Syphilis

Syphilis is a bacterial infection that if left untreated, can lead to serious chronic health issues.

How would I get it?

  • Spread through unprotected oral, vaginal, or anal sex, mutual masturbation or sharing of sex toys with an infected person
  • Direct contact with a syphilitic sore or rash
  • It may also be passed from an infected mother to infant during birth

What kind of symptoms could I have if I am infected?

  • Some people who are infected may not have any symptoms at all
  • Syphilis passes through stages (primary, secondary, latent, and tertiary) with each having different symptoms and treatment

More common symptoms throughout all stages:

  • A painless ulcer or sore at the point of infection, most often genitals, anus, or throat
  • Flu-like symptoms
  • Hair loss
  • Muscle and joint pain
  • Rash, especially on the palms of hands and soles of feet
  • Fever
  • Swollen lymph nodes
  • Weight loss
  • Headaches
  • Eye infection
  • Meningitis
  • Flat smooth warts on your genitals

When a syphilis infection reaches the last stage (tertiary), it can affect the brain, heart, bones, or blood vessels, and in rare cases these complications can lead to death.

How do I prevent this?

  • Condoms and dental dams
  • Avoid skin to skin transmission with a sore or rash

How do I get tested?

  • Blood test; expect results to come back in 1-2 weeks
  • Fluid collection from a sore

What if I test positive?

  • This infection is treated with antibiotics; you may require more than one dose depending on what stage you are in
  • If left untreated, syphilis can cause serious health problems
  • Syphilis is a reportable infection – meaning someone from Public Health may contact you for further information and you are required to notify sexual partners. Should you prefer to remain anonymous, Public Health can assist by notifying any or all partners.

Treatment

Benzathine Penicillin G

Purpose: Main drug for treating primary, secondary, and early latent syphilis.

Dosage: Single injection of 2.4 million units (MU) intramuscularly.

Effectiveness: Highly effective in early stages of syphilis. The prolonged release ensures a stable level of the antibiotic in the body.

Penicillin G

Purpose: Used for late latent syphilis or syphilis of unknown duration.

Dosage: Three injections of 2.4 MU intramuscularly, one injection per week for three weeks.

Special Features: Effectively combats the infection in late stages, preventing disease progression.

Crystalline Penicillin G

Purpose: Used in neurosyphilis and ocular syphilis.

Dosage: Administered intravenously every 4 hours (18-24 MU per day) for 10-14 days.

Effectiveness: The only recommended drug for treating central nervous system involvement caused by syphilis.

Alternative Medications for Penicillin Allergy

Azithromycin is sometimes used to treat syphilis, especially in the early stages of the disease or in patients with a penicillin allergy. However, it is not the primary medication for treating syphilis.

Doxycycline

The use of doxycycline in syphilis treatment is especially important for patients with penicillin allergies, offering a safe and effective means to address the infection.

Dosage: 100 mg twice daily for 14 days for early stages and up to 28 days for late stages of syphilis.

Special Features: Oral administration. An alternative for patients allergic to penicillin but less effective compared to penicillins.

Tetracycline

Dosage: 500 mg four times a day for 14-28 days depending on the stage of syphilis.

Effectiveness: Another alternative drug, used less frequently due to more complex dosing and side effects.

Ceftriaxone

Dosage: Intramuscular or intravenous administration in doses ranging from 1 to 2 g daily for 10-14 days.

Use: Sometimes used in neurosyphilis or in cases of penicillin allergy when other options are unsuitable.

Erythromycin

Erythromycin can be used to treat syphilis, but this is rare and is most often used if there are strict contraindications to mainstream treatments. Erythromycin is usually prescribed in a dosage of 500 mg 4 times a day. This treatment lasts for at least 14 days for early syphilis. For later stages of syphilis (e.g., latent phase), the course may be lengthened to 30 days.

Important Considerations When Using Antibiotics

Jarisch-Herxheimer Reaction: Temporary worsening of symptoms (fever, headache) possible after starting treatment, especially in late stages of syphilis. Requires symptomatic treatment and monitoring.

Follow-Up Testing: Post-treatment follow-up tests are necessary to confirm the successful elimination of the infection.

Effective treatment of syphilis requires strict adherence to the medication regimen and medical supervision, especially in complex cases or with allergies to standard antibiotics.

How do I know it’s gone?

  • You will need to have follow up testing to make sure the treatment worked
  • We also recommend regular testing if you are at risk of a new infection

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