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Syphilis


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WARNING: This page contains pictures of syphilis sores, which can be subtle or very obvious. These photos show explicit presentations of syphilis sores on genitals and other body parts.

Please DO NOT use these photos to self-diagnose. Syphilis is sometimes called "The Great Imitator" as it can look like many other conditions.

If you have signs or symptoms that concern you, please see a healthcare provider, or visit your local health department.


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How is syphilis affecting Oklahoma?

From 2014 to 2018, Oklahoma experienced a 860% increase in the number of primary and secondary syphilis cases among women. Oklahoma also saw one of the greatest absolute increases in primary and secondary syphilis cases among women over the past five years when compared to other states in the nation.

Oklahoma's absolute rate increase is higher than the national average, higher than the Southern regional average and higher than all the neighboring states.

Since 2014, Oklahoma has seen a 283% increase in congenital syphilis cases. By October 2019, Oklahoma experienced a 92% increase in the number of congenital syphilis cases from the previous year.

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by a bacteria called Treponema Pallidum. Syphilis is often called "The Great Imitator" because so many of the signs and symptoms are similar to those of other conditions. 

How do you get syphilis?

Syphilis is usually passed from person to person through direct contact with a syphilis sore, called a chancre, during oral, anal, or vaginal sex. 

Because syphilis sores can be hidden in the mouth, rectum or vagina, it may not be obvious that a sex partner has syphilis.  

A pregnant woman can also give syphilis to her unborn baby.


What are the signs and symptoms of syphilis?

Symptoms are easy to miss, and easy to mistake for something else.  Even if you don't notice symptoms, you can still have syphilis.  Each stage of syphilis looks different.

Syphilis is divided into three stages: primary, secondary and latent or tertiary syphilis. These stages are determined by clinical findings, such as tests and physical exams, which are used to guide correct treatment and followup.

Syphilis affecting the central nervous system can occur at ANY stage of syphilis. (Neurosyphilis)

If you have syphilis or think you may have syphilis, you should not have sex until ALL sex partners have been tested and treated. (including yourself)

Primary Stage - HIGHLY INFECTIOUS

  • Ulcers or Chancres at the infection site
    • Are usually firm, round and painless (DO NOT IGNORE THIS!)
    • Appear within 10-90 days, with an average of 21 days, after exposure to syphilis
    • May persist for three to six weeks, then go away (on their own)

If you do NOT receive treatment and the chancre goes away, it does not mean syphilis is gone.

WITHOUT treatment, syphilis will move to the next stage.

Secondary Stage - HIGHLY INFECTIOUS

Symptoms typically occur six weeks to six months after the the chancre (lesion), and clears up in two to ten weeks WITHOUT treatment; however, syphilis is still there.

  • Rash often no the palms of the hands, bottom of feet and on the torso or other parts of the body
  • Sores in the mouth, vagina or anus
  • Flat wart-like growths, condylomata lata, in the perianal/genital area and other moist body sites
  • Generalized enlarged lymph nodes (lymphadenopathy) and sore throat
  • Alopecia (patchy hair loss)
  • Headaches
  • Weight Loss
  • Muscle Aches
  • Fatigue

People with primary and secondary syphilis are very infectious!!!

If you have syphilis, you should not have sex until all sex partners have been tested and treated!!

Early Latent and Latent Syphilis / Syphilis of Unknown Duration 

Latent syphilis is defined as a positive syphilis infection without proof of primary or secondary symptoms. Early latent and late syphilis  can overlap the primary, secondary stages of syphilis based on length of time of infection and visible symptoms.

Measures for early latent syphilis include:

  • Documentation of a negative blood test within the past year,
  • Documented exposure to early syphilis in the past year, and
  • Symptoms of syphilis that have cleared up within the past year.

Non symptomatic syphilis acquired more than one year ago is classified as late syphilis or syphilis of unknown duration. Most people with late syphilis may have no symptoms for many years.

Neurosyphilis

Neurosyphilis is a syphilis infection of the brain and spinal cord which can occur at any stage of syphilis.

Neurosyphilis sometimes has no symptoms; however, symptoms can include:

  • Abnormal walk (gait), or unable to walk, weakness
  • Numbness in the toes, feet or legs
  • Problems with thinking, such as confusion or poor concentration
  • Problems with memory or dementia
  • Mental Problems, such as depression or irritability
  • Headache, seizure, or stiff neck
  • Loss of bladder control (incontinence)
  • Tremors or weakness
  • Eye pain
  • Visual problems, even blindness
  • Hearing problems, even hearing loss
  • Syphilitic Meningitis (inflammation of the membranes surrounding the brain and spinal cord)
  • Meningovascular Syphilis (caused by injury to the blood vessels and can result in a stroke)
  • General Paresis (slight or partial paralysis)
  • Tabes Dorasalis (slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain)

Neurosyphilis is a critical condition.

If you have symptoms of neurosyphilis, contact your healthcare provider or go to an emergency room immediately for testing.

Tertiary Syphilis

Tertiary syphilis is defined as symptomatic late latent syphilis, gummi and cardiovasculat syphilis, but not neurosyphilis. Late symptoms of syphilis usually develop of a period of 15-30 years of untreated infection.

Conditions which develop as a result of long term untreated syphilis cannot be reversed.

  • Damage to the heart, blood vessels, liver, bones and joints
  • Gummatous, soft noncancerous wounds (a wound that has a gummy or rubbery consistency)
  • Uvetitis (inflammation of the middle part of the eye) or Other Ocular Manifestations (an eye condition that directly or indirectly results from a disease process in another part of the body)
  • Death

Congenital Syphilis

Congenital syphilis is spread to an unborn baby from a mother who has NOT been treated or has gotten syphilis again.

Babies born to untreated mothers are at extreme risk for side effects, which can include:

  • Premature birth
  • Anemia
  • Enlarged Liver
  • Developmental delays (can be described as an impairment in physical, learning, language, or behavior areas)
  • Blindness or Deafness
  • Deformed teeth, bones and joints
  • Stillbirth (birth of dead fetus)

All women should be screened at their first prenatal visit. For clients who belong to communities and populations with a high prevalence of syphilis and for patients at high risk, blood tests should also be performed during the third trimester (at 28–32 weeks) and at delivery. For further information on screening guidelines, please refer to the CDC's 2015 STD Treatment Guidelines.

How is syphilis diagnosed?

A blood test is used to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies which can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years, even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can spread to and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.


What is the link between syphilis and HIV?

Genital sores caused by syphilis make it easier to spread and get HIV sexually.

There is an estimated 2- to 5-fold increased risk of getting HIV, if exposed when syphilis is present. 

Syphilis and certain other STDs might be indicators of ongoing behaviors and exposures that can place a person at greater risk for getting HIV.


What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year.

Additional doses are needed to treat someone who has had syphilis for more than a year.

For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important persons be screened for syphilis on an on-going basis if their sexual practices put them at risk for STDs.

Persons who receive syphilis treatment must not have sexual contact with ALL partners until treatment is complete and the symptoms have cleared up. Persons with syphilis must notify their sex partners so they also can be tested and receive treatment if necessary.


Can a person get syphilis again?

The short answer is, yes.

Having syphilis once does not protect a person from getting it again.

Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis.

Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis.

Talk with a health care provider will help to determine the need to be re-tested for syphilis after being treated.


How can syphilis be prevented?

The only certain way to avoid getting or spreading STDs, including syphilis, is to:

  • Not have sexual contact, and
  • Be in a mutually monogamous relationship with a partner who has been tested and does not have any STDs. (both partners are having sex with ONLY each other)

Avoiding alcohol and drug use may also help prevent getting or spreading syphilis, because these activities can prevent a person from understanding any information related to making a decision, including the consequences.

It is important that sex partners talk to each other about their HIV status and history of other STDs so they can take care of each other.

Genital ulcer diseases, like syphilis, can occur in areas that are covered or protected by a condom, as well as in areas that are not covered. Correct and consistent use of condoms can reduce the risk of STDs, only when the infectious site of potential exposure is protected/covered.

The sharing of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to not have sex and to see a healthcare provider immediately.

 If you are a business and would like to provide free condoms for your clients, email condoms@health.ok.gov for more information.


For more information, please contact the SHHR Service at 405-271-4636

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