Syphilis still remains uncommon, but the incidence of syphilis infection is the highest it has been since records began. Untreated syphilis is often asymptomatic, but can cause a wide array of symptoms and long term complications. Morbidity and prevention of transmission to sexual partners or vertical transmission during pregnancy can all be prevented by early testing and treatment. Syphilis is treated with a course of antibiotics under specialist care and follow up by a consultant in Sexual Health.
When to test for syphilis
Syphilis is easily diagnosed and treated and has public health implications. If struggling to find a cause, faced with unusual or unexplained symptoms or results, it is worth excluding syphilis and HIV.
- Routine screening is offered as part of a sexual health screen, for those attending for treatment or testing of sexually transmitted infections.
- Routine antenatal screening for infectious diseases (HIV, Hepatitis B and syphilis) should be offered to all pregnant women at an early stage in antenatal care because treatment of syphilis is beneficial to the mother and baby [ref: NICE guidance CG62 Antenatal care for uncomplicated pregnancies Section 1.8.10]. Those declining initial screening, or those with further risk, should be offered testing again at a later stage in pregnancy.
- Screening of all blood and organ donors
- Symptoms where syphilis testing may be indicated. Syphilis presents in many and varied ways:
- Unexplained ulcer (oral, anal and genital are common, also pharyngeal, rectal, vaginal ulcers - often asymptomatic)
- Rashes (especially if palms and soles involved). Syphilis rashes are varied and are often non-specific. A common characteristic is that it often affects the palms and soles, which rarely happens with other causes of rash, but the appearance of the rash on the palms and soles varies. Web search images for "syphilitic rash" to see examples.
- Warty lesions (chondylomata lata)
- Abnormal LFTs
- Optic neuritis
- Unexplained neuropathies