Why syphilis is on the rise – and how to prevent it

Edwin Hayes, MD

Infectious Diseases

Although it might seem like a disease of the past, syphilis has been an ongoing and rising issue in the U.S., especially among pregnant women. Infectious disease expert Edwin Hayes, MD, explained what to know about this disease, why syphilis is on the rise and how to prevent infection.

What is syphilis?

Syphilis is a sexually transmitted infection caused by bacteria that many people don’t even know they have.

“Unfortunately, in South Carolina especially, we’ve seen an increase in congenital syphilis with pregnant women passing syphilis to their babies,” said Dr. Hayes. Congenital syphilis can cause serious harm to the baby’s bones, brain and skin.

“One of the most important things to know is that congenital syphilis is preventable, because we can easily treat moms who have syphilis during pregnancy,” Dr. Hayes added.

How does syphilis spread?

Syphilis spreads from person to person through direct contact. Syphilis can spread during all forms of sex, including vaginal, oral and anal. You cannot, however, spread or get syphilis from things like toilet seats or sharing eating utensils.

How do you know if you have syphilis?

The best way to know if you have syphilis is to get tested with a small blood sample. There are three active stages of syphilis that happen depending on how much time has passed since exposure, and a quiet stage where there may be no symptoms.

• Primary syphilis, or the first stage, usually lasts between three to six weeks. It involves a sore that develops where the bacteria enter the body, such as the outer genitals, inner vagina, rectum or mouth. You might not know you have a sore because it’s usually not painful.
• Secondary syphilis involves a rash two weeks to two months after the sore. If you have darker skin, the rash might look lighter than your other skin. It can be anywhere but it’s often on the hands and feet. You might have other symptoms during this stage too like fatigue, headaches or fever.
• Tertiary syphilis usually happens after the rash goes away and can last as short as one year or as long as 20 years. Most people with untreated syphilis don’t develop the third stage of syphilis, but it can affect many different parts of your body like your heart and brain.
• Latent syphilis, sometimes called the “hidden” stage can be present for years. You don’t show any symptoms during this stage but may still spread disease.

How is syphilis treated?

Syphilis is treated with antibiotics. Anyone who has been diagnosed and treated can still get reinfected. It’s important to talk to any sexual partners so they can get tested and treated too.

Who’s at higher risk for syphilis?

“We see a proportionately high risk in people of color,” Dr. Hayes said. “This could be due to disparities of care or a lack of access to care.”

Rates also tend to be higher among men who have sex with men. Transgender individuals, particularly transgender women, have dramatically higher rates.

In addition, those who have been in prison or engage in transactional sex work also have higher rates of syphilis.

“For that reason, it’s so important to try and reach people who are at higher risk and make sure they’re getting the care and the screening tests they need,” Dr. Hayes said. “For things like syphilis, blood tests are drawn and sent to a lab, and we usually have results back within a day or two.”

How can you prevent syphilis?

One of the best ways to protect yourself against syphilis is to use a barrier method with every partner every time you have sex, even if you’re already pregnant. Barrier methods are things like condoms, including internal female condoms or dental dams.

Syphilis can still be spread if someone comes into contact with a sore that is not covered by a barrier method. So be sure to ask your partner about their sexual history. And if you have concerns, ask to be tested.