Clinical update


Syphilis is caused by infection with the bacterium Treponema pallidum.

Essential facts

Syphilis is caused by infection with the bacterium Treponema pallidum. It is transmitted by direct contact with an infectious lesion or by vertical transmission during pregnancy. Although the number of diagnoses of syphilis in the UK has risen substantially in the past decade, it remains one of the less common sexually transmitted infections, with fewer than 3,000 people diagnosed in 2012.

Picture credit: SPL

The British Association for Sexual Health and HIV (BASHH) has drawn up UK national guidelines for the management of syphilis. The draft guideline includes recommendations on diagnostic tests, treatment and health promotion, including how to prevent transmission and future infection.

The most common initial symptom is a single painless but highly infectious sore, usually around the genitals and lasting three to eight weeks. Chancres may also be multiple, painful, purulent, destructive or extragenital (most frequently oral). When present at extragenital sites, they can pass unnoticed by the patient.

Without treatment, 25% of people will develop signs of secondary syphilis four to ten weeks after the appearance of the initial chancre. This often presents as a widespread rash and generalised lymphadenopathy. Around 1-2% of patients will develop neurological complications. Secondary syphilis spontaneously resolves in three to 12 weeks, before entering a latent stage. Tertiary disease occurs in approximately one third of untreated patients around 20 to 40 years later. This stage is rare in the UK.

Rates of syphilis are highest among men who have sex with men. According to BASHH, those infected are predominantly white men aged 25-34, and 60% are also infected with HIV. Of 2,978 cases of syphilis in 2012, more than three quarters were men.

All patients with syphilis should undergo screening for other sexually transmitted infections, including HIV. Patients should be given a clear explanation of their diagnosis and its implications, along with written information. Those with early infectious syphilis should be advised to abstain from sex until any lesions have resolved, or until two weeks after treatment has been completed. All pregnant women should have syphilis serology at their first antenatal clinic visit.

Expert comment

Jason Warriner, UK director of quality and clinical services, Marie Stopes

‘I think the draft guidelines are very clear and will help anyone to gain a basic awareness of syphilis and its treatment.

‘For nurses who work outside sexual health, the key point is to know how to contact your local sexual health clinic so you can refer your patient for expert help. There is still a stigma attached to sexually transmitted infections. Nurses need to keep it normal – you are referring someone in the same way you would refer them to a diabetes clinic. Some healthcare professionals are unsure whether syphilis can be treated, or assume the patient requires a long course of antibiotics. In reality, treatment can be a single dose of antibiotic.’

Find out more

British Association for Sexual Health and HIV (BASHH)

BASHH: UK National Guidelines on the Management of Syphilis 2015

BASHH/Medical Foundation for HIV and Sexual Health: Standards for the management of sexually transmitted infections (January 2014)

Genito-Urinary Nurses Association (GUNA)

Terrence Higgins Trust

GMFA – the gay men’s health charity

Marie Stopes


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