Syphilis in Women

Syphilis Facts

Illustration of a syphilis bacterium.
Illustration of a syphilis bacterium.
  • Syphilis is a bacterial infection that is transmitted by sexual contact.
  • Condoms do not always necessarily prevent sexually transmitted diseases.
  • The scientific name for the syphilis organism is Treponema pallidum.
  • Early syphilis causes a mouth or genital ulcer (chancre). This is the hallmark sisgn of the first stage.
  • Later stages of syphilis can cause hair loss, headaches, sore throat, and skin rash. Eventually, syphilis can lead to heart and brain damage.
  • The standard screening blood tests for syphilis are called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen Reagent (RPR) tests. These detect the response to infection.
  • Any positive VDRL or RPR test must be confirmed by a test specific for the organism causing syphilis, such as the microhemagglutination assay for T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorbed test (FTA-ABS). Syphilis is treated with antibiotics.
  • Women who are infected during pregnancy can pass on the infection to the fetus through the placenta.

What Are Sexually Transmitted Diseases (STDs)?

Picture of syphilis
Picture of syphilis

Sexually transmitted diseases (STDs) are infections that can be transferred from one person to another through any type of sexual contact. STDs are sometimes referred to as sexually transmitted infections (STIs) since they involve the transmission of a disease-causing organism from one person to another during sexual activity. It is important to realize that sexual contact includes more than just sexual intercourse (vaginal and anal). Sexual contact includes kissing, oral-genital contact, and the use of sexual "toys," such as vibrators. STDs have been around for thousands of years, but the most dangerous of these conditions, the acquired immunodeficiency syndrome (AIDS), has only been recognized since 1981, with the causative virus first identified in 1984.

  • Many STDs are treatable, but effective cures are lacking for others, such as HIVHPV, and hepatitis B.
  • Even gonorrhea, once easily cured, has become resistant to many of the older traditional antibiotics.
  • Many STDs can be present in, and spread by, people who do not have any symptoms of the condition and have not yet been diagnosed with an STD.
  • Therefore, public awareness and education about these infections and the methods of preventing them is important.

There really is no such thing as "safe" sex. The only truly effective way to prevent STDs is abstinence. Sex in the context of a monogamous relationship wherein neither party is infected with a STD also is considered "safe." Most people think that kissing is a safe activity. Unfortunately, syphilis, herpes, and other infections can be contracted through this relatively simple act. All other forms of sexual contact carry some risk.

Condoms are commonly thought to protect against STDs. Condoms are useful in decreasing the spread of certain infections, such as Chlamydia and gonorrhea; however, they do not fully protect against other infections such as genital herpes, warts, syphilis, and AIDS.

Prevention of the spread of STDs is dependent upon the counseling of at-risk individuals and the early diagnosis and treatment of infections.


Condoms are the best protection from sexually transmitted diseases (STDs). See Answer

What Causes Syphilis?

Syphilis is an STD that has been around for centuries. It is caused by a microscopic bacterial organism called a spirochete.

  • The scientific name for the organism is Treponema pallidum. The spirochete is a wormlike, spiral-shaped organism that wiggles vigorously when viewed under a microscope.
  • It infects the person by burrowing into the moist, mucous-covered lining of the mouth or genitals.
  • The spirochete produces a classic, painless ulcer known as a chancre.

Syphilis in Women: Symptoms by Stage

There are three stages of syphilis, along with an inactive (latent) stage. 

  • The formation of an ulcer (chancre) or the first stage
  • The Systemic or the second stage
  • The Latent or the third stage

Formation of an ulcer (chancre) is the first stage. The chancre develops any time from 10 to 90 days after infection, with an average time of 21 days following infection until the first symptoms develop.

  • Syphilis is highly contagious when the ulcer is present. The infection can be transmitted from contact with the ulcer which teems with spirochetes.
  • If the ulcer is outside of the vagina or on the male's scrotum, condoms may not prevent transmission of the infection by contact.
  • Similarly, if the ulcer is in the mouth, merely kissing the infected individual can spread the infection.
  • The ulcer can resolve without treatment after three to six weeks, but the disease can recur months later as secondary syphilis if the primary stage is not treated.

In most women, an early infection resolves on its own, even without treatment. Secondary syphilis is a systemic stage of the disease, meaning that it can involve the body's various organ systems.

  • In this stage, patients can initially experience many different symptoms, but most commonly they develop a skin rash, typically appearing on the palms of the hands or bottoms of the feet, that does not itch.
  • Sometimes the skin rash of secondary syphilis is very faint and hard to recognize; it may not even be noticed in all cases.
  • This secondary stage can also include hair loss, sore throat, white patches in the nose, mouth, and vagina, plus fever and headaches.
  • There can be lesions on the genitals that look like genital warts but are caused by spirochetes and are not true warts.
  • These lesions, as well as the skin rash, are highly contagious. The rash can occur on the palms of the hands. As a result, the infection can be transmitted by casual contact.

Subsequent to secondary syphilis, some patients will continue to carry the infection in their body without symptoms. This is the so-called latent or third stage of the infection. It can develop in about 15% of people who have not been treated for syphilis, and can appear 10 to 20 years after the infection was first acquired. Typically, syphilis in the third stage is no longer contagious. Tertiary syphilis is also a systemic stage of the disease and can cause a variety of problems throughout the body including:

  • abnormal bulging of the large vessel leaving the heart (the aorta), resulting in heart problems;
  • the development of large nodules (gummas) in various organs of the body;
  • infection of the brain, causing a stroke, mental confusion, meningitis (type of brain infection), problems with sensation, or weakness (neurosyphilis);
  • involvement of the eyes leading to sight deterioration; or
  • involvement of the ears resulting in deafness. The damage sustained by the body during the tertiary stage of syphilis is severe and can even be fatal.

How Is Syphilis in Women Diagnosed?

Syphilis can be diagnosed by scraping the base of the ulcer and looking under a special type of microscope (dark field microscope) for the spirochetes. However, since these microscopes are not widely available, the diagnosis is most often made and treatment is prescribed based upon the appearance of the chancre. Diagnosis of syphilis is complicated by the fact that the causative organism cannot be grown in the laboratory. Therefore, cultures of affected areas cannot be used for diagnosis.

  • Special blood tests can also be used to diagnose syphilis.
  • The standard screening blood tests for syphilis are called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen Reagent (RPR) tests.
  • These tests detect the body's response to the infection, but not to the actual Treponema organism that causes the infection.
  • These tests are thus referred to as non-treponemal tests. Although the non-treponemal tests are very effective in detecting evidence of infection, they can also produce a positive result when no infection is actually present (so-called false-positive results for syphilis).
  • Consequently, any positive non-treponemal test must be confirmed by a treponemal test specific for the organism causing syphilis, such as the microhemagglutination assay for T. pallidum (MHA-TP) and the fluorescent treponemal antibody absorbed test (FTA-ABS).
  • These treponemal tests directly detect the body's response to Treponema pallidum.

What Is the Treatment for Syphilis in Women?

Depending on the stage of the disease and the clinical manifestations, the treatment options for syphilis vary.

  • Long-acting penicillin injections have been very effective in treating both early and late stage syphilis.
  • The treatment of neurosyphilis requires the intravenous administration of penicillin.
  • Alternative treatments include oral doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) or tetracycline (Achromycin).

Women who are infected during pregnancy can pass on the infection to the fetus through the placenta. Penicillin must be used in pregnant patients with syphilis since other antibiotics do not effectively cross the placenta to treat the infected fetus. Left untreated, syphilis can lead to blindness or even death of the infant.

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Syphilis Symptoms

What are the Stages of Syphilis Symptoms?

Syphilis may progress through 3 distinct stages. Sometimes not all 3 may be evident.

  • Primary phase: The primary phase usually starts with a sore at the site of infection.
  • Secondary phase: The secondary phase may develop 4-10 weeks after the chancre.
  • Latent (dormant) phase: The early latent phase (first 12 months following infection) is characterized by an absence of symptoms.
  • Tertiary Phase: About a third of people with latent syphilis will progress after many years (or decades) into tertiary syphilis.
CDC. Syphilis.

UpToDate. Pathogenesis, clinical manifestations, and treatment of early syphilis.