|Causative organism||Treponema pallidum spp pallidum|
9-90 days (mean 30) to primary syphilis;
30-150 days to secondary syphilis;
early latent presents post-secondary syphilis less than 2 years post last negative test; late latent presents more than 2 years post last negative test;
5-35 years to tertiary syphilis.
|How far back to trace||
According to sexual history and clinical stage of infection:
If the stage of syphilis is unclear, contact your local specialist service for advice
|Usual testing method||Serology for syphilis. PCR can be done from ulcers/rash or other lesions|
Anogenital or oral ulcers
Early infection commonly asymptomatic
Likelihood of transmission per act of unprotected intercourse
Early syphilis (primary, secondary, early latent): >20 %
Late latent and tertiary: usually not infectious
|Likelihood of long-term sexual partner being infected||
Up to 50% if early syphilis;
<1% if no contact during infectious period
|Protective effect of condoms||High if lesions covered by condoms. However, close sexual contact and oral sex are modes of transmission|
|Transmission by oral sex||Probably common|
|Duration of potential infectivity||Up to 24 months (rare after 12 months). Late latent/tertiary syphilis are usually not infectious|
Congenital infections in pregnancy
Neurosyphilis, cardiovascular syphilis, enhanced HIV transmission
|Direct benefit of detection and treatment of contacts||Cure, and prevention of transmission and congenital syphilis|
|Contact tracing considerations||
Ensure window period follow-up testing occurs where the person is not offered presumptive treatment, is pregnant or intending to become pregnant, or is the sexual partner of a pregnant person. This will decrease the risk of a missed diagnosis, reinfection and/or congenital syphilis.
Seek specialist advice if there is a concern for older children of a person newly diagnosed with syphilis during pregnancy.
|Usual management of contacts||
Consultation with sexual health physician in all cases is suggested
|Contact tracing priority||High|
Notifiable by doctors in all Australian states and territories, and in New Zealand; as well as laboratories in some Australian states and territories
Where a syphilis register exists in your State, Territory or region, ensure you promptly report the required details. Where there are any concerns or ambiguity contact your local public health service for additional support.
NPS Medcinewise, Devchand M; Trubiano JA; Penicillin allergy: a practical approach to assessment and prescribing Australian Prescriber 2 December 2019 Available online at: https://www.nps.org.au/australian-prescriber/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing
Page last updated September 2022