Syphilis Testing

Anybody with signs or symptoms of syphilis should be tested.

Screening means getting tested for a disease before it starts to cause symptoms
or serious health problems. The Centers for Disease Control and Prevention recommend that the following people should be screened for syphilis:²

• Sexually active with someone who has recently been diagnosed with syphilis
• Sexually active men who have sex with men
• Have HIV and are sexually active
• Take pre-exposure prophylaxis for to prevent HIV

Because of the devastating effects of congenital syphilis, all pregnant women should be screened for syphilis.2 Screening is recommended at the first prenatal visit, with repeat screening in the third trimester and at delivery for women who are at high risk for syphilis. In addition, all infants born to women with syphilis should be tested for congenital syphilis.

Syphilis may cause a wide variety of symptoms.² The disease is often referred to as the “Great Pretender” because it can appear like many other conditions.

PRIMARY SYPHILIS

On average, it takes 3 weeks for symptoms to appear after getting infected with syphilis, but the time frame varies widely. Sores (chancres) appear where the infection first entered the body, such as on or near the genitals, rectum, or mouth. The sores are usually round, firm, and painless. The chancres last for about 3 to 6 weeks.

SECONDARY SYPHILIS

If the infection is not treated in the primary stage, it progresses to the secondary stage — even if the chancres have disappeared on their own. Symptoms of the secondary stage include the following:

• Rash: Reddish-brown spots on the chest, back, arms, palms of hands and bottoms of feet; usually not very itchy
• Condyloma lata: Large, gray, raised spots in and around the genitals and mouth; these spots are very infectious
• Swollen lymph nodes
• Fever
• Headache and muscle aches
• Sore throat
• Weight loss
• Hair loss

LATENT SYPHILIS

If secondary syphilis is not treated, the infection will enter the latent, or hidden, stage. This is a long period when the infection persists in the body but causes no symptoms. Treatment of latent syphilis depends on whether the infection started in the past year (early latent) or more than a year ago (late latent).

NEUROSYPHILIS

Syphilis affecting parts of the nervous system.^2,3 It can appear during any stage of the infection. There are 5 types of neurosyphilis:

• Asymptomatic neurosyphilis, with no symptoms
• Meningeal neurosyphilis, with headache, stiff neck, nausea, and vomiting
• Meningovascular neurosyphilis, similar to meningeal syphilis but with the added complication of a stroke
• General paresis, with dementia and personality changes
• Tabes dorsalis, with pain in the limbs and poor coordination and balance

OCULAR SYPHILIS

Syphilis affecting the eyes and vision. Like neurosyphilis, it can happen at any stage.²

TERTIARY SYPHILIS

Appears about 10 to 30 years after the initial infection.² Manifestations of this severe infection include:

• Inflammation and widening of the largest artery in the body (aorta) that carries blood away from your heart and to the rest of the body
• Gummas (soft, tumor-like growths) in the liver, skin, bones, brain, eyes, or heart.⁴

CONGENITAL SYPHILIS

When a woman with syphilis passes the infection on to her baby during pregnancy.^2,5

• Infant death: Up to 40% of babies of pregnant women with untreated syphilis with die in pregnancy or shortly after birth
• Babies with congenital syphilis who survive may have serious problems, like low birth weight, meningitis, seizures, blindness, deafness, bone problems, anemia, and jaundice.
• Infected babies may also die later if syphilis is not treated

The sores caused by syphilis also makes it easier to get and spread HIV.

Syphilis is usually diagnosed with a series of blood tests.^2,6

NONTREPONEMAL BLOOD TESTS

like VDRL and RPR are used to screen for syphilis because they’re simple and quick to perform. A negative result during initial screening means that the test did not detect syphilis. A positive result could be caused by syphilis or other conditions and thus needs to be confirmed with a treponemal test.

TREPONEMAL BLOOD TESTS

like FTA-ABS, TP-PA, and other tests are designed to detect antibodies that your body makes in response to syphilis infection.

In the traditional approach to testing syphilis, a positive nontreponemal blood test followed by a positive treponemal blood test means you have current or past syphilis infection. This is the more common way to diagnose syphilis.

In the reverse testing algorithm, a positive treponemal test followed by a positive nontreponemal test means you have current or past syphilis infection.

Keep in mind it’s possible to have syphilis and have negative test results if the exposure to the infection was recent.

IF THE EXPOSURE WAS IN THE PAST 2 TO 4 WEEKS, REPEAT TESTING IS RECOMMENDED.

Testing for neurosyphilis involves a spinal tap and examining the spinal fluid for signs of the infection.

Anybody who is diagnosed with syphilis should also be tested for HIV. The sores caused by syphilis increase the risk of getting and spreading HIV.

Before starting treatment for syphilis, your health care provider may ask about the
following:

• Symptoms
• Risk factors for syphilis
• History of other sexually transmitted infections
• Other medical conditions
• Current medications
• Allergies to medications
• Possibility of being pregnant. (You may be asked to take a pregnancy test.)

Syphilis is treated with penicillin. The form, dose, and way of administering penicillin must be properly matched to the stage of syphilis. Oral penicillin tablets are not effective for syphilis. The following are recommended treatment regimens for adults:⁷

PRIMARY, SECONDARY, OR EARLY LATENT SYPHILIS (INFECTION STARTED IN THE PAST YEAR)

is treated with a single dose of 2.4 million units of benzathine penicillin G injected in the muscle.

LATE LATENT SYPHILIS (INFECTION STARTED MORE THAN A YEAR AGO), LATENT SYPHILIS OF UNKNOWN DURATION, AND TERTIARY SYPHILIS WITHOUT NEUROSYPHILIS

is treated with 2.4 million units of benzathine penicillin G injected in the muscle every week for 3 weeks (7.2 million units total).

NEUROSYPHILIS AND OCULAR SYPHILIS

is treated with 18 to 24 million units of aqueous crystalline penicillin G given intravenously every day for 10 to 14 days.

It is recommended to monitor symptoms and lab tests after treatment to confirm elimination of the infection.

If a nonpregnant person with syphilis is allergic to penicillin, treatment options include doxycycline or tetracycline.

PREGNANT WOMEN

with syphilis should be treated with the penicillin regimen matched to her stage of infection. If a pregnant woman with syphilis is allergic to penicillin, she should undergo a penicillin desensitization process in order to allow safe treatment with penicillin.8

SEXUAL PARTNERS

of people with primary, secondary, or early latent syphilis may need to be treated for syphilis.

The only certain way to avoid getting syphilis is to avoid vaginal, anal, or oral sex.

If you are sexually active, consider these measures to lower your risk of getting or
transmitting syphilis:

• Stay in a mutually monogamous relationship with a partner who doesn’t have syphilis or other sexually transmitted infections. Mutually monogamous means that you and your partner have sex only with each other and not with other people
• Use a latex condom at all times. Note that syphilis sores may exist in areas not covered by a condom, so using a condom is not a guarantee against syphilis.

Treatment for syphilis can cure the infection but it does not protect you from getting it again. Reinfection with syphilis is common. It’s important to get retested for syphilis if you’ve had a new exposure after treatment.

The best way to prevent congenital syphilis in a baby is to prevent and treat syphilis in pregnant women and their sexual partners.

There is no vaccine available to prevent getting syphilis.

Researchers are developing and testing syphilis vaccines.

IMPORTANT:

Question: When is syphilis contagious?

Answer: Syphilis can be spread during sex when there are sores on the skin or mucous membranes of the mouth, rectum, and genitals. Primary, secondary, and early latent syphilis are