Syphilis may sound like ye olde disease from the history books, but diagnoses are very much on the rise. There were 7,541 known cases in England alone last year, more than twice the amount recorded a decade ago, according to Public Health England.
While it’s not as common as some sexually transmitted infections, if left untreated, syphilis symptoms can include some pretty serious health issues. In many cases, it can prove fatal.
The bacterial infection is passed from person to person through contact with a syphilis sore, explains Stuart Gale, chief pharmacist and owner of Oxford Online Pharmacy. It can’t be transmitted by using the same toilet, clothing, cutlery or bathroom as an infected person.
“The sore can usually be found in the area of the penis, vagina or anus but it can also be found around the mouth,” Gale continues. “Contact may occur during vaginal, anal or oral sex. Toys can also spread the infection. Anyone who’s sexually active is potentially at risk. Syphilis can also be passed on by drug users sharing infected needles.”
Syphilis symptoms have four stages that progress in severity, so the earlier you catch it, the better your prospects. Here, MH reveals the syphilis symptoms in men to look out for, so you can react fast at the very first signs.
Syphilis Symptoms: The Four Stages
The symptoms of syphilis are often mild and difficult to recognise, which means you may pass on the infection without knowing you have it, explains Dr Junaid Patel, GP and medical team member at online sexual health screening service The STI Clinic.
“The symptoms may come and go and tend to change over time,” she continues. “Even if the symptoms do improve, there is still a risk you could pass the infection on or develop serious problems if you do not get treatment.”
There four stages of syphilis are: primary, secondary, latent, and tertiary. Each has different signs, symptoms and treatment requirements. Syphilis is the most infectious in the first two stages and most deadly in the latter.
Stage 1: Primary Syphilis
The first stage generally occurs between three and four weeks after contracting the bacteria – though it may present as soon as 10 days or as long as three months – as a small, round, sore or ulcer known as a chancre (pronounced shang-kur, FYI), which is painless but seriously infectious. It usually shows up wherever the bacteria entered; on or inside the mouth, genitals, or rectum. The sore usually lasts between three and six weeks and, crucially, heals whether you’re treated or not – the infection won’t magically go away. The glands in your neck, groin or armpits may also swell at this stage.
Stage 2: Secondary Syphilis
Without treatment the infection will move to the secondary stage, and syphilis symptoms will start to become more visible, usually lasting several weeks but potentially coming and going for years. A non-itchy, painless rash may develop – most likely on your palms and the soles of your feet, but potentially anywhere on your body – along with a fever, swollen lymph glands, sore throat, headaches, hair loss, weight loss, muscle aches and fatigue. You may also notice growths similar to genital warts in appearance. Again, these symptoms will eventually go away whether you have treatment or not.
Stage 3: Latent Syphilis
This occurs after syphilis symptoms from the secondary stage have cleared – latent means ‘hidden’. Latent syphilis can last for many years, and can be divided into two subcategories. Early latent syphilis lasts around one year, during which you are still infectious, and late latent syphilis, which occurs approximately two years after secondary syphilis has cleared. At this point, you are no longer able to pass syphilis onto others. That’s good news, then? Not exactly...
Stage 4: Tertiary Syphilis
At this point the disease starts to affect the likes of your brain and heart, as well as nerves, eyes, blood vessels, bones and joints. Tertiary syphilis symptoms vary depending on the organ system affected, but they can include meningitis, strokes, dementia symptoms, mental illness, blindness, deafness, numbness, loss of coordination and heart disease. Syphilis is still treatable at this stage, but it may have caused lasting damage that can’t be reversed. Eventually, the disease can prove fatal.
Syphilis Symptoms: Tests and Diagnosis
The only way to know whether you have syphilis is to get tested, and the only way to treat syphilis is with prescription medication. You can be tested at your nearest sexual health clinic or genitourinary medicine (GUM) clinic, or alternatively take an STI test kit at home. Remember, syphilis can take several weeks to show up on a test after you catch it. It’s important to check for other STIs too, as it’s possible to be infected with more than one – they don’t cancel each other out.
Diagnosing syphilis usually involves a blood test, and you may also have a physical exam and a swab test of any visible sores, explains Dr Laura Joigneau Prieto at UK-based online doctor, Zava UK. If you use a home test kit, you’ll usually have the results available between two and three days after the lab receives them.
“In primary and secondary syphilis, generally no other tests are required,” Dr Patel adds. “However, in the final stage, where there are complications affecting other parts of the body, further tests may be required including a chest x-ray, an ultrasound scan of the heart, and brain scans.”
Treatment usually consists of a short course of antibiotics, advises Dr Joigneau Prieto. “The type of antibiotic you will be prescribed will depend on how long you have had syphilis for,” she explains. “If you have had syphilis for less than two years, you will either be injected with penicillin or prescribed up to 14 days of antibiotic tablets if you are unable to take penicillin.” Two years or over usually requires three penicillin injections or a 28-day course of antibiotic tablets.
It hopefully goes without saying, but it’s important you don’t have sex until the sores are completely healed and a test confirms the infection has gone. “If you had the one-day course of treatment, you should avoid having sex for a week afterwards,” says Gale, adding that your current sexual partner and any other sexual partners you've had during the last six months should also be tested and treated to help stop the spread of the infection.
“The GUM clinic can organise contact tracing which means informing your previous sexual partners – confidentially and anonymously – that they need testing for STIs, including syphilis,” adds Dr Patel. “This is important if you are unable or unwilling to do this yourself.”
Syphilis Symptoms: Prevention
The nature of syphilis means contracting the infection can’t always be prevented, but you can reduce the risk. If you practice safe sex and always use a condom, your risk of catching syphilis is very much reduced, says Dr Patel, who adds that they “do not provide complete protection as syphilis ulcers can sometimes be on areas not covered by a condom”.
Use a dental dam during oral sex, she adds, and avoid sharing sex toys – but if you do share them, wash them and cover them with a condom before each use. If you inject yourself with drugs, prescription or otherwise, don’t use other people’s needles or share yours with others.
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