk of syphilis,
treated. it’s important to get tested again, even if you’ve
You may be given a contact slip to send or give previously had a negative test (see How will I
to your partner(s) or the clinic can do this for know if I have syphilis? on page 6).
you, with your permission.This is called partner
notification. It can sometimes be done by text Does syphilis cause cervical cancer?
message.The message or contact slip will say No. Syphilis doesn’t cause cervical cancer.
that they may have been exposed to a sexually
transmitted infection and suggest they go for
a check-up. It may or may not say what the
infection is. It won’t have your name on it, so your
confidentiality is protected.
You’re strongly advised to tell your partner(s),
but it isn’t compulsory.The staff at the clinic or
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How can I help protect myself O The staff will offer you as much support as you
from syphilis and other sexually need, particularly if you need help on how to
tell a partner.
transmitted infections?
The following measures will help protect you
from syphilis and most other sexually transmitted Where can I get more information
infections, such as HIV, chlamydia and gonorrhoea. and advice?
It’s possible to get a sexually transmitted infection The National Sexual Health Helpline provides
(STI) by having sex with someone who has the confidential advice and information on all aspects
infection, even if they have no symptoms. If you of sexual health.The number is 0300 123 7123. It’s
have an STI they’ll also help prevent you from open Monday to Friday from 9am-8pm.
passing it on to someone. For more information on sexual health visit
O Use condoms (male/external or female/ www.fpa.org.uk or www.sexwise.org.uk
internal) every time you have vaginal or anal Information for young people can be found at
sex. www.brook.org.uk
O If you have oral sex (going down, giving head),
use a condom to cover the penis, or a dam Clinics
(latex or plastic square) to cover the vulva To find your closest clinic you can:
(external female genitals) or anus. O use Find a Clinic at www.fpa.org.uk/clinics
O If you’re not sure how to use condoms O download FPA’s Find a Clinic app for iPhone or
correctly visit www.sexwise.org.uk for more Android.
information. You can find details of general practices and
O Avoid sharing sex toys. If you do share them, pharmacies in England at www.nhs.uk and in
wash them or cover them with a new condom Wales at www.nhsdirect.wales.nhs.uk. In Scotland
before anyone else uses them. you can find details of general practices at
www.nhsinform.scot and in Northern Ireland at
Using a service www.hscni.net
O Wherever you go, you shouldn’t be judged
because of your sexual behaviour or who you
have sex with.
O All advice, information and tests are free.
O All services are confidential.
O All tests are optional and should only be done
with your permission.
O Ask as many questions as you need to – and
make sure you get answers you understand.
A final word
This booklet can only give you general information.The
information is based on evidence-based guidance produced
by The British Association for Sexual Health and HIV
(BASHH).

the sexual health charity

www.fpa.org.uk
This booklet is produced by the sexual health charity FPA, registered
charity number 250187. Limited liability company registered in England,
number 887632. FPA does not run the National Sexual Health Helpline.
© FPA March 2018.
© Crown Copyright Public Health England.
ISBN 978-1-912202-16-4
The information in this booklet was accurate at the
time of going to print. Booklets are reviewed regularly.
Next planned review by March 2021.
If you’d like information on the evidence used to
produce this booklet or would like to give feedback
Ref: 1053

email [email protected]