Female sex workers


What is syphilis?

  • Syphilis is caused by bacteria that are sexually transmitted. 
  • The complaints can be very different from person to person.  
  • If not treated in time, the consequences can be very serious. 

What causes syphilis?

  • The syphilis bacteria can be found in the mucous membrane of the penis, vagina, anus or mouth and cause an infection there. 
  • If you have unsafe sex, i.e. without condom, the bacteria can be transmitted by contact with the mucous membrane of the penis, vagina, anus or mouth.  
  • From the mucous membrane the bacteria end up in the blood and spread to other organs. 
  • During pregnancy the infection can also be transmitted to the foetus.


Syphilis normally has three stages. 
Both the first and second stage can sometimes develop without complaints!

First stage:

  1. Two to twelve weeks after the infection, an ulcer appears in the mucous membrane of the genitalia (penis, vagina), anus or mouth.  This ulcer may become larger, up to one centimetre. 
  2. The ulcer is red, feels hard and is painless or almost painless.  
  3. On the penis this ulcer is clearly visible.  
  4. Sometimes the ulcer is hidden in the anus or vagina and then you don’t notice anything.  
  5. On other places the skin can also get infected, sometimes even on the fingers, especially if there are small wounds.  
  6. Often the lymph glands near the ulcer, such as in the groin, are swollen.  
  7. The ulcer disappears spontaneously within one to three months, but the disease lingers and you remain infectious to others!

Second stage:

  1. Three to eight weeks after the ulcer appeared, the second stage begins.  
  2. The ulcer is then often already gone.  
  3. In the second stage the following symptoms and complaints may appear:
  • Feeling of illness, with fever
  • Aching muscles and joints
  • Headache
  • A sore throat
  • Tiredness
  • Spots all over your body (sometimes hardly noticeable), even on the soles of your feet and the palms of your hand (these spots don’t itch)
  • Bald spots between your hair 
  • Infection of the eyes and partial loss of sight 
  • White grey wartlike balls on penis, anus or vagina

Lingering period:

  1. If syphilis is not treated, the illness lingers.  
  2. You don’t notice anything any more, but the bacteria are still in your body and you can infect others.

Third stage:

  1. Without treatment you can reach the third stage of the illness after two to thirty years.  
  2. In this stage almost all organs may develop infections and damage, even your skin and bones.  
  3. The complaints can be very different because it depends which organ is affected.  
  4. You may even get meningitis and you can get confused and become paralyzed.

How can the infection be diagnosed?

  • Syphilis can only be shown in the blood three months after the infection.  
  • When there are complaints, the infection can be diagnosed earlier by means of smear of the ulcer.


When the infection is diagnosed in time, you can be treated: 

  • You get  2 injections with a high dose of penicillin.   
  • If you have had syphilis for a longer time or if you are pregnant or infected with the HIV virus, you will get two injections spread over a period of three weeks (on day 1, day 8 and day 15)
  • After these three injections, you are cured. 
  • Even though you are no longer infectious for others, it will remain visible in your blood that you have ever had syphilis.  But after the treatment you can no longer infect others.  It is necessary to have your blood checked after the treatment to see whether the treatment was effective.

Warning partners

  • Because syphilis is transmitted by sexual contact, it is important to inform the partners you had sex with (without condom) that you have syphilis.  
  • This is to prevent you from getting infected again and to prevent others from getting infected with this disease.  
  • They can have a test and, if necessary, get treatment.  According to the stage you have to inform the partners you had sex with (without condom) in the past 3 to 12 months.

Work advice

Syphilis is a very contagious STI and the bacteria are transmitted very easily. 
The advice is:

  • Not to have oral, vaginal and anal sex during the first 10 days after the start of the treatment!  
  • It is safe to give a hand job.  
  • After the treatment you can start working again.


The leaflet

Bacterial infections