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Sexual Health

STIs: Syphilis
What is syphilis?

Syphilis is an STI that was first described during the 15th century. It is caused by the bacterium Treponema pallidum, which enters the body through mucous membranes or broken skin. If untreated, the disease progress through four stages, each with its own symptoms. Untreated syphilis can lead to severe health problems including death.

How is syphilis transmitted?

Syphilis is transmitted through direct contact with a syphilis sore or rash. The sore appears at the site of sexual contact. Sore transmission can occur during vaginal, anal, or oral sex. It can also occur during kissing.

An infected mother can transmit syphilis to her child during pregnancy or childbirth. Syphilis can cause severe birth defects and death of the fetus.

Is syphilis common?

In 2002, there were 32,000 cases of syphilis in primary and secondary stages reported in the United States. Most of these infections occurred in persons 20-39.

It is well-known that Marion County experienced a significant syphilis outbreak in 1998-1999, when the incidence rate reached 50 per 100,000. In 2004, the incidence rate of syphilis was lower at 1 per 100,000.

What are the symptoms of syphilis?

Some people do not notice symptoms, but they are still be at risk for late-stage complications. Symptoms depend on the stage of the disease. These symptoms might include:

Primary Stage
The primary stage of syphilis is typically characterized by the appearance of a single sore (chancre), though more than one chancre can appear. The sore(s) can appear in the genitals, in the vagina, on the cervix, lips, mouth, or anus. A chancre is usually firm, round, small, and painless sore that appears within 90 days of exposure to the bacterium and last 3 to 6 weeks before healing on its own. Even though the sore heals without treatment, the infection will continue to progress to the next stage.

Secondary Stage
The secondary stage of syphilis develops 2 to 8 weeks after a person is infected. Symptoms during this stage can include a skin rash, appearing as rough, red, or reddish brown spots on the palms of the hands and/or the bottoms of the feet. A syphilis rash, however, can have different appearances and occur on different parts of the body. Sometimes the rash is so mild that it is not noticed. In addition to rashes, persons in the secondary stage of syphilis might experience fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The symptoms of secondary syphilis will go away without treatment, but the infection will continue to progress; and secondary symptoms can recur.

Latent Stage
Syphilis can remain dormant in the body for many years, typically between the secondary and late stages. During this time, symptoms are not present; but the infection remains in your body is infectious to sex partners.

Late Stage
The late stage of syphilis can occur anywhere from 2 to 30 years after initial infection. During this stage, damage can occur to the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. The damage may not show up for many years. In this late stage, as a result of the damage, a person might experience uncoordinated muscle movements, paralysis, numbness, gradual blindness, and dementia. The damage syphilis can cause to internal organs can result in death. A person is not usually infectious at this stage.

How is syphilis diagnosed?

A blood test "RPR" is done to detect syphilis. The RPR is a quantitative test and in early infection the titer (number) increases. After a period of time, the titer declines and may return to 0 (negative). If the RPR is positive, a confirmatory test "FTA" is also done.

Once an FTA is positive on an individual, it does not revert to a negative result. Someone with a negative RPR may have a positive FTA due to an old infection (treated or untreated).

How is syphilis treated?

The preferred treatment for syphilis is an injection of Penicillin. Early stages of the infection (less than one year) require 1 shot. Later stages require 3 injections 1 week apart over a 3 week period. If an individual is allergic to Penicillin, oral antibiotics may be prescribed.


Indiana state law requires that syphilis infection be reported to the Indiana State Department of Health. Trained health department workers may contact the individual diagnosed with syphilis infection to ensure treatment of the reported person and their contacts.