Pākewakewa Syphilis

The symptoms of syphilis depend on the stage of infection — primary, secondary, and late (tertiary).

Primary syphilis

The first sign of syphilis is a sore or ulcer (called a chancre) at the site of infection, usually the genitals, anus or mouth. The sore may be painless and hidden from view so may not be noticed.

The sore usually appears about 3 weeks after infection. It can take between 3 and 6 weeks before the sore heals. The sore will heal with or without treatment.

Without treatment you will remain infectious and develop secondary syphilis.

Secondary syphilis

Untreated primary syphilis will progress to the next stage of disease. The secondary stage of infection with syphilis has different symptoms to the primary stage of infection.

These symptoms include:

• rashes, often with red or brownish spots on the palms of the hands and soles of the feet
• swollen lymph glands
• fever
• hair loss
• muscle and joint aches
• headaches
• tiredness
• warty growths in skin folds, especially in the genital or anal areas.

Symptoms of secondary syphilis can happen while the sore is healing or several weeks after it has healed.

The symptoms of secondary syphilis can last up to 6 months and will disappear without treatment.

Without treatment you will remain infectious. You may develop late (tertiary) syphilis.

Late (tertiary) syphilis

If not treated, a small number of people will get late stage (tertiary) syphilis years after the initial infection. Late syphilis can cause damage to the:

• heart
• brain
• nerves
• eyes
• blood vessels
• liver
• bones and joints.

If you have late syphilis you are not infectious to those you have sexual contact with.

If you have syphilis and are pregnant, your fetus may be infected. It may die in the womb (stillbirth), shortly after birth, or your pēpi may be born early, possibly with congenital abnormalities, such as:

• blindness
• deafness
• meningitis caused by the infection.

Untreated babies may become developmentally delayed, have seizures, or die.

To find out if you have syphilis, your healthcare provider will order a blood test. The blood test may not pick up the early stages of infection and you may need repeat tests.

Your sexual partners will need to be tested, and treated if they have been infected.

Syphilis is treated with antibiotics. The length of treatment varies depending on the type of infection and the antibiotic used. In most cases, penicillin injections are used.

After treatment with penicillin injections, some people (particularly in early syphilis) have a flu-like illness for 24 hours. This includes fevers, aches and pains and generally feeling sick. These symptoms go away and do not need any treatment except rest.

You will need follow up blood tests for at least 1 year to check the treatment has been successful.

Reinfection

It is possible to be reinfected with syphilis again through sexual contact with someone who has syphilis.

The spread of syphilis can be prevented by:

• practising safer sex including using a condom or oral dam
• avoiding sex with someone who has a visible ulcer or sore on their genitals
• having regular STI check ups for timely diagnosis and treatment
• informing sexual partners if you are diagnosed with syphilis so they can also be tested and treated.

Safer sex and condoms

Syphilis is one of the routine blood tests for pregnant women in Aotearoa New Zealand. Treatment of syphilis early in pregnancy is very effective in preventing syphilis in the fetus. It is important to continue to test for syphilis if there is a risk of infection during pregnancy.

Blood tests in pregnancy — Ministry of Health (external link)↗