AskDocQ: 14 things you need to know about syphilis


In the nineteenth century, hospitals used donkeys to breastfeed foundling babies born with syphilis. It’s true! They did it to protect wet nurses from catching the highly contagious disease.

Syphilis, often thought of as an ancient disease, is on the rise again globally.

There is currently an outbreak in the north of Australia mainly affecting indigenous communities. Most cases elsewhere are in men who have sex with men, but it is also easily spread in the straight community.

One case recently in far north Queensland involving a tourism worker who had sexual contact with a huge number of young women.

Here are 14 syphilis facts:

1. It’s caused by a microscopic spiral bacterium called Treponema pallidum.

2. You can’t tell if someone has syphilis just by looking at them or their genitals, although if they have a rash or an ulcer it does raise suspicion.

3. It can take many weeks for a syphilis chancre (ulcer) to develop, and some people never get one.

4. Sometimes the only symptom is a mouth ulcer, a rash or sore glands. And some people get no symptoms at all!

5. Condoms don’t always protect against syphilis. It’s a “skin-to-skin” disease, spread by close contact.

6. You can get syphilis from oral sex.

7. Untreated syphilis becomes latent in the body, and can go on to cause neurosyphilis and other terrible complications. These can include gait disturbance, dementia, heart valve problems, paralysis, blindness, deafness and impotence.

8. Treatment for syphilis is very simple – two injections of long-acting penicillin into the buttocks and you’re all done. Yes, the shots are rather painful, but not for long, and they are 100% effective.

9. After treatment, you need to wait seven days before you can be up close and intimate with anyone.

10. If you don’t get treated for syphilis, you will continue to be infectious to others even after your symptoms go away.

11. A pregnant woman can pass syphilis to her unborn child, leading to congenital syphilis with devastating consequences. So, if you have been diagnosed with syphilis, it’s vital you let any sexual contacts know, to help prevent this terrible situation.

12. If you’ve ever had syphilis, your screening test and rapid test will always be positive, but a follow-up blood test can tell whether you have a new infection.

13. If you’re sexually active, then it’s worth getting a syphilis test every 3 months. If you’re on PrEP this should be happening anyway, and helps you stay on top of any pesky STIs.

14. There are also some promising trials looking at using the antibiotic doxycycline as PrEP for syphilis. This is still an area of research, so watch this space!

The big message with syphilis is that you can’t necessarily tell if you have it, so regular testing is the answer.

Dr Fiona Bisshop specialises in LGBTIQ health. For more by Dr Bisshop visit, follow @DrFionaBisshop on Twitter, or send your health questions to

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