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Syphilis 101

Updated: Mar 30, 2020

What is it

Syphilis is a sexually transmitted infection caused by the bacteria Treponema Pallidum. It is relatively simple to treat but can have very serious systemic effects if left untreated. Though it’s a systemic infection, its main mode of transmission is sexual which is why it’s considered an STI.

How do you get it

Syphilis is transmitted through contact with a syphilitic sore (known as a chancre). They occur on or around the external genitals, in the vagina, around the anus, in the rectum, and in or around the mouth. Syphilis can even be transmitted by pregnant women before the birth of their unborn child.

What are the symptoms

Syphilis symptoms appear in almost all cases, and takes between 10-90 days between the exposure and the start of the first symptom. Syphilis follows a progression of stages which can take years to complete.

Primary Syphilis

  • In this stage, a single lesion (chancre) appears. It’s usually firm, round and painless and occurs at the place syphilis enters the body (ie; the site of exposure). The chancre can be easy to miss, and only last 3-6 weeks before clearing up naturally.

  • A lack of treatment at this stage will lead to progression into the secondary stage.

Secondary syphilis

  • At this stage, there are rashes and sores in the mouth, vagina and anus. The rash is usually not itchy and will look like rough reddish brown spots, commonly on the palms of the hand and soles of the feet, though they can also be faint enough to be missed. Rashes with a different look might appear elsewhere also.

  • Additionally, fever, swollen glands, sore throat, patch hair loss, headaches, weight loss, muscle aches and fatigue are all possible symptoms in this stage.

  • Latent stage

  • The latent stage is a period where there are no symptoms whatsoever, despite carrying the bacteria inside them. This stage can last 10-30 years after the initial infection

  • Early latent syphilis is used to refer to infections that have happened within the last twelve months, while late latent syphilis means that the infection occurred more than 12 months ago.

Tertiary stage

  • Tertiary syphilis is rare and only develops in some cases of latent syphilis. This form of syphilis can be fatal, and affects the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Depending on the organs affected, symptoms differ greatly.

Neurosyphilis and ocular(eye) syphilis

  • can occur at any stage of the infection.

  • Neurosyphilis involves the nervous system being invaded by the virus, causing headaches, and changes in behaviour, locomotion and perception, eventually leading to paralysis and dementia

  • Ocular syphilis involves a syphilitic infection of the eye, leading to changes in vision that can eventually lead to irreversible blindness

There is also a strong correlation between syphilis and HIV, and an individual who has syphilis is 2 to 5 times more likely to get HIV if exposed while infected.


There are two types of tests available for syphilis, both of which are offered at CHC Clinic.

  1. TPHA (rapidtest) - This is a qualitative test that checks for the presence of syphilis antibodies used for diagnosis of syphilis for someone who has never previously tested positive for syphilis. It cannot be used for people who have previously tested positive for syphilis. This is available as both a lab test and as a rapidtest.

  2. RPR - this is a lab test that is used to detect the quantity of active bacteria in your body by assessing the level of antibodies in the system. A solution made from your sample will be diluted until it is no longer detectable. A very high number of dilutions (eg: 1:256) indicates that the bacteria is quite active while a low titre (eg; 1:1) indicates that the bacteria is not active in your system


The treatment for syphilis depends on the stage of the infection. In clients with primary, secondary, or early latent syphilis, a single intramuscular dose of Benzathine penicillin. For those in the late latent stage or who don’t know when they were infected, three doses of penicillin spaced out over three weeks is the recommended treatment. In the tertiary stage, or with neurosyphilis or ocular syphilis, IV penicillin needs to be administered continuously for 10-14 days in order to prevent further progression of the illness. However, any damage already done cannot be reversed.

Once treatment has been received, it’s important to abstain from sexual contact until any syphilis sores are completely healed.

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