My Doctor Online The Permanente Medical Group

Symptoms

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Syphilis can be difficult to diagnose because it can be a "silent" disease: an infected person may not notice the symptoms. Syphilis is also called the "Great Imitator," since it can cause symptoms that are very similar to other diseases. These things can make diagnosis of syphilis difficult and delay the medical care an infected person needs.

There are four stages of syphilis, and each stage has different symptoms.

Primary syphilis

The primary stage begins when syphilis bacteria are passed from an infected person to an uninfected person. No immediate symptoms occur, but about 20 days after infection a newly infected person will develop an open sore called a chancre (pronounced shanker). In some people, this sore can appear in as little as 10 days or as long as 3 months in others. This sore is usually painless and can last for 4 to 6 weeks before it disappears. A person can have one sore or several.

Because syphilis is often sexually transmitted, the chancre most often appears in the genital area or around the mouth or anus. It is possible for an infected woman to develop this sore inside her vagina, which makes it very difficult to notice.

Secondary syphilis

The secondary stage usually begins 6 to 8 weeks after infection, though it can take up to 6 months in some cases. There are certain symptoms that are common at this stage, but some people will develop unusual symptoms that can be very different from one person to the next.

The most common symptom is a skin rash, which can be red or pink and usually does not itch. It can be very pronounced and occur over multiple body parts, or it may be very faint and occur over only a small area. A person with syphilis is highly contagious during the secondary stage; the infection can be passed to others who come in contact with the skin rash or other skin lesions. Other common symptoms include:

• Fever
• Muscle aches
• Sore throat
• Weight loss
• Patchy hair loss
• Headache
• Swollen lymph nodes

These symptoms may clear up after several weeks, or they may last for up to a year. Sometimes they will disappear and reoccur several times.

Latent (hidden) syphilis

The latent stage beings when symptoms from the secondary stage disappear. This stage is called latent or hidden because syphilis is still present in the body, but it no longer causes symptoms. Particularly early on in the latent stage it still possible to transmit syphilis to others.

The latent stage may last for years. Some people never experience symptoms again, but about 15 percent of people with untreated syphilis progress on to the fourth stage.

Late (tertiary) syphilis

Late stage syphilis can occur years after the initial infection. In the late stage, the disease can cause damage to the heart, brain, and nervous system. In extreme cases, it can cause blindness, physical deformity, paralysis and even death.

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Causes

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You can prevent syphilis by practicing safer sex, using latex condoms, avoiding sexual encounters with a high-risk partner, and limiting the number of your sexual partners. Since syphilis can be passed from mother to child, screening for syphilis is a routine part of prenatal care.

Talk with your partner

Before you start a sexual relationship, talk with your partner about STDs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.

Talk openly and honestly with your partner about the importance of safe sex. Be clear about what you will and will not do sexually and respect what your partner will and will not do. Decide together what is right for both of you.

Protect Yourself With Condoms

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The only certain way to prevent getting an STD is to abstain from sex. If you do choose to have sex, using condoms correctly and consistently is the best way you can protect yourself.

• Condoms can protect you from pregnancy and many STDs, even HIV.
• Most drugstores and supermarkets carry condoms.
• Condoms must be used before the start of any sexual contact to be effective in preventing pregnancy and STDs.

Find Help if Your Partner Has Ever Hurt or Threatened You

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Unfortunately, abusive relationships are common. Abuse can include pressuring or forcing you to have sex, or refusing to use a condom to protect against pregnancy or STDs. If you think you are being abused, you can get help by talking to us or you can:

• Contact the National Domestic Violence Hotline, 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired.
• Visit the National Sexual Assault Hotline or call 1-800-656-4673.

Risk Factors

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Syphilis is easy to diagnose and treat. However, if untreated, you can pass it on to your partners and casual acquaintances and to your unborn child if you become pregnant.

If left untreated, syphilis can continue to develop in the body and cause significant damage to many organs including severe heart damage, blindness, brain damage, and possibly death.

Babies born with syphilis can have serious medical problems such as deafness, blindness, bone deformities, brain dysfunction, and facial deformities.

Syphilis and Pregnancy

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Congenital syphilis refers to syphilis passed from a mother to her baby during pregnancy or during labor and delivery. We strongly recommend that all pregnant women be screened for syphilis because of the severe consequences of being pregnant while infected or having a child born with congenital syphilis. Screening should be done:

• At the first prenatal visit for all pregnant women.
• At the beginning of the third trimester of pregnancy and again at delivery for women who are at high risk of acquiring syphilis.

Congenital syphilis increases the risk of fetal death and medical complications in newborns. Syphilis enters the fetal blood system through the placenta, causing infection of the newborn or death of the fetus. Symptoms of congenital syphilis in babies include:

• A highly contagious watery discharge from the nose ("sniffles")
• Painful inflammation of the bone coverings
• Contagious rash, frequently appearing over the palms of the hands and soles of the feet
• Reduced red blood cells in the blood (anemia)
• Enlarged liver and spleen
• Swelling of the lymph nodes
• Failure to grow and develop normally

Because there are other conditions with similar symptoms, an accurate diagnosis is important for treatment.

Treatments

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While syphilis can sometimes be difficult to diagnose, it can be quickly and effectively treated with antibiotics if caught in the early stages. Treatment is still effective for late-stage syphilis, but it cannot undo damage already caused by the disease.

During treatment, it is important to avoid sexual contact with others, as it is still possible for you to spread the infection. We will recommend follow-up blood tests to ensure the treatment has been effective.

If you have had syphilis in the past and have been cured, you still are at risk of catching it again. Because of this, it is important that you practice safe sex, and that your sexual partner or partners are tested and treated for syphilis as well.

Why Treatment is Important

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Syphilis is easy to diagnose and treat. However, if it is untreated, you can pass it on to your partners and casual acquaintances and to your unborn child if you become pregnant.

If left untreated, syphilis can continue to develop in the body and cause significant damage to many organs including severe heart damage, blindness, brain damage, and possibly death.

Babies born with syphilis can have serious medical problems such as deafness, blindness, bone deformities, brain dysfunction, and facial deformities.

Syphilis and pregnancy

It is possible for an infected mother to pass syphilis to her baby during pregnancy and childbirth. This is called congenital syphilis, and it increases the risk of miscarriage and infant illness.

Because of this, we believe screening for syphilis should be a routine part of every pregnancy. We offer screening to all pregnant women at their first prenatal visit and then again to women in their third trimester if they may have acquired syphilis during their pregnancy.

Your Care with Me

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If you are worried about being exposed to a sexually transmitted disease (STD) like syphilis and:

• You are experiencing symptoms like pain, itching, bleeding, or unusual vaginal discharge, I recommend you make an appointment to see me. We can decide how best to treat your symptoms and discuss ways to protect you from STDs in the future.
• You do not have any symptoms, please e-mail me or call the Appointment and Advice line to request testing. Once we order those tests, you can have blood and urine testing for STDs in our lab without having to come in for a full appointment.

It is important to be tested for STDs, even if you do not think you are at risk.

• If you are under 25 years old, I recommend that you be tested for STDs every year.
• Everyone should be tested for HIV at least once in a lifetime. Even if you think you are not at risk, it is important to be sure.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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