Syphilis

• Rates of infectious syphilis in British Columbia have been increasing over the past five years. In 2022, 1,964 infectious syphilis cases were reported in B.C. (the highest on record in the last 40 years), with 47 per cent of cases occurring among VCH residents.
• Although the majority of infectious syphilis cases in the past decade have been among gay, bisexual, and other men who have sex with men, in recent years the number and proportion of cases have been growing substantially among heterosexual individuals, including pregnant persons, raising concern of syphilis infections among newborns (i.e. congenital syphilis).
• In response to the increase in B.C. syphilis rates, and reports  of congenital syphilis, all pregnant persons are  recommended to be screened for syphilis during the first trimester and at the time of delivery.

Syphilis is a sexually transmitted infection (STI) caused by the bacteria Treponema pallidum. Syphilis can be cured with antibiotics, but if left untreated, syphilis can progress to a late stage that causes serious health problems, including blindness, mental illness, problems with the heart and nervous system and even death.

Syphilis is passed from person to person through vaginal, oral, and anal sexual contact, where there is an exchange of body fluids or skin-to-skin contact. You can get it by sharing sex toys. Once you have syphilis you can pass it to others even if you don’t have symptoms.

If you have syphilis, it’s common to not notice any symptoms. Syphilis is known as “the great imitator” because it appears to be like many other infections or conditions, and is difficult to diagnose. If untreated, syphilis progresses over time: from primary, secondary, early latent to late latent. Individuals with latent infections don’t often have symptoms.

Primary Syphilis Infection

• A painless sore around the genitals, mouth, rectum or vagina. The sore is often not noticeable and usually occurs anywhere from three to 90 days after sexual contact.
•  The sore most often appears in the genital area, but may also be on the lips and mouth.
• The sore will go away on its own within a few weeks, but syphilis will continue to progress.

Secondary Syphilis Infection

• A non-itchy rash that can occur anywhere on the body, but often occurs on the chest, belly, genitals or palms of the hands and soles of the feet, anywhere from 14-90 days after sexual contact.
• The rash usually disappears, but it can come back months later.
• Other symptoms may include headache, fever, hair loss, swollen lymph nodes and bumps or patches inside the mouth, anus, penis/external genitals, or vagina/internal genitals.

Latent Syphilis Infection

• If syphilis is not treated, it progresses to a latent stage.
• The latent period can last up to 30 years or more, and you may not have symptoms during this time.

As syphilis clinical presentation can vary widely, syphilis testing should be considered for everyone who is sexually active presenting with new symptoms, or has a sexual partner who has tested positive for syphilis.

Regular syphilis screening is recommended for all individuals who are sexually active with new or casual sexual partners. In some instances, your healthcare provider may recommend routine screening for syphilis every three to six months.

Syphilis screening and testing is primarily done through collecting a blood sample. Individuals presenting with a lesion may have it swabbed to be sent off for syphilis testing as well.

Syphilis is a curable infection when properly treated. Syphilis is primarily treated through an antibiotic injection provided by a health-care provider. Depending on the stage of your infection, you may require one set of injections or three sets over three weeks. Oral antibiotic course for two to four weeks is available for those who cannot receive injections. It is important to complete treatment in order to avoid passing syphilis to others or having your infection progress to latent symptoms. 

• It is important to not have sex (even with a condom) for 14 days after the start of your treatment.
• If you do have sex during this time, you could pass syphilis to your sexual partners or get it again.

The medications used to treat syphilis are available for free in BC. 

• Bicillin
• Doxycycline

After treatment, follow-up blood tests are done to make sure the antibiotic treatment has worked. You can get syphilis again; antibiotic treatment does not protect against future exposures.

Whether you have never had the infection, or have had it before and are trying to keep from getting it again, it is important to practice safer sex.

• If you are sexually active, get tested every three to six months.
• Condoms are great if they work for you — the correct use of condoms reduces your chances of getting and passing syphilis. Note: while regular use of condoms will reduce the risk of picking up or passing on both syphilis and HIV, contact with a sore outside of the area covered by a condom can still cause syphilis infection.
• Talking with partners about safer sex makes sure everyone knows what to expect.
• Syphilis is often passed along by people who don’t have symptoms and don’t know they are infected.

• Syphilis is a reportable infection  in British Columbia
• Individuals who test positive for syphilis, or are identified as a partner for someone who has tested positive, may be contacted directly by a Public Health nurse
• Public Health works with all syphilis cases to make sure they receive treatment and are engaged in follow-up care
• Your sexual partners within the last three to 12 months should be tested and treated for syphilis. Public Health can help identify which partners need to be contacted. There are a few ways to tell partners; you can tell partners yourself or anonymously. Talk to your health-care provider about what is right for you.