Syphilis often fools people as it can cause a wide variety of symptoms, or cause no symptoms at all. Sometimes the symptoms are very mild and last only a few days and so are dismissed. Typically, syphilis progresses through several stages. That said, not everyone develops symptoms at each stage. When syphilis is transferred to the skin during intimate contact, the bacteria multiply and create an ulcer or sore on the skin. The ulcer is shallow, does not bleed, and is not painful. Sometimes it is small and hard to see, or, depending on the type of sex when it was transmitted, it may be tucked away somewhere less obvious like under the foreskin or at the back of the throat. Sores may develop days to weeks after contact and will eventually heal on their own. The sore is referred to as primary syphilis. While in the skin, the bacteria will multiply and eventually migrate from the skin ulcer into the bloodstream and thus spread throughout the body. This stage is called secondary syphilis and can have a variety of symptoms. The most common symptom of secondary syphilis is a rash. The rash may be everywhere or on only some parts of the body, and may or may not appear on the palms of the hands and soles of the feet. People with secondary syphilis may also have fevers and muscle aches, like the flu. Because syphilis at this stage is spread through the bloodstream, it can infect any organ. For example, the bacteria can get into the eye and cause blurry vision, infect the liver and cause hepatitis, or enter the brain and cause meningitis. If untreated, the secondary symptoms will eventually go away on their own and the bacteria will become less active. This period of low activity is called latent syphilis and lasts for years. At this latent stage, people have no symptoms. Over time though, the bacteria can continue to cause harm. Years after infection, syphilis can damage the heart, the spinal cord making it difficult to walk, and the brain causing dementia much like Alzheimer’s.

Syphilis is diagnosed by recognizing the symptoms, and by a blood test. In Ontario, the blood test has 3 parts: the screening test, called the CLIA, and the confirmatory test called the TP-PA. When you get syphilis, these blood tests become positive and will remain positive even after treatment. The third test is called the RPR and is reported as a number such as 1:2 or 1:64. This number reflects how active the infection is. After treatment, as the bacteria die the RPR number will fall and after many months the RPR may eventually become negative. If you get syphilis again, the RPR number will rise again.