Syphilis is a sexually transmitted disease (STD) caused by a bacterium. Syphilis can cause long-term complications and/or death if not adequately treated. Syphilis is transmitted from person to person by direct contact with syphilis sores. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Syphilis can be transmitted during vaginal, anal, or oral sexual contact. Pregnant women with the disease can pass it to their unborn children. The average time between infection with syphilis and appearance of the first symptom is 21 days, but it can range from 10 to 90 days. There are 3 stages of syphilis: First stage, second stage, and later stage. The appearance of a single sore marks the first (primary) stage of syphilis symptoms, but there may be multiple sores. The sore appears at the location where syphilis entered the body. The sore is usually firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore lasts 3 to 6 weeks and heals regardless of whether or not a person is treated. However, if the infected person does not receive adequate treatment the infection progresses to the secondary stage. Skin rashes and/or sores in the mouth, vagina, or anus mark the secondary stage of symptoms. This stage usually starts with a rash on one or more areas of the body. Rashes associated with secondary syphilis can appear from the time when the primary sore is healing to several weeks after the sore has healed. The rash usually does not cause itching. This rash may appear as rough, red, or reddish brown spots both on the palms of the hands and/or the bottoms of the feet. However, this rash may look different on other parts of the body and can look like rashes caused by other diseases. The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person can continue to have syphilis in their body even though there are no signs or symptoms. This latent stage can last for years. About 15% of people who have not been treated for syphilis develop late stage syphilis, which can appear 10–30 years after infection began. Symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. In the late stages of syphilis, the disease damages the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can result in death. Syphilis is diagnosed by a blood test. Shortly after infection, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. Some health care providers can diagnose syphilis by examining material from a syphilis sore using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope. Follow-up testing is recommended to be sure that treatment is successful. Having syphilis once does not protect a person from getting it again. Even following successful treatment, people can still be re-infected. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, anus, under the foreskin, or mouth, it may not be obvious that a sex partner has syphilis. Unless a person knows that their sex partners have been tested and treated, they may be at risk of getting syphilis again from an untreated sex partner. Depending on how long a pregnant woman has been infected with syphilis, she has a good chance of having a stillbirth (birth of an infant who has died prior to delivery) or of giving birth to a baby who dies shortly after birth.
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