Syphilis can invade the nervous system neurosyphilis , visual system ocular syphilis , or auditory system otosyphilis at any stage of infection. These infections can cause a wide range of symptoms.
When a pregnant woman has syphilis, the infection can be transmitted to her unborn baby. All pregnant women should be tested for syphilis at the first prenatal visit. Some women need to be tested again during the third trimester 28 weeks gestation and at delivery.
This includes women who live in areas of high syphilis morbidity, are previously untested, had a positive screening test in the first trimester, or are at higher risk for syphilis i. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth or of giving birth to a baby who dies shortly after birth.
Untreated syphilis in pregnant women results in infant death in up to 40 percent of cases. An infected baby born alive may not have any signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die. All babies born to mothers who test positive for syphilis during pregnancy should be screened for syphilis and examined thoroughly for evidence of congenital syphilis.
Treponemal tests e. Treponemal antibodies appear earlier than nontreponemal antibodies and usually remain detectable for life, even after successful treatment. If a treponemal test is used for screening and the results are positive, a nontreponemal test with titer should be performed to confirm diagnosis and guide patient management decisions. Based on the results, further treponemal testing may be indicated.
Reverse sequence testing can identify persons previously treated for syphilis and those with untreated syphilis. False-positive results can occur in those with low likelihood of infection with reverse sequence testing as well.
Special note: Because untreated syphilis in a pregnant woman can infect her developing baby, every pregnant woman should have a blood test for syphilis. All women should be screened at their first prenatal visit. Some patients should receive a second test during the third trimester at 28 weeks and again at delivery.
All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated for congenital syphilis. A quantitative nontreponemal test should be performed on infant serum and, if reactive, the infant should be examined thoroughly for evidence of congenital syphilis. Suspicious lesions, body fluids, or tissues e.
Other recommended evaluations may include analysis of cerebrospinal fluid by VDRL, cell count and protein, CBC with differential and platelet count, and long-bone radiographs. For further guidance on evaluation of infants for congenital syphilis, please refer to the STI Treatment Guidelines. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present. The recommended treatment for adults and adolescents with primary, secondary, or early latent syphilis is Benzathine penicillin G 2.
The recommended treatment for adults and adolescents with late latent syphilis or latent syphilis of unknown duration is Benzathine penicillin G 7. The recommended treatment for neurosyphilis, ocular syphilis, or otosyphilis is Aqueous crystalline penicillin G million units per day, administered as million units intravenously every 4 hours or continuous infusion, for days. Treatment will prevent disease progression, but it might not repair damage already done.
Selection of the appropriate penicillin preparation is important to properly treat and cure syphilis. Combinations of some penicillin preparations e. Although data to support the use of alternatives to penicillin is limited, options for non-pregnant patients who are allergic to penicillin may include doxycycline, tetracycline, and for neurosyphilis, potentially ceftriaxone. These therapies should be used only in conjunction with close clinical and laboratory follow-up to ensure appropriate serological response and cure.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed.
Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary. Any person with signs or symptoms suggestive of syphilis should be tested for syphilis.
Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with syphilis should be tested for syphilis. Since , the number of people with infectious syphilis in Victoria has increased rapidly, mainly among gay men and other men who have sex with men MSM. An increase of syphilis in women particularly in women of reproductive age has also led to the re-emergence of congenital syphilis including foetal deaths in Victoria since Regular sexual health check-ups at least annually are recommended for all sexually active people.
Some who are at increased risk of syphilis infection include:. If you are sexually active, get a full sexual health check including tests for syphilis, HIV, gonorrhoea and chlamydia at least once a year. There are three stages of syphilis. Only the first 2 stages are infectious, and symptoms vary depending on the stage. You are more at risk of HIV infection during sexual contact if you have syphilis symptoms. The first stage of syphilis usually occurs over 4 to 12 weeks. Some people may not notice they have syphilis because they have no symptoms.
First stage syphilis is highly contagious, and symptoms usually begin as a sore ulcer on the genital area including the penis or vagina , anus or mouth. If you are not treated for syphilis at this stage, you may go on to develop the second stage of the infection.
The second stage begins around 2 to 4 months after contracting syphilis and may last up to 2 years. If you are infected with syphilis and do not seek treatment at this stage, you may develop the third stage of the infection. The third stage of syphilis may occur 10 to 30 years after the initial infection. This stage affects around one third of untreated people. Congenital syphilis occurs when a mother with syphilis passes the infection on to her baby during pregnancy or at birth.
Congenital syphilis can have serious health impacts on your baby. This depends on how long you had syphilis and if, or when, you were treated for the infection. You can catch syphilis by having unprotected oral, vaginal or anal sex with a person who is in the first 2 stages of the infection.
Syphilis is highly contagious when the sore or rash is present. Pregnant women who have syphilis can pass on the infection to their baby during pregnancy or at birth. Syphilis can also be passed through infected blood.
However, blood used in blood donations is routinely screened for syphilis in Australia. A regular sexual health check-up with your local GP doctor or sexual health centre can detect syphilis.
Just ask your doctor or nurse for a test. Penicillin is a very effective treatment for all stages of syphilis including congenital syphilis. Other treatments are available if you are allergic to penicillin, or you may be able to undergo a desensitisation procedure that safely allows you to be given penicillin.
Early treatment helps to prevent further complications and to avoid passing the infection on to sexual partners or to an unborn baby during pregnancy. Avoid sexual contact until your treatment is completed. Although the treatment is straightforward, it is important to have repeat blood tests to check that the treatment has worked.
Follow-up blood tests may be recommended at 3, 6 and 12 months after treatment. Having syphilis once does not protect you from getting it again.
It is important to let your sexual partner or partners know that you have syphilis. Most people will appreciate being told they may have an infection and it is an important step in preventing further infection in the community. If your partner is treated it will also prevent you from getting the infection again. Your local GP and sexual health centre can help you inform your partners and let them know that they need a test.
It can be done anonymously, and your confidentiality is always respected. Letting your partners know will also prevent you from getting the infection again. You can also anonymously notify your sexual partners of the need to get tested and treated for syphilis via the Let Them Know website if you feel unable to speak to them personally.
There are also nurses called partner notification officers who can help you anonymously notify your partners. Find sexual health clinic contact details. You should avoid any kind of sexual activity or close sexual contact with another person until at least 2 weeks after your treatment finishes. This usually happens during vaginal, anal or oral sex, or by sharing sex toys with someone who's infected. Anyone who's sexually active is potentially at risk. It may be possible to catch syphilis if you inject yourself with drugs and you share needles with somebody who's infected, or through blood transfusions , but this is very rare in the UK as all blood donations are tested for syphilis.
Syphilis cannot be spread by using the same toilet, clothing, cutlery or bathroom as an infected person. Find out more about syphilis in pregnancy. Syphilis cannot always be prevented, but if you're sexually active you can reduce your risk by practising safer sex:.
These measures can also reduce your risk of catching other sexually transmitted infections STIs. If you inject yourself with drugs, do not use other people's needles or share your needles with others.
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