What is syphilis?

Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if you do not treat it. It is easy to cure if you treat it early.

In the past 10 years, the number of syphilis cases reported in Australia has significantly increased.

What are the symptoms of syphilis?

The symptoms of syphilis depend on the stage of your infection. There are 4 stages of syphilis infection:

1. primary syphilis
2. secondary syphilis
3. latent syphilis
4. tertiary syphilis

Primary syphilis

Primary syphilis happens between 10 and 90 days after infection. You may get a painless sore or sores in or on your:

• mouth
• anus
• penis
• vagina
• cervix

The sore is a round area of broken skin. The centre may be weepy (oozing) and have pus coming from it. The sores usually go away by themselves after 2 to 6 weeks.

It can be easy to miss the sores because they are usually painless. They may also be hidden from view in your rectum or on your cervix.

However, even when the sore goes away, you can still pass syphilis on to others.

Secondary syphilis

Secondary syphilis usually happens more than 6 weeks after infection. Symptoms of secondary syphilis include:

• a red rash on your body or on the palms of your hands, soles of your feet, chest or back — the rash is slightly lumpy, but not itchy or painful
• fever
• swollen glands in your armpits and groin
• hair loss
• headaches
• tiredness

Often you may not notice these symptoms. If untreated, the symptoms slowly get better over a period of weeks, but they can come back.

Secondary syphilis can spread easily to sexual partners. It can also spread to an unborn baby if you have syphilis and are pregnant.

Latent syphilis

There are usually no obvious symptoms of latent syphilis. Infection is only found with blood tests.

If you do not treat syphilis at this stage, it can remain latent for life or turn into tertiary syphilis.

Latent syphilis can also be transmitted to an unborn baby during pregnancy.

Tertiary syphilis

Tertiary syphilis develops in about 1 in 3 people with untreated latent syphilis.

The bacteria can damage almost any part of your body including your:

• heart
• brain
• spinal cord
• eyes
• skin
• bones
• liver and other organs

This can happen many years after you were first infected with syphilis.

There are three major forms of tertiary syphilis:

• Cardiovascular syphilis — this can affect your heart.
• Neurosyphilis — this can affect your brain, spinal cord and eyes.
• Gummatous syphilis — this can affect your skin, bones, liver and other organs.

Some people with syphilis have no symptoms. This is why it is important to be tested regularly.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes syphilis?

Syphilis is caused by bacteria called Treponema pallidum.

When should I see my doctor?

You should see your doctor, visit a family planning clinic or a sexual health clinic if you:

• think you may have syphilis or another STI, even if you do not have any symptoms
• have had sexual contact with someone who has syphilis or another STI
• have any genital, anal or mouth ulcers or lumps without a known cause

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

How is syphilis spread?

You can get syphilis if you have unprotected skin-to-skin contact during vaginal, anal or oral sex.

Syphilis is very contagious (spreads easily) during the primary and secondary stages when you have a sore or rash.

You can also pass on syphilis to someone else if you are in the early latent phase and do not have any sores.

If you are pregnant, syphilis can pass to your baby through the placenta. This is called congenital syphilis.

Syphilis can sometimes spread through contact with blood, for example from a needlestick injury or sharing injecting equipment.

Your risk of getting syphilis through a blood transfusion is very low due to:

• the screening of donors
• the way the blood is stored

Who is at risk?

In Australia, population groups at higher risk of syphilis include:

• men who have sex with men
• adolescents and young adults
• people who may become pregnant
• Aboriginal and/or Torres Strait Islander peoples

How is syphilis diagnosed?

Your doctor can diagnose syphilis by:

• examining you and asking you questions about your symptoms
• taking a swab from your sore for testing
• doing a blood test to confirm a diagnosis
• performing a lumbar puncture and sending a sample of cerebrospinal fluid (only in tertiary syphilis)

Blood tests to diagnose syphilis look for antibodies. Your body makes antibodies to fight the syphilis infection. Your blood test results can tell you if you have syphilis now or if you had it in the past. It can take your body some time to develop antibodies. This is why your blood test results can be negative, even if you have recently caught syphilis. If this happens to you, you should have another blood test 2 weeks later.

Sometimes you can also have other STIs at the same time as syphilis. Your doctor may offer to test you for other STIs when testing for syphilis.

Syphilis is a nationally notifiable disease in Australia. This means that government health authorities must be told about all cases of syphilis. This is done so that infections can be tracked. It is important to try to stop outbreaks because syphilis can cause long-term health complications.

Notifying sexual partners

If you have syphilis, it is very important that you help with contact tracing. This means telling anyone you have had sex with during the past 12 months. They will need testing and treatment if they have it. This will help stop you from being infected again. It also reduces the spread of syphilis.

Your doctor can help you work out who you need to contact.

If you are worried about telling recent sexual partners that you have syphilis, you can send them an anonymous text message or email through some websites, such as Let Them Know.

How is syphilis treated?

Syphilis is usually treated with an antibiotic medicine called penicillin, as an injection. If you are allergic to penicillin, there are other treatment options available.

Your sexual partners will also need to be tested and treated.

After treatment with penicillin, you may feel like you have the flu. If you feel unwell, you should rest and drink plenty of fluids. This will soon go away without any extra treatment.

There are other things you should do as part of your treatment:

• Avoid all sexual contact for 7 days after you have started your treatment or until you have finished your treatment and symptoms have gone away, whichever is later.
• Avoid sex with any of your sexual partners from the past 12 months until they have been tested and treated as this will help prevent reinfection.
• Have follow-up blood tests at 3 months, 6 months and 12 months after you were diagnosed to make sure the infection has gone away.

What if I have syphilis and am pregnant?

If you are pregnant, you will be tested for syphilis at:

• your first antenatal visit
• weeks 28 to 32 of pregnancy
• week 36 of pregnancy

If you are at high risk of syphilis, you will also be tested again around 6 weeks after your baby is born.

It is important that you are treated for syphilis during pregnancy if you have it. If you do not treat syphilis, you can pass it on to your baby (known as congenital syphilis).

Congenital (present from birth) syphilis may cause these serious complications:

• miscarriage
• stillbirth
• premature birth
• serious birth defects
• low birthweight
• death shortly after birth

You can safely take treatment for syphilis while pregnant. If you treat your infection early, you can reduce the amount of damage congenital syphilis does to your baby.

Read more about syphilis and pregnancy on Pregnancy, Birth and Baby.

What are the complications of syphilis?

Syphilis can cause serious health problems if it is not treated. Complications may include:

• neurological issues such as psychosis, memory loss, difficulty walking or paralysis (loss of muscle movement)
• cardiovascular damage, including aneurysms, heart valve disease or heart failure
• eye disease (ocular syphilis) that can lead to blurred vision or blindness
• gummatous syphilis, which can cause nodules (bumps) on skin, bone, liver and other organs that can lead to pain or long-term damage
• congenital syphilis in babies, causing miscarriage, stillbirth or lifelong health problems if passed on during pregnancy

Syphilis can be passed to your baby during pregnancy. This can be very serious.

Can syphilis be prevented?

You can prevent syphilis and other STIs by practising safe sex:

• Always use a condom with a water-based lubricant when you have vaginal, oral or anal sex, or a dental dam if you are having oral sex.
• Avoid having sex if you or your partner have ulcers or sores on their genitals or mouth.
• Have regular sexual health checks.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

If you have previously had syphilis and recovered, you can still get it again.

The Australian Government is responding to rising syphilis cases by working with state and territory governments to help reduce the spread.

Resources and support

• The Let Them Know website helps you send free, anonymous text messages or emails to sexual partners to help with contact tracing.
• If you have been sexually assaulted, you can contact 1800RESPECT on 1800 737 732 24 hours a day, 7 days a week for confidential information, counselling and support services.
• If you want to get tested for syphilis, see your doctor or call your nearest sexual health clinic:
  • Australian Capital Territory — Canberra Sexual Health Centre
  • New South Wales — Sexual Health Info Link
  • Northern Territory — Sexual health services
  • Queensland — List of Queensland sexual health and HIV services
  • South Australia — Sexual health services
  • Tasmania — Sexual health services
  • Victoria — Stay STI Free
  • Western Australia — Could I have it?

Languages other than English

• The Stay STI Free website has fact sheets on syphilis and other STIs in Chinese, Korean and Spanish.
• Visit All Good to learn more about sexually transmissible infections and how to protect yourself in a range of community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• Young Deadly Free has resources to encourage STI testing in remote Aboriginal communities.
• You can also watch the Young Deadly Free video on STIs and blood-borne viruses made for Aboriginal and/or Torres Strait Islander people across Australia.

Information for sexually and gender-diverse families

• Drama Down Under is a website specifically for males with male sexual partners. Learn more about STIs, contact tracing and receive reminders when it is time to be retested.
• Read about syphilis on the Gay Men&'s Health Australia website and the SAMESH website.